In Utero Losartan Withdrawal and Subsequent Development of Fetal Inferior Vena Cava Thrombosis

Abstract

This theory may help explain the fetal stillbirths in women taking this class of medications during the second and third trimester of pregnancy.

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,…”

“…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]29,30,32,[33][34][35][36][37]40 and 19 had unfavorable outcomes ( Figure 1). 7,9,11,17,18,24,29,...…”

“…The outcomes of 63 fetuses, 7,[32][33][34][35][37][38][39]40 including our case, were analyzed in relation to the status of amniotic fluid volume (AFV) after excluding 20 pregnancies consisting of 14 23,30,32,35,40 terminated pregnancies and six 7,8,29,31,36,40 pregnancies with unspecified AFV status. Of the 58 fetuses with documented oligohydramnios, 57 were exposed to ARBs at GW ⩾ 20, and 19 [10][11][12][13]18,23,25,29,33,35,37,39,40 exhibited resolution of oligohydramnios after cessation of ARBs. The time interval after the cessation of ARBs until confirmed resolution of oligohydramnios ranged from 1 13 to 6 weeks.…”

“…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). Infants with unfavorable outcomes were defined as those who had one or more of following: variable degree of renal insufficiency at aged 1 month or older, nephrogenic diabetes insipidus at aged 1 year or older, motor dysfunction such as increased muscle tone with tremor, retardation of linguistic development, mental retardation and short stature of less than the 5th percentile for body height.…”

“…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.…”