Angiotensin II Receptor Blocker Induced Fetopathy: 7 Cases

Abstract

These case reports again underline the hazardousness of maternal sartan intake with potential fatal outcome for the newborn. Though the use of sartans in pregnancy is contraindicated and several case reports of sartan induced fetopathies exist, the risk of sartan treatment generally seems to be underestimated.

Outcomes of 83 fetuses exposed to angiotensin receptor blockers during the second or third trimesters: a literature review

“…12,28,35,40 Twenty-one infants (25%) died after live birth, within 7 days in 18 cases, 7,14,15,19,[21][22][23]29,35,40 at 45 days old in one case, 38 at 3 months old in one case, 7 and at 6 months old in one case. 40 Finally, 42 infants (51%) survived, [7][8][9][10][11]13,[16][17][18]20,[24][25][26][27][29][30][31][32][33][34][35][36][37]39,40 including our case. Twenty-three of the 42 fetuses who survived had favorable outcomes, including our case, 8,10,13,16,18,20,[25][26][27]29,30,…”

“…Among those literature reports describing the gestational age, substance used, period of medication intake (gestational trimester) and outcome of the single cases, we identified 34 literature reports 7-40 describing pregnant women who took ARBs on and after GW 13. Among these 34 literature reports, single cases were described in 24 literatures reports, [8][9][10][11][12][13][14]16,17,[19][20][21][22][25][26][27][28]31,33,34,[36][37][38][39] two cases (including one set of twins 15 ) in four reports, 15,18,24,32 three cases in one report, 23 four cases in one report, 30 five cases in one report, 29 seven cases in one report, 7 20 cases in one report 35 and 45 cases in one report. 40 Thus, information was obtained from these 34 reports regarding the clinical courses of 116 fetuses whose mothers took ARBs on and after GW 13.…”

“…40 Thus, information was obtained from these 34 reports regarding the clinical courses of 116 fetuses whose mothers took ARBs on and after GW 13. However, because 5 of the 45 cases reported by Oppermann et al 40 were reported previously 7,29 and data for 29 cases were prospectively collected, we excluded these 34 cases from the present analysis and will discuss the 29 prospectively observed cases by Oppermann et al 40 later. Thus, retrospective data for 82 fetuses who were exposed to ARBs in utero on and after GW 13 were available from 34 literature reports.…”

“…Even in larger case series by Spaggiari et al 35 and Oppermann et al, 40 which were published after the review by Bullo et al, 1 information on the outcomes of pregnancies was available in 12 and 40 cases, respectively: eight women elected to undergo termination of the pregnancy among 20 cases presented in the report by Spaggiari et al 35 and 5 of 45 cases (prospective and retrospective cases were 29 and 16 cases, respectively) presented by Oppermann et al 40 were reported previously. 7,29 To provide better counseling to pregnant women who erroneously took ARBs during the second trimester or later, we performed an extensive literature search focusing on the outcomes of the infants. Here, we report the results of a literature search together with a case report describing a pregnant woman in whom ARBs were not discontinued until gestational week (GW) 24 and anhydramnios resolved after the cessation of ARBs.…”

Antihipertenzivna terapija u trudnoći

“…Primena inhibitora angiotenzin-konvertujućeg enzima (ACEi) i antagonista angiotenzin II receptora (sartana) u drugom i trećem trimestru trudnoće može da dovede do oligohidramniemije, zaostajanja u fetalnom rastu, pulmonarne hipoplazije, zgrčenosti zglobova, neonatalnih bubrežnih poremećaja, hipotenzije i smrti [14][15][16]. Rizik nastanka ozbiljnih kongenitalnih malformacija je veći kod novorođenčadi koja su izložena ACEi, u odnosu na druge grupe antihipertenzivnih lekova.…”