Angiotensin II Receptor Blockers in Pregnancy: A Case Report and Systematic Review of the Literature

Abstract

Exposure to ARBs for a period longer than the first trimester of pregnancy appears to be associated with a high risk for adverse fetal outcomes.

Are angiotensin-converting enzyme inhibitors and angiotensin receptor blockers safe in pregnancy: a report of ninety-one pregnancies

“…Our results are, therefore, in sharp contradistinction to those of Cooper et al in the United States [11]. Our results for the use of ARBs are also in contrast to the findings of Velazquez-Armenta et al [13]. Examining the world literature they reported the outcome in 64 pregnancies.…”

“…This contrasted with major anomalies in 2.0% of infants exposed to other antihypertensive drugs in pregnancy and 2.6% in which the mother took no antihypertensive drugs [11]. The possibility that the ARBs may also be associated with developmental malformations has been raised by sporadic reports, and an analysis of 64 published cases in which unfavourable outcomes were reported in 42% [12,13].…”

Angiotensin-(1–9) reverses experimental hypertension and cardiovascular damage by inhibition of the angiotensin converting enzyme/Ang II axis

“…These observations (1)(2)(3)(4)(5)(6)(7)(8)(9). AT2R is the predominant Ang II receptor subtype in the fetal and early postnatal period, and the absence of AT2R negatively affect cardiac and renal maturation and growth [35][36][37]. Thus, studies with tissuespecific and inducible AT2R knockout in mice will help to clarify the role of AT2R in Ang-(1-9) beneficial actions on BP and cardiovascular remodeling.…”

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

“…Five literature reports cited in the review by Bullo et al 1 were excluded from the present analysis because only women who took ARBs during the first trimester only were presented in four of the reports, [41][42][43][44] and no women with ARBs were presented in one study. 45 Of the 34 literature reports analyzed in this study, one literature report published in 2006 33 was not cited by the review by Bullo et al, 1 and three 35,39,40 were published after the review by Bullo et al 1 Surviving infants were classified into two groups according to the presence or absence of abnormal development in cognitive and/or motor function, kidney dysfunction and short stature (that is, favorable outcome and unfavorable outcome groups).…”