The effect of antihypertensive drugs on the fetus

Rosenthal, Talma; Oparil, Suzanne

doi:10.1038/sj.jhh.1001400

Cited by 40 publications

(18 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…␤ -Blockers are prescribed for hypertension and arrhythmias during pregnancy [68,69] . ␤ -Blockers cross the placenta and reach the fetus at concentrations very close to those present in the pregnant mother [70] .…”

Section: Clinical Relevancementioning

confidence: 99%

β<sub>1</sub>-Adrenergic Receptors Maintain Fetal Heart Rate and Survival

et al. 2006

View full text Add to dashboard Cite

β-Adrenergic receptor (βAR) activation has been shown to maintain heart rate during hypoxia and to rescue the fetus from the fetal lethality that occurs in the absence of norepinephrine. This study examines whether the same subtype of βAR is responsible for survival and heart rate regulation. It also investigates which βARs are located on the early fetal heart and whether they can be directly activated during hypoxia. Cultured E12.5 mouse fetuses were treated with subtype-specific βAR antagonists to pharmacologically block βARs during a hypoxic insult. Hypoxia alone reduced heart rate by 35–40% compared to prehypoxic levels. During hypoxia, heart rate was further reduced by 31% in the presence of a β₁AR antagonist, CGP20712A, at 100 nM, but not with a β₂ (ICI118551)- or a β₃ (SR59230A)-specific antagonist at 100 nM. Survival in utero was also mediated by β₁ARs. A β₁ partial agonist, xamoterol, rescued 74% of catecholamine-deficient (tyrosine-hydroxylase-null) pups to birth, a survival rate equivalent to that with a nonspecific βAR agonist, isoproterenol (87%). Receptor autoradiography showed that β₁ARs were only found on the mouse heart at E12.5, while β₂ARs were localized to the liver and vasculature. To determine if the response to hypoxia was intrinsic to the heart, isolated fetal hearts were incubated under hypoxic conditions in the presence of a βAR agonist. Heart rate was reduced to 25–30% by hypoxia alone, but was restored to 63% of prehypoxic levels with 100 nM isoproterenol. Restoration was completely prevented if β₁ARs were blocked with CGP20712A at 300 nM, a concentration that blocks β₁ARs, but not β₂- or β₃ARs. Our results demonstrate that β₁ARs are located on the heart of early fetal mice and that β₁AR stimulation maintains fetal heart rate during hypoxia and mediates survival in vivo.

show abstract

Section: Clinical Relevancementioning

confidence: 99%

β<sub>1</sub>-Adrenergic Receptors Maintain Fetal Heart Rate and Survival

et al. 2006

View full text Add to dashboard Cite

show abstract

“…Angiotensin-converting enzyme (ACE) inhibitors are contraindicated in the second and third trimesters as they have been linked to fetal hypocalvaria, oligohydramnios and renal defects. 7,8 Beta-blockers such as metoprolol and labetalol are commonly used during pregnancy; atenolol has been linked to intrauterine growth restriction when given early in pregnancy. [8][9][10] DAPT involves aspirin and clopidogrel.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Beta-blockers such as metoprolol and labetalol are commonly used during pregnancy; atenolol has been linked to intrauterine growth restriction when given early in pregnancy. [8][9][10] DAPT involves aspirin and clopidogrel. Chronic or intermittent high doses of aspirin may increase the risk of hemorrhage 7 and may lead to premature closure of the ductus arteriosus in the third trimester.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy in women after coronary revascularization

et al. 2014

View full text Add to dashboard Cite

show abstract

“…The standard first line oral antihypertensive medication in a young patient would be an angiotensin-converting enzyme (ACE) inhibitor, but it is avoided in pregnancy because it impairs fetal and neonatal renal function causing oligohydramnios, hypotension and possibly death in utero. 3 Diuretics are also avoided because they reduce the placental blood flow. The antihypertensives considered safe in pregnancy are labetalol, methyldopa or hydralazine.…”

Section: What Is the Definition And Pathophysiology Of Pcos?mentioning

confidence: 99%

“…The antihypertensives considered safe in pregnancy are labetalol, methyldopa or hydralazine. 3 Hypercholesterolaemia is primarily managed by lifestyle changes including healthy diet and exercise. A referral to a dietician could be beneficial as well.…”

Section: What Is the Definition And Pathophysiology Of Pcos?mentioning

confidence: 99%

Infertility in a young woman with Type 2 diabetes

Szaboova

Devendra

2015

London Journal of Primary Care

View full text Add to dashboard Cite

A 33-year-old teacher (BMI 28 kg/m 2 ) saw her general practitioner (GP) due to primary infertility. She was previously fit and healthy apart from a history of hirsutism which had been treated by laser therapy in her 20s. As part of her initial diagnostic work-up, she was identified to have Type 2 diabetes and polycystic ovaries on a transvaginal ultrasound scan. Her recent HbA 1c was 7.7% (DCCT) (IFCC 60.7 mmol/mol). She was referred to a structured education programme and a dietician. She was also started on metformin and the dose was gradually increased to 2 g/day. Her total cholesterol was 6.2 mmol/l and her blood pressure was 144/86 mmHg. Her case was brought to the Ealing multidisciplinary group meeting for further discussion. Ways to think about the problemWhat is the likely cause of her infertility?In the UK, approximately one in seven heterosexual couples experience problems conceiving and investigations reveal a cause in 75% of these. The most frequent causes of subfertility are outlined in Table 1 Why this matters to mePolycystic ovarian syndrome (PCOS) is a frequently encountered condition in general practice and can have a significant impact on the quality of life of young women. Apart from addressing ovulatory problems in these women, it is important to remember to screen for other associated conditions such as Type 2 diabetes, hypertension or hypercholesterolaemia. This article outlines the pathophysiology of PCOS and its diagnostic pathways and also summarises the safety of medical management for the metabolic complications in pregnant women. It is important for healthcare professionals to be aware of the latest guidance for treatment of PCOS in order to provide high-standard evidencebased care.

show abstract

The effect of antihypertensive drugs on the fetus

Cited by 40 publications

References 54 publications

β<sub>1</sub>-Adrenergic Receptors Maintain Fetal Heart Rate and Survival

β<sub>1</sub>-Adrenergic Receptors Maintain Fetal Heart Rate and Survival

Pregnancy in women after coronary revascularization

Infertility in a young woman with Type 2 diabetes

Contact Info

Product

Resources

About