Antihypertensive Drugs and the Risk of Congenital Anomalies

Vasilakis‐Scaramozza, Catherine; Aschengrau, Ann; Cabral, Howard; Jick, Susan S.

doi:10.1002/phar.1212

Cited by 19 publications

(24 citation statements)

References 24 publications

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“…The use of these agents has been reported in association with miscarriage, in utero death and congenital malformation, in particular foetal renal failure [103][104][105]. The cause of associated defects is thought to be related to the foetal hypotension that develops, as well as reduced renal blood flow in the foetus, and disruption of prenatal development of the foetal uropoietic system as a result of suppression on the foetal renin-angiotensin system [105,106].…”

Section: Oral Treatment For Hypertensive Disorders In Pregnancymentioning

confidence: 95%

Hypertension in Pregnancy: Natural History and Treatment Options

et al. 2015

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Hypertensive disorders of pregnancy affect approximately 5-10% of all maternities and are major contributors of maternal and neonatal morbidity and mortality worldwide. This group of disorders encompasses chronic hypertension, as well as conditions that arise de novo in pregnancy: gestational hypertension and pre-eclampsia. The latter group is thought to be part of the same continuum but with arbitrary division. Research into the aetiology of hypertension in pregnancy have largely been focused on pre-eclampsia, with a majority of studies exploring either pregnancy-associated factors such as placental-derived or immunologic responses to pregnancy tissue, or maternal constitutional factors such as cardiovascular health and endothelial dysfunction. The evidence base for the pathophysiology and progression of hypertensive disorders in pregnancy, particularly pre-eclampsia, is reviewed. Clinical algorithms and pharmacological agents for the management of hypertension in pregnancy are summarised, with a brief focus on post-partum considerations and long-term health implications. Novel therapeutic options for the management of pre-eclampsia are also explored.

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Section: Oral Treatment For Hypertensive Disorders In Pregnancymentioning

confidence: 95%

Hypertension in Pregnancy: Natural History and Treatment Options

et al. 2015

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“…Because of their teratogenicity, the need to discontinue drugs that act on the renin-angiotensin system complicates the management of proteinuric patients (44,45).…”

Section: Discussionmentioning

confidence: 99%

Association of Low-Protein Supplemented Diets with Fetal Growth in Pregnant Women with CKD

Piccoli¹,

Leone²,

Attini

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Women affected by CKD increasingly choose to get pregnant. Experience with lowprotein diets is limited. The aim of this study was to review results obtained from pregnant women with CKD on supplemented vegan-vegetarian low-protein diets.Design, setting, participants, & measurements This was a single-arm, open intervention study between 2000-2012 of a low-protein diet in pregnant patients with stages 3-5 CKD or severe proteinuria (.1 g/d in the first trimester or nephrotic at any time). Stages 3-5 CKD patients who were not on low-protein diets for clinical, psychologic, or logistic reasons served as controls. The setting was the Obstetrics-Nephrology Unit dedicated to kidney diseases in pregnancy. The treated group included 24 pregnancies-21 singleton deliveries, 1 twin pregnancy, 1 abortion, and 1 miscarriage. Additionally, there were 21 controls (16 singleton deliveries, 5 miscarriages). The diet was a vegan-vegetarian low-protein diet (0.6-0.8 g/kg per day) with keto-acid supplementation and 1-3 proteinunrestricted meals allowed per week.Results Treated patients and controls were comparable at baseline for median age (35 versus 34 years), referral week (7 versus 8), eGFR (59 versus 54 ml/min), and hypertension (43.5% versus 33.3%); median proteinuria was higher in patients on the low-protein diet (1.96 [0.1-6.3] versus 0.3 [0.1-2.0] g/d; P,0.001). No significant differences were observed in singletons with regard to gestational week (34 versus 36) or Caesarean sections (76.2% versus 50%). Kidney function at delivery was not different, but proteinuria was higher in the diet group. Incidence of small for gestational age babies was significantly lower in the diet group (3/21) versus controls (7/16; chi-squared test; P=0.05). Throughout follow-up (6 months to 10 years), hospitalization rates and prevalence of children below the third percentile were similar in both groups.Conclusion Vegan-vegetarian supplemented low-protein diets in pregnant women with stages 3-5 CKD may reduce the likelihood of small for gestational age babies without detrimental effects on kidney function or proteinuria in the mother.

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“…Further, due to publication bias resulting in greater publication of adverse pregnancy outcomes, this review likely overestimates the complication rate of exposed pregnancies. However, five cohort studies have examined the effects of first‐trimester exposure to these agents …”

Section: Pharmacologic Treatment Of Hypertensionmentioning

confidence: 99%

“…A matched cohort study of 1116 pregnant women was conducted evaluating the association of antihypertensive exposure with congenital malformations . Five cohorts were established: no exposure to antihypertensives (682 women), first trimester ACE inhibitor exposure (40 women), BB exposure (214 women), CCB exposure (55 women), and other antihypertensives exposure (125 women).…”

Section: Pharmacologic Treatment Of Hypertensionmentioning

confidence: 99%

“…However, five cohort studies have examined the effects of first-trimester exposure to these agents. [60][61][62][63][64] A retrospective cohort study evaluated 29,507 infants. 60 Three cohorts were established in the trial: ACE inhibitor cohort (mothers who had exposure to an ACE inhibitor in their first trimester), non-ACE inhibitor cohort (mothers who had exposure to other antihypertensive agents in their first trimester), and normal control cohort (mothers who neither had a diagnosis of hypertension nor had exposure to any antihypertensive agent).…”

Section: Inhibitors Of the Renin-angiotensin Systemmentioning

confidence: 99%

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Pharmacologic Management of Types 1 and 2 Diabetes Mellitus and Their Complications in Women of Childbearing Age

2015

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The numbers of women of childbearing age with pregestational diabetes mellitus (diabetes existing before pregnancy) are increasing, primarily because more patients are developing type 2 diabetes at younger ages. The teratogenicity associated with hyperglycemia in early pregnancy is well documented, and tight glucose control minimizes the risk of congenital malformation. Preconception planning is essential; thus contraception that does not worsen complications of diabetes is desirable. In addition, because contraceptives are not 100% effective, the treatment of elevated blood glucose levels, hypertension, and dyslipidemia in these women requires consideration of unplanned pregnancy. We summarized the literature to aid clinicians in choosing individualized treatment that minimizes risk in case pregnancy occurs and maximizes benefit in preventing the complications of diabetes. In women with well-controlled diabetes without vascular disease, all contraceptive methods are safe. Intrauterine devices are recommended due to their minimal effects on risk factors for diabetic complications and their lack of reliance on patient adherence for efficacy. Among insulins, the insulin analogs-insulin lispro, insulin aspart, and insulin detemir-offer patients greater convenience than regular insulin and NPH insulin, and they are safe in case of unplanned pregnancy. Of the noninsulin agents, glyburide and metformin are the safest during pregnancy, but many of the other agents pose minimal risk as long as they are withdrawn during early pregnancy. The risks and benefits of angiotensin-converting enzyme inhibitors in women with compelling indications must be weighed individually. In hypertensive patients at a high risk for unplanned pregnancy, nifedipine should be considered due to literature supporting its safety during early pregnancy. Pravastatin is recommended for women with dyslipidemia who are using effective contraception because there have been no reports of birth defects with this statin when used during early pregnancy in humans and animals.

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Antihypertensive Drugs and the Risk of Congenital Anomalies

Cited by 19 publications

References 24 publications

Hypertension in Pregnancy: Natural History and Treatment Options

Hypertension in Pregnancy: Natural History and Treatment Options

Association of Low-Protein Supplemented Diets with Fetal Growth in Pregnant Women with CKD

Pharmacologic Management of Types 1 and 2 Diabetes Mellitus and Their Complications in Women of Childbearing Age

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