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Is there an embryopathy associated with first-trimester exposure to angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists? A critical review of the evidence.

Abstract

Drugs that interfere with the renin-angiotensin system, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), are widely used to manage hypertension and heart failure. Adequate functioning of the RAS is essential for normal fetal kidney development. The potential for ACEIs and ARBs to impair fetal and neonatal renal function if taken after the first trimester of pregnancy has been well documented. Although these drugs were not found to be teratogenic in animals, until recently little was known about the teratogenic effects of ACEIs and ARBs in humans when exposure was limited to the first trimester of pregnancy. New evidence from epidemiologic studies indicates that there may be an elevated teratogenic risk when these drugs are taken during the first trimester of pregnancy. However, this elevated risk does not appear to be specific to ACEIs and ARBs, but is instead related to maternal factors and diseases that typically coexist with hypertension in pregnancy, such as diabetes, advanced maternal age, and obesity. Women who become pregnant while being treated with an ACEI or ARB should be advised to avoid exposure to these drugs during the second and third trimesters of pregnancy by switching to a different class of antihypertensive drugs between weeks 8 and 10 after conception.

Authors+Show Affiliations

Department of Pediatrics, University of Washington, Seattle, Washington, USA. polifka@u.washington.edu

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22807387

Citation

Polifka, Janine E.. "Is There an Embryopathy Associated With First-trimester Exposure to Angiotensin-converting Enzyme Inhibitors and Angiotensin Receptor Antagonists? a Critical Review of the Evidence." Birth Defects Research. Part A, Clinical and Molecular Teratology, vol. 94, no. 8, 2012, pp. 576-98.
Polifka JE. Is there an embryopathy associated with first-trimester exposure to angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists? A critical review of the evidence. Birth Defects Res Part A Clin Mol Teratol. 2012;94(8):576-98.
Polifka, J. E. (2012). Is there an embryopathy associated with first-trimester exposure to angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists? A critical review of the evidence. Birth Defects Research. Part A, Clinical and Molecular Teratology, 94(8), pp. 576-98. doi:10.1002/bdra.23027.
Polifka JE. Is There an Embryopathy Associated With First-trimester Exposure to Angiotensin-converting Enzyme Inhibitors and Angiotensin Receptor Antagonists? a Critical Review of the Evidence. Birth Defects Res Part A Clin Mol Teratol. 2012;94(8):576-98. PubMed PMID: 22807387.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is there an embryopathy associated with first-trimester exposure to angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists? A critical review of the evidence. A1 - Polifka,Janine E, Y1 - 2012/07/17/ PY - 2012/02/15/received PY - 2012/03/23/revised PY - 2012/04/11/accepted PY - 2012/7/19/entrez PY - 2012/7/19/pubmed PY - 2013/6/20/medline SP - 576 EP - 98 JF - Birth defects research. Part A, Clinical and molecular teratology JO - Birth Defects Res. Part A Clin. Mol. Teratol. VL - 94 IS - 8 N2 - Drugs that interfere with the renin-angiotensin system, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), are widely used to manage hypertension and heart failure. Adequate functioning of the RAS is essential for normal fetal kidney development. The potential for ACEIs and ARBs to impair fetal and neonatal renal function if taken after the first trimester of pregnancy has been well documented. Although these drugs were not found to be teratogenic in animals, until recently little was known about the teratogenic effects of ACEIs and ARBs in humans when exposure was limited to the first trimester of pregnancy. New evidence from epidemiologic studies indicates that there may be an elevated teratogenic risk when these drugs are taken during the first trimester of pregnancy. However, this elevated risk does not appear to be specific to ACEIs and ARBs, but is instead related to maternal factors and diseases that typically coexist with hypertension in pregnancy, such as diabetes, advanced maternal age, and obesity. Women who become pregnant while being treated with an ACEI or ARB should be advised to avoid exposure to these drugs during the second and third trimesters of pregnancy by switching to a different class of antihypertensive drugs between weeks 8 and 10 after conception. SN - 1542-0760 UR - https://www.unboundmedicine.com/medline/citation/22807387/Is_there_an_embryopathy_associated_with_first_trimester_exposure_to_angiotensin_converting_enzyme_inhibitors_and_angiotensin_receptor_antagonists_A_critical_review_of_the_evidence_ L2 - https://doi.org/10.1002/bdra.23027 DB - PRIME DP - Unbound Medicine ER -