A case report of prenatal exposure to rosuvastatin and telmisartan

Abstract

A vailable information regarding the outcome of human pregnancies during which the fetus was exposed to statins and sartans is limited and inconclusive.Statins inhibit 3-hydroxy-3-methylglutaryl coenzyme A reductase, which catalyzes the formation of mevalonic acid from 3-hydroxy-3-methylglutaryl coenzyme A -the ratelimiting step in cholesterol synthesis. Statins are considered to be the standard treatment for hyperlipidemia, but are contraindicated during pregnancy because of potential teratogenic effects (1).Telmisartan is an antihypertensive medication, which acts as an angiotensin II receptor antagonist, and has an inhibitory effect on the renin-angiotensin system. Telmisartan is contraindicated in pregnancy; adverse effects have been reported in both animal and human pregnancies (2). CASE prESEntAtionThe propositus was a 15-month-old boy born to a nonconsanguineous 31-year-old mother with hypertension and hyperlipidemia, and a healthy 29-year-old father, both of northern European descent. Other siblings included a healthy five-year-old brother and a 13-year-old maternal half brother with a history of pyloric stenosis and attention-deficit hyperactivity disoder. Neither sibling was exposed to statins or sartans in the prenatal period.The patient was conceived naturally, and the pregnancy was not detected until the third trimester due to irregular maternal menstrual periods. There was occasional spotting during the first half of the pregnancy but no frank vaginal bleeding. The fetus was exposed to telmisartan (80 mg/day) during the first seven months and to rosuvastatin (10 mg/day) during the entire gestational period. The mother also reported smoking one-half pack of cigarettes per day, but she denied any alcohol intake. Fetal movements were reportedly absent, but prenatal ultrasounds were normal. Spontaneous vaginal delivery occurred at 39 weeks; the infant's birth weight was 3.6 kg and there were no complications at birth. There were no anomalies noted at birth, except for microcephaly. The initial presentation to medical care was for global developmental delay.On initial examination at 15 months, the patient was very irritable, appeared much smaller than his chronological age and was extremely microcephalic. His length was 75 cm (10th percentile for age), weight was 6.95 kg (less than the fifth percentile for age; 50th percentile for four months) and head circumference was 41.5 cm (less than the third Statins are considered to be a standard treatment for hyperlipidemia. Central nervous system, limb and midline defects have been reported in newborns exposed to statins in utero, although causality has been questioned. A 22-month-old boy with severe microcephaly, growth retardation, dysmorphic features, profound global developmental delay and peri-Sylvian polymicrogyria on brain imaging is presented. He was born to a mother exposed to telmisartan during the first seven months and rosuvastatin throughout the entire pregnancy. There were no features of fetopathy associated with sartans including telmisartan, su...