903: Pharmacokinetics of amlodipine besylate during pregnancy—how much infant exposure occurs?

Morgan, Jamie L.; Kogutt, Benjamin K.; Meek, Claudia; Wells, C. Edward; Stehel, Elizabeth K.; Roberts, Scott W.

doi:10.1016/j.ajog.2016.11.812

Cited by 3 publications

(2 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Avoid if asthmatic.No association with congenital abnormalities.Reduced birth weight in unadjusted observational data.Neonatal bradycardia (2%) and hypoglycaemia (5%).Safe[11–16] NifedipineSafeSafeNoneNo association with congenital abnormalities.Safe[14, 15] AmlodipineSafeLimited data.NoneLimited data. No adverse effects reported.Safe[17, 18] MethyldopaSafeSafeAvoid in depression or if risk of depression.No association with congenital abnormalities.Avoid in all due to risk of postnatal depression.[14, 15] DoxazosinSafeLimited dataNoneNo evidence of harm in animal studies< 1% maternal dose detected.[15] HydralazineSafeSafeRisk of hypotension, tachycardiaNo association with congenital abnormalitiesSafe[15] Beta-blockersSafeLimited data on individual drugsAvoid if asthmatic. Use in pregnancy determined by maternal indication.No association with congenital abnormalities.Reduced birth weight, clinical significance unclear.Neonatal bradycardia (1%) and hypoglycaemia (3%).No adverse effects reported[15, 16, 19–22] Angiotensin converting enzyme inhibitorsNo apparent increase in risk with first trimester use when data are corrected for underlying hypertension.…”

Section: Rationale For Clinical Practice Guidelinesmentioning

confidence: 99%

Clinical practice guideline on pregnancy and renal disease

et al. 2019

View full text Add to dashboard Cite

The aim of this guideline is to improve the standard of, and to reduce regional variation in, the care of women with CKD in the UK who are pregnant, planning a pregnancy or post-partum. Scope This guidance covers the care of women with CKD (including renal transplant recipients) who are planning a pregnancy, pregnant, or in the post-partum period. It also covers contraception and fertility for women with CKD. This guideline can be used in the following settings: General practice Community and hospital antenatal clinics Antenatal, labour and postnatal wards Renal outpatients Renal wards Dialysis units The target audience and intended users of this guideline are nephrologists, obstetricians, obstetric physicians, midwives, renal nurses, pharmacists, specialist trainees in both nephrology and obstetrics, and women with CKD who are pregnant or considering pregnancy. Qualitative data on the experience of pregnancy and renal disease is provided in Appendix 1. A summary of clinical responsibility for elements of the guideline is provided in Appendix 2. The clinical issues covered in this guideline are: Structure of care Medication Pre-pregnancy care 3.1.Contraception 3.2.Fertility 3.3.Pre-pregnancy counselling and optimisation for pregnancy Pregnancy care 4.1 Assessment of renal function in pregnancy 4.2 Antenatal care 4.3 Pre-eclampsia prophylaxis 4.4 Blood pressure management 4.5 Thromboembolism prophylaxis 4.6 Anaemia 4.7 Bone health 4.8 Renal biopsy 4.9 Peripartum care 4.10 Postnatal care Pregnancy Care Assessment of renal function in pregnancy Guideline 4.1.1 We recommend renal function in pregnancy is assessed using serum creatinine concentrations as estimated GFR (eGFR) is not valid for use in pregnancy (1C). Guideline 4.1.2 We recommend women with CKD have formal quantification of proteinuria in pregnancy (1D). Guideline 4.1.3 We recommend quantification of proteinuria is undertaken by protein:creatinine ratio (uPCR) or albumin:creatinine ratio (uACR). Twenty-four hour urine collection for quantification of protein is not required (1B). Antenatal care Guideline 4.2.1 We suggest pregnant women with CKD who have not had pre-pregnancy counselling by the MDT are referred to the MDT and receive the same counselling and optimisation as for women attending pre-pregnancy (2D). Guideline 4.2.2 We recommend pregnant women with CKD receive routine antenatal care, in addition to specialist input (1D). Guideline 4.2.3 We recommend pregnant women with CKD be referred for assessment by a consultant obstetrician (1D). Guideline 4.2.4 We recommend pregnant women with CKD have access to usual trisomy screening with specialist interpretation of high-risk results (1C). Guideline 4.2.5 We recommend women with CKD exposed to teratogenic drugs in the first trimester are referred to a specialist fetal medicine unit (1D). Guideline 4.1.6 We recommend pregnant women with CKD have scans to assess fetal growth and wellbeing in the third trimester (1C). Guideline 4.2.7 We recommend pregnant women taking prednisolone and/or calcineurin inhib...

show abstract

Section: Rationale For Clinical Practice Guidelinesmentioning

confidence: 99%

Clinical practice guideline on pregnancy and renal disease

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Fewer safety data are available for amlodipine and doxazosin, although no adverse fetal effects are reported (NICE, 2011;Morgan et al, 2017).…”

Section: Management Of Blood Pressurementioning

confidence: 99%

Reproductive health and pregnancy in women with chronic kidney disease

2018

View full text Add to dashboard Cite

Chronic kidney disease (CKD) is associated with reduced fertility and an increased risk of adverse pregnancy outcomes. Rates of pre-eclampsia, fetal growth restriction and preterm delivery increase incrementally with the severity of CKD and proteinuria. Pre-pregnancy counselling can facilitate informed decision-making. Safe and effective contraception is required for women who wish to delay or avoid pregnancy. Pregnancy planning for women who wish to conceive involves appropriate substitution of known teratogens - including mycophenolate mofetil, angiotensin blockers and cyclophosphamide - and can aid optimization of disease control. However, pregnancy, which can occur in women with any stage of CKD, can exacerbate comorbidities such as anaemia, vitamin D deficiency and hypertension. Increased haemodialysis provision is associated with improved pregnancy outcomes for women on dialysis. Diagnosis of pre-eclampsia in women with CKD is complicated in patients with pre-existing hypertension and proteinuria but can be improved by the use of vasoactive biomarkers as well as placental and fetal Doppler ultrasound. Pregnancy data for newer drugs used in CKD are limited as pregnancy and CKD are common exclusion criteria for drug and intervention trials. Although prospective data may be available for older drugs, the use of most drugs in pregnancy is based on retrospective data and expert consensus.

show abstract