1
|
Coulm B, Latour M, Beguin D, Vauzelle C, Éléfant E, Ulinski T, Marin B. [Clinical monitoring of children with in utero exposure to angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:352-355. [PMID: 37044250 DOI: 10.1016/j.gofs.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023]
Abstract
Angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers are widely used to reduce high blood pressure or in other conditions such as congestive heart failure and prevention of diabetic nephropathy. To date, no teratogenic effect has been attributed to them, but in the 2nd and 3rd trimesters of pregnancy, their foetotoxicity is broadly documented: transient oligohydramnios or anamnios, associated to possible neonatal anuria and permanent renal damage, which can lead to intrauterine or neonatal death. Long-term effects among children with in utero exposure are poorly known, but the regression of an oligohydramnios might not always be associated with normal renal function after birth or later in life. This justifies seeking the advice of a pediatric nephrologistto consider the most appropriate monitoring for the child at birth and in the following weeks, and possibly beyond, even in case of normal prenatal ultrasound.
Collapse
Affiliation(s)
- Bénédicte Coulm
- Département de santé publique, centre de référence sur les agents tératogènes (CRAT), Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, hôpital Trousseau, Sorbonne université, 75012 Paris, France.
| | - Mathilde Latour
- Département de santé publique, centre de référence sur les agents tératogènes (CRAT), AP-HP, Sorbonne université, hôpital Trousseau, 75012 Paris, France
| | - Delphine Beguin
- Département de santé publique, centre de référence sur les agents tératogènes (CRAT), AP-HP, Sorbonne université, hôpital Trousseau, 75012 Paris, France
| | - Catherine Vauzelle
- Département de santé publique, centre de référence sur les agents tératogènes (CRAT), AP-HP, Sorbonne université, hôpital Trousseau, 75012 Paris, France
| | - Elisabeth Éléfant
- Département de santé publique, centre de référence sur les agents tératogènes (CRAT), AP-HP, Sorbonne université, hôpital Trousseau, 75012 Paris, France
| | - Tim Ulinski
- Service de néphrologie pédiatrique, ORIGYNE, AP-HP, Sorbonne université, hôpital Trousseau, 75012 Paris, France
| | - Benoît Marin
- Département de santé publique, centre de référence sur les agents tératogènes (CRAT), Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, hôpital Trousseau, Sorbonne université, 75012 Paris, France
| |
Collapse
|
2
|
Barkhordarian M, Lawrence JA, Ulusan S, Erbay MI, Aronow WS, Gupta R. Benefit and risk evaluation of quinapril hydrochloride. Expert Opin Drug Saf 2023; 22:271-277. [PMID: 37060355 DOI: 10.1080/14740338.2023.2203481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
INTRODUCTION Angiotensin-converting enzyme (ACE) inhibitors are a mainstay of antihypertensive therapy. Quinapril hydrochloride, a less commonly used, and less-studied ACE inhibitor has been approved for its primary use in hypertension. Studies also indicate its off-label use for congestive heart failure and diabetic nephropathy. The ANDI and TREND trials have been pivotal in demonstrating the effectiveness of quinapril. AREAS COVERED The authors conducted a review of the literature analyzing the clinical efficacy and safety profile of quinapril. This review discusses the development of quinapril, provides an updated summary of the indications and contraindications, and presents a comparison with other ACE inhibitors. EXPERT OPINION Quinapril is a safe and well-tolerated antihypertensive medication with a favorable safety profile compared to other ACE inhibitors. However, a lack of ample recent clinical trials and post-marketing data investigating the efficacy of quinapril in large cohorts has resulted in limited use in clinical practice. Quinapril may be an effective antihypertensive option for elderly populations as well as those who cannot tolerate the side effects profiles of other ACE inhibitors and as an additional treatment option for patients with heart failure with preserved ejection fraction.
Collapse
Affiliation(s)
- Maryam Barkhordarian
- Department of Internal Medicine, Hackensack Meridian Health - Palisades Medical Center, North Bergen, NJ, USA
| | - Jannel A Lawrence
- Department of Internal Medicine, Ross University School of Medicine, Largo, MD, USA
| | - Sebahat Ulusan
- Suleyman Demirel University School of Medicine, Isparta, Turkey
| | | | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, New York, USA
| | - Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA
| |
Collapse
|
3
|
Fakhouri F, Schwotzer N, Cabiddu G, Barratt J, Legardeur H, Garovic V, Orozco-Guillen A, Wetzels J, Daugas E, Moroni G, Noris M, Audard V, Praga M, Llurba E, Wuerzner G, Attini R, Desseauve D, Zakharova E, Luders C, Wiles K, Leone F, Jesudason S, Costedoat-Chalumeau N, Kattah A, Soto-Abraham V, Karras A, Prakash J, Lightstone L, Ronco P, Ponticelli C, Appel G, Remuzzi G, Tsatsaris V, Piccoli GB. Glomerular diseases in pregnancy: pragmatic recommendations for clinical management. Kidney Int 2023; 103:264-281. [PMID: 36481180 DOI: 10.1016/j.kint.2022.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022]
Abstract
Our understanding of the various aspects of pregnancy in women with kidney diseases has significantly improved in the last decades. Nevertheless, little is known about specific kidney diseases. Glomerular diseases are not only a frequent cause of chronic kidney disease in young women, but combine many challenges in pregnancy: immunologic diseases, hypertension, proteinuria, and kidney tissue damage. An international working group undertook the review of available current literature and elicited expert opinions on glomerular diseases in pregnancy with the aim to provide pragmatic information for nephrologists according to the present state-of-the-art knowledge. This work also highlights areas of clinical uncertainty and emphasizes the need for further collaborative studies to improve maternal and fetal health.
Collapse
Affiliation(s)
- Fadi Fakhouri
- Service de Néphrologie et d'Hypertension, Département de Médecine, Centre Hospitalier Universitaire Vaudois, and Université de Lausanne, Lausanne, Switzerland.
| | - Nora Schwotzer
- Service de Néphrologie et d'Hypertension, Département de Médecine, Centre Hospitalier Universitaire Vaudois, and Université de Lausanne, Lausanne, Switzerland
| | - Gianfranca Cabiddu
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Department of Nephrology, San Michele Hospital, ARNAS G. Brotzu, Cagliari, Italy
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Hélène Legardeur
- Gynaecology, Woman Mother Child Department of the Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Vesna Garovic
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA; Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Alejandra Orozco-Guillen
- National Institute of Perinatology Isidro Espinosa de los Reyes (INPER), Department of Nephrology, Ciudad de Mexico, Mexico
| | - Jack Wetzels
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Eric Daugas
- Service de Néphrologie, Hôpital Bichat and Université Paris Cité, Paris, France; Institut national de la santé et de la recherche médicale Inserm U1149, Paris, France
| | - Gabriella Moroni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Nephrology and Dialysis Division, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Marina Noris
- Istituto di Ricerche Farmacologiche Mario Negri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Laboratory of Immunology and Genetics of Rare Diseases, Bergamo, Italy
| | - Vincent Audard
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France; Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France
| | - Manuel Praga
- Department of Nephrology, Hospital Universitario 12 de Octubre, Complutense University Madrid, Madrid, Spain
| | - Elisa Llurba
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau - IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Madrid, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), Instituto de Salud Carlos III, Madrid, Spain
| | - Grégoire Wuerzner
- Service de Néphrologie et d'Hypertension, Département de Médecine, Centre Hospitalier Universitaire Vaudois, and Université de Lausanne, Lausanne, Switzerland
| | - Rossella Attini
- Department of Obstetrics and Gynecology, University of Turin, Città della Salute e della Scienza, Sant'Anna Hospital, Turin, Italy
| | - David Desseauve
- Gynaecology, Woman Mother Child Department of the Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. Sergey Petrovich Botkin, Moscow, Russian Federation; Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - Claudio Luders
- Centro de Nefrologia e Dialise, Hospital Sirio-Libanes, São Paulo, Brazil
| | - Kate Wiles
- Department of Women's Health, Barts Health NHS Trust, London, UK
| | - Filomena Leone
- Clinical Nutrition Unit, S. Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Shilpanjali Jesudason
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Nathalie Costedoat-Chalumeau
- Centre de Référence Maladies Auto-Immunes et Systémiques Rares de l'île de France, Cochin Hospital, Université Paris Cité, Paris, France; Unité de l'Institut national de la santé et de la recherche médicale (INSERM) Unité 1153, Center for Epidemiology and Statistics (CRESS), Paris, France
| | - Andrea Kattah
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Virgilia Soto-Abraham
- Pathology Department, Hospital General de México Dr Eduardo Liceaga, México City, México
| | - Alexandre Karras
- Paris University, Paris, France; Renal Division, Georges Pompidou European Hospital, Paris, France
| | - Jai Prakash
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Liz Lightstone
- Imperial Lupus Centre, Department of Medicine, Imperial College London, London, UK; Section of Renal Medicine and Vascular Inflammation, Department of Medicine, Imperial College London, London, UK
| | - Pierre Ronco
- Sorbonne Université, and Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1155, Paris, France; Department of Nephrology, Centre Hospitalier du Mans, Le Mans, France
| | | | - Gerald Appel
- Division of Nephrology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Laboratory of Immunology and Genetics of Rare Diseases, Bergamo, Italy
| | - Vassilis Tsatsaris
- Maternité Port-Royal, Fédération Hospitalo-Universitaire Prématurité (FHU PREMA), Assistance Publique des Hôpitaux de Paris AP-HP, Hôpital Cochin, AP-HP, Paris, France; Centre-Université de Paris, Université de Paris, Paris, France
| | | |
Collapse
|
4
|
Demir LÜ, Mathiesen ER, Damm P, Ringholm L. Major congenital malformations in offspring of women with chronic diseases-impact of the disease or the treatment? AJOG GLOBAL REPORTS 2022; 3:100153. [PMID: 36655167 PMCID: PMC9841280 DOI: 10.1016/j.xagr.2022.100153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
In a narrative review, we summarized previous findings on the risk of major congenital malformations in offspring of women with chronic hypertension, hypothyroidism, or depression compared with the background population, and evaluated whether exposure to medical treatment in the first trimester affected this risk. In a literature search in the PubMed database, cohort studies were included if they were published from 2010 to 2022 and contained data on major congenital malformations from ≥500 offspring of women with chronic hypertension, hypothyroidism, or depression during the first trimester of pregnancy, and data on both untreated and treated women. Data were compared with the background population of women without these diseases. In total, 7 cohort studies were identified. In comparison with the background population, 2 studies including 54,996 offspring of women with chronic hypertension showed an adjusted odds ratio of 1.20 to 1.30 for major congenital malformations in the offspring, regardless of antihypertensive treatment. One study including 16,364 offspring of women with hypothyroidism showed an adjusted odds ratio of 1.14 (1.06-1.22) for major congenital malformations in the offspring, regardless of thyroid substitution. Four studies including 48,913 offspring of women with depression showed adjusted odds ratios of 1.07 to 1.27 (0.91-1.78) for major congenital malformations in the offspring of untreated women. Three of these 4 studies showed similar prevalence of malformations in women treated for depression. The findings of this narrative review suggest that chronic hypertension and hypothyroidism, rather than exposure to their medical treatments in the first trimester, were associated with increased risk of major congenital malformations, whereas depression was generally not associated with major congenital malformations.
Collapse
Affiliation(s)
- Laila Ülkü Demir
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark (Ms Demir, Dr Mathiesen, and Dr Ringholm)
| | - Elisabeth Reinhardt Mathiesen
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark (Ms Demir, Dr Mathiesen, and Dr Ringholm),Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark (Dr Mathiesen, Dr Damm, and Dr Ringholm),Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Mathiesen and Dr Damm)
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark (Dr Mathiesen, Dr Damm, and Dr Ringholm),Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Mathiesen and Dr Damm),Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark (Dr Damm)
| | - Lene Ringholm
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark (Ms Demir, Dr Mathiesen, and Dr Ringholm),Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark (Dr Mathiesen, Dr Damm, and Dr Ringholm),Corresponding author: Lene Ringholm, PhD.
| |
Collapse
|
5
|
Reddy R, Baijnath S, Moodley R, Moodley J, Naicker T, Govender N. South African medicinal plants displaying angiotensin-converting enzyme inhibition: Potential use in the management of preeclampsia. J Ayurveda Integr Med 2022; 13:100562. [PMID: 35675745 PMCID: PMC9178479 DOI: 10.1016/j.jaim.2022.100562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 01/13/2023] Open
Abstract
In resource-limited settings, such as South Africa, hypertensive disorders of pregnancy such as preeclampsia, is the most common direct cause of maternal deaths. Current management strategies of preeclampsia primarily involve the use of pharmaceutical drugs, which are frequently associated with undesirable side-effects. Moreover, these drugs are often not easily accessible due to financial and economic constraints. Consequently, many patients rely on traditional medicine obtained from medicinal plants to manage health-related conditions. Angiotensin-converting enzyme inhibitors are widely used drugs for the management of preeclampsia. This narrative review aims to highlight the use of indigenous medicinal plants from South Africa with Angiotensin-converting enzyme inhibitory activity whilst also evaluating their potential use in the treatment of hypertension in pregnancy. This information will influence traditional healers and sangomas in their patient management. Furthermore, the antihypertensive potential of these plants will be unraveled thus facilitating the development of new naturally occurring pharmaceutical products to reduce maternal and neonatal mortality and morbidity.
Collapse
Affiliation(s)
- Rebecca Reddy
- Department of Basic Medical Science, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Sooraj Baijnath
- Catalysis and Peptide Research Unit, Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Roshila Moodley
- School of Chemistry and Physics, University of KwaZulu-Natal, Durban, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Thajasvarie Naicker
- Discipline of Optics and Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, 4001, South Africa
| | - Nalini Govender
- Department of Basic Medical Science, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa.
| |
Collapse
|
6
|
Fu J, Tomlinson G, Feig DS. Increased risk of major congenital malformations in early pregnancy use of angiotensin-converting-enzyme inhibitors and angiotensin-receptor-blockers: a meta-analysis. Diabetes Metab Res Rev 2021; 37:e3453. [PMID: 33779043 DOI: 10.1002/dmrr.3453] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/04/2021] [Accepted: 02/26/2021] [Indexed: 12/31/2022]
Abstract
AIMS To evaluate the risk of adverse fetal outcomes after exposure to angiotensin converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) in first trimester of pregnancy, by conducting a systematic review and meta-analysis. MATERIALS AND METHODS A systematic literature search was conducted using Medline, Embase, Cochrane and PubMed from inception to 25 November 2019. Studies were included if they evaluated pregnancies exposed to ACE-Is or ARBs, reported fetal outcomes, and compared these outcomes with a control group. Pooled odds ratios (ORs) were estimated using inverse variance-weighted random effects model. The protocol was registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42020160566). RESULTS Studies reporting on 6234 pregnancies exposed to ACE-Is or ARBs, 4104 pregnancies exposed to other oral antihypertensives, and 1,872,733 pregnancies without exposure were included in the meta-analysis. ACE-I or ARB exposed pregnancies, compared to non-exposed controls, had higher risk of major congenital malformations (OR 1.82; 95% confidence interval [CI]: 1.42-2.34), cardiovascular malformations (OR 2.50; 95% CI: 1.62-3.87) and stillbirths (OR 1.75; 95% CI: 1.21-2.53). There was no difference in congenital malformations observed between pregnancies exposed to other antihypertensives compared to non-exposed controls (OR 0.96; 95% CI: 0.69-1.33). CONCLUSIONS Women exposed to ACE-Is or ARBs during early pregnancy had higher risk of adverse fetal outcomes, including malformations and stillbirths, than non-exposed controls. This increased risk was independent of underlying maternal hypertension, as those exposed to other antihypertensives did not exhibit a higher risk than healthy controls. Women planning for pregnancy using these medications, including those with diabetic nephropathy, should be counselled appropriately.
Collapse
Affiliation(s)
- Jennifer Fu
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George Tomlinson
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Denice S Feig
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Ijomone OK, Osahon IR, Okoh COA, Akingbade GT, Ijomone OM. Neurovascular dysfunctions in hypertensive disorders of pregnancy. Metab Brain Dis 2021; 36:1109-1117. [PMID: 33704662 DOI: 10.1007/s11011-021-00710-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
Hypertensive disorders in pregnancy pose a huge challenge to the socioeconomic stability of a community; being a major cause of maternal and neonatal morbidity and mortality during delivery. Although there have been recent improvements in management strategies, still, the diversified nature of the underlying pathogenesis undermines their effectiveness. Generally, these disorders are categorized into two; hypertensive disorders of pregnancy with proteinuria (pre-eclampsia and eclampsia) and hypertensive disorders of pregnancy without proteinuria (gestational and chronic hypertension). Each of these conditions may present with unique characteristics that have interwoven symptoms. However, the tendency of occurrence heightens in the presence of any pre-existing life-threatening condition(s), environmental, and/or other genetic factors. Investigations into the cerebrovascular system demonstrate changes in the histoarchitectural organization of neurons, the proliferation of glial cells with an associated increase in inflammatory cytokines. These are oxidative stress indicators which impose a deteriorating impact on the structures that form the neurovascular unit and the blood-brain barrier (BBB). Such a pathologic state distorts the homeostatic supply of blood into the brain, and enhances the permeability of toxins/pathogens through a process called hyperperfusion at the BBB. Furthermore, a notable aspect of the pathogenesis of hypertensive disorders of pregnancy is endothelial dysfunction aggravated when signaling of the vasoprotective molecule, nitric oxide, amongst other neurotransmitter regulatory activities are impaired. This review aims to discuss the alterations in cerebrovascular regulation that determine the incidence of hypertension in pregnancy.
Collapse
Affiliation(s)
- Olayemi K Ijomone
- The Neuro- Lab, School of Health and Health Technology, Federal University of Technology, Akure, Nigeria.
- Department of Anatomy, Faculty of Basic Medical Sciences, University of Medical Sciences, Ondo, Nigeria.
| | - Itohan R Osahon
- Department of Anatomy, College of Health Sciences, Edo State University, Uzairue, Nigeria
| | - Comfort O A Okoh
- The Neuro- Lab, School of Health and Health Technology, Federal University of Technology, Akure, Nigeria
| | - Grace T Akingbade
- The Neuro- Lab, School of Health and Health Technology, Federal University of Technology, Akure, Nigeria
- Department of Human Anatomy, School of Health and Health Technology, Federal University of Technology, Akure, Nigeria
| | - Omamuyovwi M Ijomone
- The Neuro- Lab, School of Health and Health Technology, Federal University of Technology, Akure, Nigeria.
- Department of Human Anatomy, School of Health and Health Technology, Federal University of Technology, Akure, Nigeria.
| |
Collapse
|
8
|
Coris EE, Moran B, Sneed K, Del Rossi G, Bindas B, Mehta S, Narducci D. Stimulant Therapy Utilization for Neurocognitive Deficits in Mild Traumatic Brain Injury. Sports Health 2021; 14:538-548. [PMID: 34292098 DOI: 10.1177/19417381211031842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT There are 3.8 million mild traumatic brain injuries (mTBIs) that occur each year in the United States. Many are left with prolonged life-altering neurocognitive deficits, including difficulties in attention, concentration, mental fatigue, and distractibility. With extensive data on the safety and efficacy of stimulant medications in treating attention deficit, concentration difficulties and distractibility seen with attention deficit disorder, it is not surprising that interest continues regarding the application of stimulant medications for the persistent neurocognitive deficits in some mTBIs. EVIDENCE ACQUISITION Studies were extracted from PubMed based on the topics of neurocognitive impairment, mTBI, stimulant use in mTBI, stimulants, and the association between attention deficit/hyperactivity disorder and mTBI. The search criteria included a date range of 1999 to 2020 in the English language. STUDY DESIGN Literature review. LEVEL OF EVIDENCE Level 4. RESULTS Currently, there is very limited literature, and no guidelines for evaluating the use of stimulant medication for the treatment of prolonged neurocognitive impairments due to mTBI. However, a limited number of studies have demonstrated efficacy and safety of stimulants in the treatment of neurocognitive sequelae of mTBI in the adult, pediatric, military, and athletic populations. CONCLUSION There is limited evidence to suggest stimulant medication may be beneficial in patients with mTBI with persistent neurocognitive symtpoms. The decision to utilize stimulant medication for mTBI patients remains physician and patient preference dependent. Given the limited encouraging data currently available, physicians may consider stimulant medication in appropriate patients to facilitate the recovery of prolonged neurocognitive deficits, while remaining cognizant of potential adverse effects.
Collapse
Affiliation(s)
- Eric E Coris
- USF Morsani College of Medicine, Department of Family Medicine, Tampa, Florida.,USF Morsani College of Medicine, Department of Orthopedics and Sports Medicine, Tampa, Florida
| | - Byron Moran
- USF Morsani College of Medicine, Department of Family Medicine, Tampa, Florida.,USF Morsani College of Medicine, Department of Orthopedics and Sports Medicine, Tampa, Florida
| | | | - Gianluca Del Rossi
- USF Morsani College of Medicine, Department of Orthopedics and Sports Medicine, Tampa, Florida
| | - Bradford Bindas
- USF Morsani College of Medicine, Department of Family Medicine, Tampa, Florida
| | - Shaan Mehta
- USF Morsani College of Medicine, Department of Family Medicine, Tampa, Florida
| | - Dusty Narducci
- USF Morsani College of Medicine, Department of Family Medicine, Tampa, Florida.,USF Morsani College of Medicine, Department of Orthopedics and Sports Medicine, Tampa, Florida
| |
Collapse
|
9
|
Fitton CA, Fleming M, Aucott L, Pell JP, Mackay DF, McLay JS. Congenital defects and early childhood outcomes following in-utero exposure to antihypertensive medication. J Hypertens 2021; 39:581-588. [PMID: 33044380 DOI: 10.1097/hjh.0000000000002670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypertensive disorders during pregnancy are an important risk to mother and fetus, frequently necessitating antihypertensive treatment. Data describing the safety of in-utero exposure to antihypertensive treatment is conflicting with many studies suffering from significant methodological issues. METHOD We conducted a retrospective cohort study using linked routinely collected healthcare records for 268 711 children born 2010-2014 in Scotland to assess outcomes following in-utero exposure to antihypertensive medication. RESULTS We identified a cohort of 265 488 eligible mother-child pairs born over the study period; of which, 2433 were exposed in utero to antihypertensive medication, 4391 exposed to treated late-onset hypertension and 6066 exposed to untreated hypertension during pregnancy. In-utero antihypertensive exposure was associated with an increased risk of circulatory defects (aOR 2.29; 99% CI 1.14-4.59) compared with normal controls and the untreated hypertensive group. We report no increased odds of any developmental outcomes at 2.5 years of age following exposure to antihypertensive medication during pregnancy, untreated hypertension or late-onset hypertension. CONCLUSION Although circulatory defects may be associated with antihypertensive medication exposure during pregnancy, the mechanisms underlying this process are unclear.
Collapse
Affiliation(s)
- Catherine A Fitton
- Division of Applied Health Sciences, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
| | - Michael Fleming
- The Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Lorna Aucott
- Division of Applied Health Sciences, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
| | - Jill P Pell
- The Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Daniel F Mackay
- The Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - James S McLay
- Division of Applied Health Sciences, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
| |
Collapse
|
10
|
Gleeson S, Lightstone L. Glomerular Disease and Pregnancy. Adv Chronic Kidney Dis 2020; 27:469-476. [PMID: 33328063 DOI: 10.1053/j.ackd.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 12/28/2022]
Abstract
Nephrologists are routinely involved in the care of pregnant women with glomerulonephritis. Prepregnancy counseling is vital to inform women of the potential risks of pregnancy and to reduce those risks by optimizing clinical status and medications. In general, for all glomerulonephritides, the best pregnancy outcomes are achieved when the disease is in remission and the woman has preserved renal function with no proteinuria or hypertension. Each glomerulonephritis has specific considerations, for example in lupus nephritis, mycophenolate is teratogenic and must be stopped at least 6 weeks before conception, hydroxychloroquine is recommended for all pregnant women, and flares are frequently encountered and must be treated appropriately. De novo glomerulonephritis should be considered when significant proteinuria is found early in pregnancy or an acute kidney injury with active urine is encountered. Biopsy can be safely undertaken in the first trimester. Treatment is often with corticosteroids, azathioprine, and/or tacrolimus. Rituximab is increasingly used for severe disease. Women with glomerulonephritis should ideally be managed in a joint renal-obstetric clinic. This review details the approach to the care of women with glomerulonephritis from prepregnancy counseling, through antenatal care and delivery, to the postpartum period. Special attention is given to medications and treatment of glomerulonephritis in pregnancy.
Collapse
|
11
|
Buawangpong N, Teekachunhatean S, Koonrungsesomboon N. Adverse pregnancy outcomes associated with first-trimester exposure to angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers: A systematic review and meta-analysis. Pharmacol Res Perspect 2020; 8:e00644. [PMID: 32815286 PMCID: PMC7438312 DOI: 10.1002/prp2.644] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022] Open
Abstract
This study aimed to determine the effects of prenatal exposure to angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), particularly when exposure is limited to the first trimester of pregnancy, on adverse maternal and neonatal outcomes. A systematic search was performed on four databases, that is, PubMed, Scopus, Web of Science, and Cochrane Library, to identify relevant articles published up to December 31, 2019. Included studies were limited to original investigations assessing the association between prenatal exposure to ACEIs/ARBs and adverse pregnancy outcomes. Odds ratios were used as a summary effect measure. Pooled-effect estimates of each outcome were calculated by the random-effects meta-analysis. The main outcomes included overall and specific congenital malformations, low birth weight, miscarriage, elective termination of pregnancy, stillbirth, and preterm delivery. Of 19 included articles involving a total of 4 163 753 pregnant women, 13 studies reported an increased risk of, at least, one adverse pregnancy outcome in pregnant women who were exposed to ACEIs/ARBs. Meta-analysis revealed a significant association between overall congenital malformations and first trimester-only exposure to ACEIs/ARBs (OR = 1.94, 95% CI = 1.71-2.21, P < .0001). Cardiovascular malformations, miscarriage, and stillbirth also provided a significant relation with ACEI/ARB exposure. In conclusion, prenatal exposure to ACEIs/ARBs in the first trimester of pregnancy was found to be associated with an increased risk of adverse pregnancy outcomes. Women of reproductive age should be aware of the potential teratogenic risks of these drugs if they become pregnant.
Collapse
Affiliation(s)
- Nida Buawangpong
- Department of Family MedicineFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | | | - Nut Koonrungsesomboon
- Department of PharmacologyFaculty of MedicineChiang Mai UniversityChiang MaiThailand
- Musculoskeletal Science and Translational Research CenterChiang Mai UniversityChiang MaiThailand
| |
Collapse
|
12
|
Beanlands H, McCay E, Pahati S, Hladunewich MA. Through the Lens of Chronic Kidney Disease: A Qualitative Study of the Experiences of Young Women Living With CKD. Can J Kidney Health Dis 2020; 7:2054358120945475. [PMID: 32864150 PMCID: PMC7430077 DOI: 10.1177/2054358120945475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 06/03/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Young women may be particularly vulnerable to the negative psychosocial consequences of living with chronic kidney disease (CKD). To date, little is known about how women themselves experience and manage their illness. Objectives: This study explored the experiences of young women living with CKD. Design: Qualitative descriptive study. Setting: Nephrology program in an urban setting in Ontario, Canada. Participants: Women with category G1-3 glomerular-based CKD between 18 and 40 years of age. Methods: Focus group discussions guided by semi-structured interview questions. Qualitative content analysis was used to analyze interview transcripts. Results: Eleven women participated in 3 separate focus group discussions. Participants described living life through the lens of CKD, which was the central theme unifying their experiences of encountering CKD, re-encountering CKD, and getting on with life. Life decisions significant to women like pursuing a career or motherhood were often colored by CKD, particularly by illness-related challenges, such as unsatisfactory health care support and the physical implications of chronic illness. The women used a variety of strategies including seeking information and relying on supportive people to mitigate these challenges. Although these strategies sometimes enabled them to balance the demands of illness with other life priorities, the lack of resources directed toward their unique needs as young women with CKD often caused them difficulties in managing their illness. Limitations: Participants were from one nephrology program in an urban setting and were well educated overall. Their experiences may not be reflective of young women in other settings or from diverse backgrounds. Conclusions: The women’s emotional well-being and life choices were considerably influenced by CKD. Although the women were often able to manage challenges associated with CKD, they acknowledged the need to seek additional professional resources to complement their own self-identified strategies. As the women sought out these supports, they identified gaps in resources specific to women with CKD. This article summarizes recommendations from their perspective. Trial Registration: Not applicable as this was a qualitative study.
Collapse
Affiliation(s)
- Heather Beanlands
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Elizabeth McCay
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Sheryll Pahati
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Michelle A Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| |
Collapse
|
13
|
The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2020; 42:1235-1481. [PMID: 31375757 DOI: 10.1038/s41440-019-0284-9] [Citation(s) in RCA: 976] [Impact Index Per Article: 244.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
14
|
Gheysen W, Kennedy D. An update on maternal medication-related embryopathies. Prenat Diagn 2020; 40:1168-1177. [PMID: 32524623 DOI: 10.1002/pd.5764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022]
Abstract
There is a general perception that any exposure to medication during pregnancy poses a potential risk to the fetus. Most available data about teratogenic drugs is derived from animal studies, case reports, or cohort studies. As a result, counseling women and their partners about the safety of drugs during pregnancy can be difficult due to limited information about efficacy, pharmacokinetics, and teratogenicity of some drugs. However, this should always be done in the context of weighing up potential teratogenic risks with the perinatal risks of an untreated medical or psychiatric condition. Ideally, this counseling should occur prior to a planned pregnancy so that medications and treatment of chronic medical conditions can be optimized. It is important that clinicians providing antenatal care are able to confidently manage women including utilizing appropriate resources. This paper aims at reviewing a selected (non-exhaustive) list of the most commonly prescribed medications considered significant human teratogens and provides recommendations for pre-conception and antenatal counseling.
Collapse
Affiliation(s)
- Willem Gheysen
- Department of Maternal-Fetal-Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Debra Kennedy
- MotherSafe, Royal Hospital for Women, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of NSW, Sydney, New South Wales, Australia
| |
Collapse
|
15
|
Limaye MA, Buyon JP, Cuneo BF, Mehta-Lee SS. A review of fetal and neonatal consequences of maternal systemic lupus erythematosus. Prenat Diagn 2020; 40:1066-1076. [PMID: 32282083 DOI: 10.1002/pd.5709] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/20/2020] [Accepted: 04/06/2020] [Indexed: 12/14/2022]
Abstract
Systemic lupus erythematosus (SLE) primarily affects women of childbearing age and is commonly seen in pregnancy. The physiologic and immunologic changes of pregnancy may alter the course of SLE and impact maternal, fetal, and neonatal health. Multidisciplinary counseling before and during pregnancy from rheumatology, maternal fetal medicine, obstetrics, and pediatric cardiology is critical. Transplacental passage of autoantibodies, present in about 40% of women with SLE, can result in neonatal lupus (NL). NL can consist of usually permanent cardiac manifestations, including conduction system and myocardial disease, as well as transient cutaneous, hematologic, and hepatic manifestations. Additionally, women with SLE are more likely to develop adverse pregnancy outcomes such as preeclampsia, fetal growth restriction, and preterm birth, perhaps due to an underlying effect on placentation. This review describes the impact of SLE on maternal and fetal health by trimester, beginning with prepregnancy optimization of maternal health. This is followed by a discussion of NL and the current understanding of the epidemiology and pathophysiology of anti-Ro/La mediated cardiac disease, as well as screening, treatment, and methods for prevention. Finally discussed is the known increase in preeclampsia and fetal growth issues in women with SLE that can lead to iatrogenic preterm delivery.
Collapse
Affiliation(s)
- Meghana A Limaye
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, NYU Langone Medical Center, New York, New York, USA
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Bettina F Cuneo
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Shilpi S Mehta-Lee
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, NYU Langone Medical Center, New York, New York, USA
| |
Collapse
|
16
|
Fitton CA, Fleming M, Steiner MFC, Aucott L, Pell JP, Mackay DF, Mclay JS. In Utero Antihypertensive Medication Exposure and Neonatal Outcomes: A Data Linkage Cohort Study. Hypertension 2019; 75:628-633. [PMID: 31884860 PMCID: PMC8032216 DOI: 10.1161/hypertensionaha.119.13802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypertensive disorders during pregnancy are an important risk to mother and fetus, frequently necessitating antihypertensive treatment. Data describing the safety of in utero exposure to antihypertensive treatment is conflicting, with many studies suffering from significant methodological issues, such as inappropriate study design, small sample sizes, and no untreated control group. We conducted a retrospective cohort study using linked routinely collected healthcare records for 268 711 children born 2010-2014 in Scotland to assess outcomes following in utero exposure to antihypertensive medication. We identified a cohort of 265 488 eligible children born over the study period; of which, 2350 were exposed to in utero antihypertensive medication, 4391 exposed to treated late-onset hypertension, and 7971 exposed to untreated hypertension during pregnancy. Untreated hypertension was associated with increased risk of preterm birth (adjusted risk ratio [aRR], 1.15 [99% CI, 1.01-1.30]), low birth weight (aRR, 2.01 [99% CI, 1.72-2.36]) and being small for gestational age (aRR, 1.50 [99% CI, 1.35-1.66]), while in utero antihypertensive exposure was also associated with preterm birth (aRR, 3.12 [99% CI, 2.68-3.64]), low birth weight (aRR, 2.23 [99% CI, 1.79-2.78]), and being small for gestational age (aRR, 2.13 [99% CI, 1.81-2.52]). Late-onset hypertension was also associated with preterm birth (aRR, 2.21 [99% CI, 1.86-2.62]), low birth weight (aRR, 2.06 [99% CI, 1.74-2.43]), and being small for gestational age (aRR, 1.90 [99% CI, 1.68-2.16]). Our results suggest that hypertension is a key risk factor for low birth weight and preterm birth. Although preterm birth may be associated with antihypertensive medication exposure during pregnancy, these associations may reflect increasing hypertension severity necessitating treatment.
Collapse
Affiliation(s)
- Catherine A Fitton
- From the Department of Child Health, Division of Applied Health Sciences, University of Aberdeen, Royal Aberdeen Children's Hospital, Scotland (C.A.F., M.F.C.S., L.A., J.S.M.)
| | - Michael Fleming
- The Institute of Health and Wellbeing, University of Glasgow, Scotland (M.F., J.P.P., D.F.M.)
| | - Markus F C Steiner
- From the Department of Child Health, Division of Applied Health Sciences, University of Aberdeen, Royal Aberdeen Children's Hospital, Scotland (C.A.F., M.F.C.S., L.A., J.S.M.)
| | - Lorna Aucott
- From the Department of Child Health, Division of Applied Health Sciences, University of Aberdeen, Royal Aberdeen Children's Hospital, Scotland (C.A.F., M.F.C.S., L.A., J.S.M.)
| | - Jill P Pell
- The Institute of Health and Wellbeing, University of Glasgow, Scotland (M.F., J.P.P., D.F.M.)
| | - Daniel F Mackay
- The Institute of Health and Wellbeing, University of Glasgow, Scotland (M.F., J.P.P., D.F.M.)
| | - James S Mclay
- From the Department of Child Health, Division of Applied Health Sciences, University of Aberdeen, Royal Aberdeen Children's Hospital, Scotland (C.A.F., M.F.C.S., L.A., J.S.M.)
| |
Collapse
|
17
|
Mito A, Murashima A, Wada Y, Miyasato-Isoda M, Kamiya CA, Waguri M, Yoshimatsu J, Yakuwa N, Watanabe O, Suzuki T, Arata N, Mikami M, Ito S. Safety of Amlodipine in Early Pregnancy. J Am Heart Assoc 2019; 8:e012093. [PMID: 31345083 PMCID: PMC6761676 DOI: 10.1161/jaha.119.012093] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Amlodipine is used for the treatment of hypertension, but reports on its use in early pregnancy are limited. Methods and Results In the present study, we recruited 231 women with chronic hypertension, including those who received amlodipine or other antihypertensives during early pregnancy, and investigated frequencies of morphologic abnormalities in their 231 offspring. Specifically, we evaluated 48 neonates exposed to amlodipine in the first trimester (amlodipine group, Group A), 54 neonates exposed to antihypertensives other than amlodipine (other antihypertensive group, Group O), and 129 neonates not exposed to antihypertensives (no‐antihypertensive group, Group N). The number of morphologic abnormalities of offspring in each group were 2 in Group A (4.2%; 95% CI, 0.51–14.25); 3 in Group O (5.6%; 95% CI, 1.16–15.39) and 6 in Group N (4.7%; 95% CI, 1.73–9.85). The odds ratio of the primary outcome comparing Group A and Group O was 0.74 (95% CI: 0.118–4.621) and Group A and Group N was 0.89 (95% CI: 0.174–4.575). Conclusions The odds of birth defects in Group A in the first trimester were not significantly different from those with or without other antihypertensives. See Editorial Malha and August
Collapse
Affiliation(s)
- Asako Mito
- Drug Information Institute in Pregnancy Tokyo Japan.,Division of Maternal Medicine Center for Maternal-Fetal-Neonatal and Reproductive Medicine National Center for Child Health and Development Tokyo Japan
| | - Atsuko Murashima
- Drug Information Institute in Pregnancy Tokyo Japan.,Division of Maternal Medicine Center for Maternal-Fetal-Neonatal and Reproductive Medicine National Center for Child Health and Development Tokyo Japan
| | - Yoshinao Wada
- Department of Obstetric Medicine Osaka Women's and Children's Hospital Osaka Japan
| | | | - Chizuko A Kamiya
- Department of Perinatology and Gynecology National Cerebral and Cardiovascular Center Osaka Japan
| | - Masako Waguri
- Department of Obstetric Medicine Osaka Women's and Children's Hospital Osaka Japan
| | - Jun Yoshimatsu
- Department of Perinatology and Gynecology National Cerebral and Cardiovascular Center Osaka Japan
| | - Naho Yakuwa
- Drug Information Institute in Pregnancy Tokyo Japan
| | - Omi Watanabe
- Drug Information Institute in Pregnancy Tokyo Japan
| | - Tomo Suzuki
- Drug Information Institute in Pregnancy Tokyo Japan.,Division of Obstetrics Center for Maternal-Fetal-Neonatal and Reproductive Medicine National Center for Child Health and Development Tokyo Japan
| | - Naoko Arata
- Drug Information Institute in Pregnancy Tokyo Japan.,Division of Maternal Medicine Center for Maternal-Fetal-Neonatal and Reproductive Medicine National Center for Child Health and Development Tokyo Japan
| | - Masashi Mikami
- Division of Biostatistics Clinical Research Center National Center for Child Health and Development Tokyo Japan
| | - Shinya Ito
- Motherisk Program Division of Clinical Pharmacology and Toxicology Department of Paediatrics The Hospital for Sick Children University of Toronto Toronto Canada
| |
Collapse
|
18
|
Braunthal S, Brateanu A. Hypertension in pregnancy: Pathophysiology and treatment. SAGE Open Med 2019; 7:2050312119843700. [PMID: 31007914 PMCID: PMC6458675 DOI: 10.1177/2050312119843700] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/22/2019] [Indexed: 12/14/2022] Open
Abstract
Hypertensive disorders of pregnancy, an umbrella term that includes preexisting and gestational hypertension, preeclampsia, and eclampsia, complicate up to 10% of pregnancies and represent a significant cause of maternal and perinatal morbidity and mortality. Despite the differences in guidelines, there appears to be consensus that severe hypertension and non-severe hypertension with evidence of end-organ damage need to be controlled; yet the ideal target ranges below 160/110 mmHg remain a source of debate. This review outlines the definition, pathophysiology, goals of therapy, and treatment agents used in hypertensive disorders of pregnancy.
Collapse
Affiliation(s)
| | - Andrei Brateanu
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
19
|
Lallemant M, Prévost S, Nobili F, Riethmuller D, Ramanah R, Seronde MF, Mottet N. Prenatal hypocalvaria after prolonged intrauterine exposure to angiotensin II receptor antagonists. J Renin Angiotensin Aldosterone Syst 2019; 19:1470320318810940. [PMID: 30394825 PMCID: PMC6243420 DOI: 10.1177/1470320318810940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report a case of prenatal exposure to angiotensin II receptor antagonists (ARA
II) from the beginning of pregnancy in a patient with a hypokinetic dilated
cardiomyopathy. This case report emphasizes the fetal renal impact of prolonged
intrauterine exposure to renin-angiotensin system (RAS) blockers, and highlights
that this exposure can cause severe prenatal hypocalvaria. This delayed
ossification can be reversible after birth, but the presence of anhydramnios
indicates an early and irreversible block of RAS blockers in the fetus that is
responsible for fetal kidney development abnormalities. This association carries
a high risk of neonatal death. Prolonged exposure to ARA II or other RAS
blockers remains prohibited throughout pregnancy.
Collapse
Affiliation(s)
- Marine Lallemant
- 1 Obstetrics and Gynaecology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - Sarah Prévost
- 1 Obstetrics and Gynaecology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - François Nobili
- 2 Paediatric Nephrology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - Didier Riethmuller
- 1 Obstetrics and Gynaecology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - Rajeev Ramanah
- 1 Obstetrics and Gynaecology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - Marie-France Seronde
- 3 Cardiology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - Nicolas Mottet
- 1 Obstetrics and Gynaecology Department, Besançon University Medical Centre, Franche-Comté University, France
| |
Collapse
|
20
|
Bualeong T, Wyss JM, Roysommuti S. Inhibition of Renin-Angiotensin System from Conception to Young Mature Life Induces Salt-Sensitive Hypertension via Angiotensin II-Induced Sympathetic Overactivity in Adult Male Rats. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1155:45-59. [PMID: 31468385 DOI: 10.1007/978-981-13-8023-5_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Previous studies indicate that perinatal compromise of taurine causes cardiovascular disorders in adults via the influence of taurine on renin-angiotensin system (RAS). This study tested whether perinatal inhibition of the RAS would itself alter the adult cardiovascular system in a similar way. Female Sprague-Dawley rats were fed normal rat chow and given water alone (Control) or water containing captopril (400 mg/l) from conception until weaning. Then, the male offspring drank water or water containing captopril until 5 weeks of age followed by normal rat chow and water alone until 7 weeks of age. Thereafter, they drank water alone (Control, Captopril) or 1% NaCl solution (Control+1%, Captopril+1%). At 9 weeks of age, all animals were implanted with femoral arterial and venous catheters. Forty-eight hours later, blood chemistry, glucose tolerance, and hemodynamic parameters were determined in freely moving conscious rats. Then, the same experiments were repeated 2 days after captopril treatment. Body weights, kidney and heart to body weight ratios, fasting and non-fasting blood sugar, glucose tolerance, and heart rates were not significantly different among groups. Further, plasma sodium, mean arterial pressure, and sympathetic activity significantly increased whereas baroreflex sensitivity decreased in Captopril+1% compared to other groups. These changes were normalized by acute captopril treatment and the arterial pressure differences also by acute ganglionic and central adrenergic blockade. The present study suggests that inhibition of the RAS in the early life induces RAS overactivity, leading to salt-sensitive hypertension via sympathetic nervous system overactivity and depressed baroreflex sensitivity in adult male rats.
Collapse
Affiliation(s)
- Tippaporn Bualeong
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Department of Physiology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
| | - James Michael Wyss
- Department of Cell, Developmental and Integrative Biology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sanya Roysommuti
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| |
Collapse
|
21
|
Ahmed B, Tran DT, Zoega H, Kennedy SE, Jorm LR, Havard A. Maternal and perinatal outcomes associated with the use of renin-angiotensin system (RAS) blockers for chronic hypertension in early pregnancy. Pregnancy Hypertens 2018; 14:156-161. [PMID: 30527105 DOI: 10.1016/j.preghy.2018.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 09/18/2018] [Accepted: 09/30/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous research reported greater risk of adverse perinatal outcomes associated with first trimester exposure to angiotensin converting enzyme inhibitors (ACEIs) in comparison to unexposed pregnancies among non-hypertensive women. We examined the relationship between first trimester exposure to ACEIs and angiotensin receptor blockers (ARBs), and maternal and perinatal outcomes, whilst controlling for the underlying hypertension. STUDY DESIGN We performed a population-based cohort study among 130,061 pregnancies resulting in birth in NSW, Australia between 2005 and 2012. Birth data were linked to hospital discharge and pharmaceutical dispensing records. After restricting to women with chronic hypertension, 67 and 73 pregnancies exposed to ACEIs and ARBs respectively during the first trimester were compared with 316 pregnancies exposed to methyldopa. STUDY OUTCOMES Preterm delivery, caesarean section, low birth weight, small for gestational age and Apgar score <7. RESULTS Compared to pregnancies exposed to methyldopa, the adjusted odds ratio (aOR) for ACEI exposure was 0.5 (95% CI: 0.2-1.1) for preterm delivery, 1.6 (0.8-3.1) for caesarean section, 0.6 (0.2-1.3) for LBW and 0.8 (0.4-1.9) for SGA. The corresponding aORs and confidence intervals for ARB exposure were 0.7 (0.3-1.5), 1.2 (0.6-2.6), 1.3 (0.7-2.6), and 1.2 (0.6-2.4). CONCLUSION No association between early pregnancy exposure to ACEIs and ARBs and perinatal outcomes was observed, however, the possibility of an association cannot be ruled out due to limited power. Nonetheless, this study suggests that the magnitude of risk is smaller than that reported previously.
Collapse
Affiliation(s)
- Bilal Ahmed
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
| | - Duong T Tran
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Helga Zoega
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia; Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavk, Iceland
| | - Sean E Kennedy
- School of Women's & Children's Health, University of New South Wales (NSW), Sydney, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Alys Havard
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
22
|
Increased rate of birth defects after first trimester use of angiotensin converting enzyme inhibitors – Treatment or hypertension related? An observational cohort study. Pregnancy Hypertens 2018; 13:65-71. [DOI: 10.1016/j.preghy.2018.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 04/07/2018] [Accepted: 04/28/2018] [Indexed: 11/19/2022]
|
23
|
Hoeltzenbein M, Tissen-Diabaté T, Fietz AK, Zinke S, Kayser A, Meister R, Weber-Schoendorfer C, Schaefer C. Pregnancy outcome after first trimester use of angiotensin AT1 receptor blockers: an observational cohort study. Clin Res Cardiol 2018; 107:679-687. [PMID: 29574489 DOI: 10.1007/s00392-018-1234-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 03/20/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ongoing discussion about the safety of renin-angiotensin inhibitors in the first trimester and limited data on pregnancy outcomes after exposure to angiotensin AT1 receptor blockers (ARBs). METHODS Observational cohort study compares outcomes of 215 prospectively ascertained pregnancies with first trimester exposure to ARBs with 642 non-hypertensive pregnancies. RESULTS The rate of major birth defects in the ARB cohort (9/168, 5.4%) was higher than in the comparison group (17/570, 3%), but not significantly increased (ORadj 1.9, 95% CI 0.7-4.9). There was no distinct pattern of anomalies among infants with birth defects. The risk of spontaneous abortions was not increased (HRadj 0.9, 95% CI 0.5-1.6), although the cumulative incidence was in the upper normal range (0.22, 95% CI 0.15-0.32). Higher rates of prematurity (ORadj 3.0; 95% CI 1.7-5.1) and a reduced birth weight after adjustment for sex and gestational age were observed. There was no evidence for an increased risk for major birth defects, spontaneous abortions, or preterm birth in a sensitivity analysis comparing ARB exposed hypertensive women to hypertensive women without ARB exposure during the first trimester. CONCLUSION Our study supports the hypothesis that ARBs are not major teratogens. Patients inadvertently exposed to ARBs during the early pregnancy may be reassured. Nevertheless, women planning pregnancy should avoid ARBs. In selected cases, ARBs might be continued under careful monitoring of menstrual cycle and discontinued as soon as pregnancy is recognized.
Collapse
Affiliation(s)
- Maria Hoeltzenbein
- Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Tatjana Tissen-Diabaté
- Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anne-Katrin Fietz
- Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sandra Zinke
- Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Angela Kayser
- Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Reinhard Meister
- Department of Mathematics, Beuth Hochschule für Technik Berlin, Berlin, Germany
| | - Corinna Weber-Schoendorfer
- Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christof Schaefer
- Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| |
Collapse
|
24
|
Blom K, Odutayo A, Bramham K, Hladunewich MA. Pregnancy and Glomerular Disease: A Systematic Review of the Literature with Management Guidelines. Clin J Am Soc Nephrol 2017; 12:1862-1872. [PMID: 28522651 PMCID: PMC5672957 DOI: 10.2215/cjn.00130117] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
During pregnancy, CKD increases both maternal and fetal risk. Adverse maternal outcomes include progression of underlying renal dysfunction, worsening of urine protein, and hypertension, whereas adverse fetal outcomes include fetal loss, intrauterine growth restriction, and preterm delivery. As such, pregnancy in young women with CKD is anxiety provoking for both the patient and the clinician providing care, and because the heterogeneous group of glomerular diseases often affects young women, this is an area of heightened concern. In this invited review, we discuss pregnancy outcomes in young women with glomerular diseases. We have performed a systematic review in attempt to better understand these outcomes among young women with primary GN, we review the studies of pregnancy outcomes in lupus nephritis, and finally, we provide a potential construct for management. Although it is safe to say that the vast majority of young women with glomerular disease will have a live birth, the counseling that we can provide with respect to individualized risk remains imprecise in primary GN because the existing literature is extremely dated, and all management principles are extrapolated primarily from studies in lupus nephritis and diabetes. As such, the study of pregnancy outcomes and management strategies in these rare diseases requires a renewed interest and a dedicated collaborative effort.
Collapse
Affiliation(s)
- Kimberly Blom
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; and
| | - Ayodele Odutayo
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; and
| | - Kate Bramham
- Department of Renal Medicine, Division of Transplantation Immunology and Mucosal Biology, King’s College, London, United Kingdom
| | - Michelle A. Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; and
| |
Collapse
|
25
|
Fitton CA, Steiner MF, Aucott L, Pell JP, Mackay DF, Fleming M, McLay JS. In-utero exposure to antihypertensive medication and neonatal and child health outcomes: a systematic review. J Hypertens 2017; 35:2123-2137. [PMID: 28661961 PMCID: PMC5625961 DOI: 10.1097/hjh.0000000000001456] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although medication is generally avoided wherever possible during pregnancy, pharmacotherapy is required for the treatment of pregnancy associated hypertension, which remains a leading cause of maternal and fetal morbidity and mortality. The long-term effects to the child of in-utero exposure to antihypertensive agents remains largely unknown. OBJECTIVE The aim of this study was to systematically review published studies on adverse outcomes to the child associated with in-utero exposure to antihypertensive medications. METHODS OVID, Scopus, EBSCO Collections, the Cochrane Library, and Web of Science databases were searched for relevant publications published between January 1950 and October 2016 and a total of 688 potentially eligible studies were identified. RESULTS Following review, 47 primary studies were eligible for inclusion. The Critical Appraisal Skills Programme checklist was used to assess study quality. Five studies were of excellent quality; the remainder were either mediocre or poor. Increased risk of low birth weight, low size for gestational age, preterm birth, and congenital defects following in-utero exposure to all antihypertensive agents were identified. Two studies reported an increased risk of attention deficit hyperactivity disorder following exposure to labetalol, and an increased risk of sleep disorders following exposure to methyldopa and clonidine. CONCLUSION The current systematic review demonstrates a paucity of relevant published high-quality studies. A small number of studies suggest possible increased risk of adverse child health outcomes; however, most published studies have methodological weaknesses and/or lacked statistical power thus preventing any firm conclusions being drawn.
Collapse
Affiliation(s)
- Catherine A. Fitton
- The Department of Child Health, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
| | - Markus F.C. Steiner
- The Department of Child Health, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
| | - Lorna Aucott
- The Department of Child Health, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel F. Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - James S. McLay
- The Department of Child Health, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
| |
Collapse
|
26
|
Human teratogens and genetic phenocopies. Understanding pathogenesis through human genes mutation. Eur J Med Genet 2016; 60:22-31. [PMID: 27639441 DOI: 10.1016/j.ejmg.2016.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 09/12/2016] [Indexed: 12/27/2022]
Abstract
Exposure to teratogenic drugs during pregnancy is associated with a wide range of embryo-fetal anomalies and sometimes results in recurrent and recognizable patterns of malformations; however, the comprehension of the mechanisms underlying the pathogenesis of drug-induced birth defects is difficult, since teratogenesis is a multifactorial process which is always the result of a complex interaction between several environmental factors and the genetic background of both the mother and the fetus. Animal models have been extensively used to assess the teratogenic potential of pharmacological agents and to study their teratogenic mechanisms; however, a still open issue concerns how the information gained through animal models can be translated to humans. Instead, significant information can be obtained by the identification and analysis of human genetic syndromes characterized by clinical features overlapping with those observed in drug-induced embryopathies. Until now, genetic phenocopies have been reported for the embryopathies/fetopathies associated with prenatal exposure to warfarin, leflunomide, mycophenolate mofetil, fluconazole, thalidomide and ACE inhibitors. In most cases, genetic phenocopies are caused by mutations in genes encoding for the main targets of teratogens or for proteins belonging to the same molecular pathways. The aim of this paper is to review the proposed teratogenic mechanisms of these drugs, by the analysis of human monogenic disorders and their molecular pathogenesis.
Collapse
|
27
|
Abstract
Women with type 1 diabetes (T1DM) have unique needs during the preconception, pregnancy, and postpartum periods. Preconception counseling is essential for women with T1DM to minimize pregnancy risks. The goals of preconception care should be tight glycemic control with a hemoglobin A1c (A1C) < 7 % and as close to 6 % as possible, without significant hypoglycemia. This will lower risks of congenital malformations, preeclampsia, and perinatal mortality. The safety of medications should be assessed prior to conception. Optimal control of retinopathy, hypertension, and nephropathy should be achieved. During pregnancy, the goal A1C is near-normal at <6 %, without excessive hypoglycemia. There is no clear evidence that continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) is superior in achieving the desired tight glycemic control of T1DM during pregnancy. Data regarding continuous glucose monitoring (CGM) in pregnant women with T1DM is conflicting regarding improved glycemic control. However, a recent CGM study does provide some distinct patterns of glucose levels associated with large for gestational age infants. Frequent eye exams during pregnancy are essential due to risk of progression of retinopathy during pregnancy. Chronic hypertension treatment goals are systolic blood pressure 110-129 mmHg and diastolic blood pressure 65-79 mmHg. Labor and delivery target plasma glucose levels are 80-110 mg/dl, and an insulin drip is recommended to achieve these targets during active labor. Postpartum, insulin doses must be reduced and glucoses closely monitored in women with T1DM because of the enhanced insulin sensitivity after delivery. Breastfeeding is recommended and should be highly encouraged due to maternal benefits including increased insulin sensitivity and weight loss and infant and childhood benefits including reduced prevalence of overweight. In this article, we discuss the care of pregnant patients with T1DM.
Collapse
Affiliation(s)
- Anna Z Feldman
- Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02115, USA
| | | |
Collapse
|
28
|
Laliberte B, Reed BN, Ather A, Devabhakthuni S, Watson K, Lardieri AB, Baker-Smith CM. Safe and Effective Use of Pharmacologic and Device Therapy for Peripartum Cardiomyopathy. Pharmacotherapy 2016; 36:955-70. [DOI: 10.1002/phar.1795] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Benjamin Laliberte
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Brent N. Reed
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Ayesha Ather
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Sandeep Devabhakthuni
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Kristin Watson
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Allison B. Lardieri
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | | |
Collapse
|
29
|
Hladunewich MA, Melamed N, Bramham K. Pregnancy across the spectrum of chronic kidney disease. Kidney Int 2016; 89:995-1007. [PMID: 27083278 DOI: 10.1016/j.kint.2015.12.050] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 12/06/2015] [Accepted: 12/18/2015] [Indexed: 01/14/2023]
Abstract
Management of the pregnant woman with chronic kidney disease is difficult for both nephrologists and obstetricians. Prepregnancy counselling with respect to risk stratification, optimization of maternal health prior to pregnancy, as well as management of the many potential pregnancy-associated complications in this complex patient population remains challenging due to the paucity of large, well-designed clinical studies. Furthermore, the heterogeneity of disease and the relative infrequency of pregnancy, particularly in more advanced stages of chronic kidney disease, leaves many clinicians feeling ill prepared to manage these pregnancies. As such, counselling is imprecise and management varies substantially across centers. All pregnancies in women with chronic kidney disease can benefit from a collaborative multidisciplinary approach with a team that consists of nephrologists experienced in the management of kidney disease in pregnancy, maternal-fetal medicine specialists, high-risk pregnancy nursing staff, dieticians, and pharmacists. Further access to skilled neonatologists and neonatal intensive care unit support is essential given the risks for preterm delivery in this patient population. The goal of this paper is to highlight some of the data that currently exist in the literature, provide management strategies for the practicing nephrologist at all stages of chronic kidney disease, and explore some of the knowledge gaps where future multinational collaborative research efforts should concentrate to improve pregnancy outcomes in women with kidney disease across the globe.
Collapse
Affiliation(s)
- Michelle A Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Nir Melamed
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kate Bramham
- Division of Transplantation, Immunology and Mucosal Biology, Department of Renal Medicine, King's College, London, UK
| |
Collapse
|
30
|
Shimada C, Akaishi R, Cho K, Morikawa M, Kaneshi Y, Yamda T, Minakami H. Outcomes of 83 fetuses exposed to angiotensin receptor blockers during the second or third trimesters: a literature review. Hypertens Res 2015; 38:308-13. [DOI: 10.1038/hr.2015.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/29/2014] [Accepted: 11/01/2014] [Indexed: 11/09/2022]
|
31
|
S. Mukherjee M, Coppenrath VA, Dallinga BA. Pharmacologic Management of Types 1 and 2 Diabetes Mellitus and Their Complications in Women of Childbearing Age. Pharmacotherapy 2015; 35:158-74. [DOI: 10.1002/phar.1535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | | | - Bree A. Dallinga
- Edward M. Kennedy Community Health Center; Framingham Massachusetts
| |
Collapse
|
32
|
Pucci M, Sarween N, Knox E, Lipkin G, Martin U. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in women of childbearing age: risks versus benefits. Expert Rev Clin Pharmacol 2015; 8:221-31. [DOI: 10.1586/17512433.2015.1005074] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
33
|
van Gelder MMHJ, Van Bennekom CM, Louik C, Werler MM, Roeleveld N, Mitchell AA. Maternal hypertensive disorders, antihypertensive medication use, and the risk of birth defects: a case-control study. BJOG 2014; 122:1002-9. [DOI: 10.1111/1471-0528.13138] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2014] [Indexed: 12/01/2022]
Affiliation(s)
- MMHJ van Gelder
- Department for Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
| | - CM Van Bennekom
- Slone Epidemiology Center at Boston University; Boston MA USA
| | - C Louik
- Slone Epidemiology Center at Boston University; Boston MA USA
| | - MM Werler
- Slone Epidemiology Center at Boston University; Boston MA USA
| | - N Roeleveld
- Department for Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
- Department of Paediatrics; Radboud University Medical Center; Nijmegen the Netherlands
| | - AA Mitchell
- Slone Epidemiology Center at Boston University; Boston MA USA
| |
Collapse
|
34
|
Fetal renin-angiotensin-system blockade syndrome: renal lesions. Pediatr Nephrol 2014; 29:1221-30. [PMID: 24477978 DOI: 10.1007/s00467-013-2749-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 12/16/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Fetuses exposed to angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists during the second and/or third trimesters of gestation are at high risk of developing severe complications. They consist in fetal hypotension, and anuria/oligohydramnios leading to Potter sequence, frequently associated with hypocalvaria. Most fetuses die during the pre- or postnatal period, whereas others recover normal or subnormal renal function. However, the secondary occurrence of renal failure or hypertension has been reported in children after apparent complete recovery. METHODS In this context, we analyzed renal lesions in 14 fetus/neonates who died soon after exposure to renin-angiotensin-system (RAS) blockers. Our objective was to determine the causes for the persistence or the secondary occurrence of renal complications reported in some of the survivors. RESULTS As previously described, renal tubular dysgenesis is usually observed. Additional lesions, such as thickening of the muscular wall of arterioles and interlobular arteries, glomerular cysts, and interstitial fibrosis, develop early during fetal life. CONCLUSION We suggest that renal lesions that develop before birth may persist after withdrawal of the causative drugs and normalization of blood and renal perfusion pressure. Their persistence could explain the severe long-term outcome of some of these patients. Long-term study of children exposed to RAS blockers during fetal life is strongly recommended.
Collapse
|
35
|
Observational cohort study of pregnancy outcome after first-trimester exposure to fluoroquinolones. Antimicrob Agents Chemother 2014; 58:4392-8. [PMID: 24841264 DOI: 10.1128/aac.02413-14] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Fluoroquinolones are avoided during pregnancy due to developmental toxicity in animals. The aim of this study was to assess the fetal risk after intrauterine fluoroquinolone exposure. We performed an observational study of a prospectively ascertained cohort of pregnant women exposed to a fluoroquinolone during the first trimester. Pregnancy outcomes were compared to those of a cohort exposed to neither fluoroquinolones nor teratogenic or fetotoxic drugs. The outcomes evaluated were major birth defects (structural abnormalities of medical, surgical, or cosmetic relevance), spontaneous abortion, and elective termination of pregnancy. Pregnancy outcomes of 949 women with fluoroquinolone treatment were compared with those of 3,796 nonexposed controls. Neither the rate of major birth defects (2.4%; adjusted odds ratio [OR(adj)], 0.91; 95% confidence interval [CI], 0.6 to 1.5) nor the risk of spontaneous abortion (adjusted hazard ratio [HR(adj)], 1.01; 95% CI, 0.8 to 1.3) was increased. However, there was a nonsignificant increase in major birth defects after exposure to moxifloxacin (6/93, 6.5%; crude odds ratio [OR(crude)], 2.40; 95% CI, 0.8 to 5.6). Neither a critical exposure time window within the first trimester nor a specific pattern of birth defects was demonstrated for any of the fluoroquinolones. The rate of electively terminated pregnancies was increased among the fluoroquinolone-exposed women (HR(adj), 1.32; 95% CI, 1.03 to 1.7). The gestational ages at delivery and birth weights did not differ between groups. Our study did not detect an increased risk of spontaneous abortion or major birth defects. These reassuring findings support the recommendation to allow fluoroquinolone use in early pregnancy in selected cases. After the use of moxifloxacin, a detailed fetal ultrasound examination should be considered.
Collapse
|
36
|
Cadnapaphornchai MA, George DM, McFann K, Wang W, Gitomer B, Strain JD, Schrier RW. Effect of pravastatin on total kidney volume, left ventricular mass index, and microalbuminuria in pediatric autosomal dominant polycystic kidney disease. Clin J Am Soc Nephrol 2014; 9:889-96. [PMID: 24721893 DOI: 10.2215/cjn.08350813] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES In autosomal dominant polycystic kidney disease (ADPKD), progressive kidney cyst formation commonly leads to ESRD. Because important manifestations of ADPKD may be evident in childhood, early intervention may have the largest effect on long-term outcome. Statins are known to slow progressive nephropathy in animal models of ADPKD. This randomized double-blind placebo-controlled phase III clinical trial was conducted from 2007 to 2012 to assess the effect of pravastatin on height-corrected total kidney volume (HtTKV) and left ventricular mass index (LVMI) by magnetic resonance imaging (MRI) and urine microalbumin excretion (UAE) in children and young adults with ADPKD. DESIGNS, SETTING, PARTICIPANTS, & MEASUREMENTS There were 110 pediatric participants with ADPKD and normal kidney function receiving lisinopril who were randomized to treatment with pravastatin or placebo for a 3-year period with evaluation at 0, 18, and 36 months. The primary outcome variable was a ≥ 20% change in HtTKV, LVMI, or UAE over the study period. RESULTS Ninety-one participants completed the 3-year study (83%). Fewer participants receiving pravastatin achieved the primary endpoint compared with participants receiving placebo (69% versus 88%; P=0.03). This was due primarily to a lower proportion reaching the increase in HtTKV (46% versus 68%; P=0.03), with similar findings observed between study groups for LVMI (25% versus 38%; P=0.18) and UAE (47% versus 39%; P=0.50). The percent change in HtTKV adjusted for age, sex, and hypertension status over the 3-year period was significantly decreased with pravastatin (23% ± 3% versus 31% ± 3%; P=0.02). CONCLUSIONS Pravastatin is an effective agent to slow progression of structural kidney disease in children and young adults with ADPKD. These findings support a role for early intervention with pravastatin in this condition.
Collapse
Affiliation(s)
- Melissa A Cadnapaphornchai
- Departments of Pediatrics and, †Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, ‡Department of Radiology, Children's Hospital Colorado, Aurora, Colorado
| | | | | | | | | | | | | |
Collapse
|
37
|
|
38
|
Lindle KA, Dinh K, Moffett BS, Kyle WB, Montgomery NM, Denfield SD, Knudson JD. Angiotensin-converting enzyme inhibitor nephrotoxicity in neonates with cardiac disease. Pediatr Cardiol 2014; 35:499-506. [PMID: 24233240 DOI: 10.1007/s00246-013-0813-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/26/2013] [Indexed: 11/24/2022]
Abstract
Angiotensin-converting enzyme inhibitors (ACEi) are commonly used for pediatric cardiology patients. However, studies examining their safety for neonates with cardiac disease are scarce. The current study aimed to test the hypothesis that ACEi-mediated nephrotoxicity occurs in neonates and may be underappreciated in this population. A retrospective review of 243 neonates with cardiac disease between 2007 and 2010 was performed. Demographic data, weight, length, captopril and enalapril dosing, serum [K⁺], serum creatinine, and concomitant medications during ACEi therapy were recorded and analyzed. Body surface area (BSA), creatinine clearance (CrCl), and change in [K⁺] were calculated. The age range of neonates at ACEi initiation was 15.9-18.1 days. The inclusion criteria was met by 206 neonates: 168 term (82%) and 38 preterm (18%) newborns. Of these neonates, 42% were female, and all the patients had a BSA smaller than 0.33 m² (a group known to have relative renal insufficiency). The mean dose of enalapril was 0.08 ± 0.007 mg/kg for the preterm neonates and 0.08 ± 0.003 mg/kg for the term neonates. The mean dose of captopril was 0.07 ± 0.009 mg/kg for the preterm neonates and 0.13 ± 0.019 mg/kg for the term neonates. A significant decrease in CrCl occurred for both the preterm (p < 0.01) and term (p < 0.001) neonates while they were receiving ACEi. However, the two groups did not differ significantly (p = 0.183). Nearly 42% of all the patients showed renal risk, with approximately 30% demonstrating renal failure by modified pRIFLE (pediatric risk, injury, failure, loss, and end-stage renal disease) criteria. Despite the lack of significantly different CrCl, the premature neonates were more likely to experience ACEi-related renal failure by pRIFLE (55%) than their term counterparts (23%; p < 0.001). Despite its common use for term neonates with cardiac disease, ACEi should be used cautiously and only when indications are clear. These results also raise the question whether ACEi should be used at all for preterm neonates.
Collapse
|
39
|
Morton AP. Are angiotensin-converting enzyme inhibitors and angiotensin 2 receptor blockers teratogenic? Diabet Med 2013; 30:1263-4. [PMID: 23802776 DOI: 10.1111/dme.12265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- A P Morton
- Mater Health Services, South Brisbane, Qld, Australia.
| |
Collapse
|
40
|
Oppermann M, Padberg S, Kayser A, Weber-Schoendorfer C, Schaefer C. Angiotensin-II receptor 1 antagonist fetopathy--risk assessment, critical time period and vena cava thrombosis as a possible new feature. Br J Clin Pharmacol 2013; 75:822-30. [PMID: 22816796 DOI: 10.1111/j.1365-2125.2012.04388.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 07/16/2012] [Indexed: 11/26/2022] Open
Abstract
AIMS Angiotensin-II receptor 1 antagonists (AT₁-antagonists) may cause severe and even lethal fetopathy in late pregnancy. However, exposure still occurs in spite of warnings in package leaflets. This study aimed to assess the risk of fetopathy, the sensitive time window, and possible new symptoms in prospective as well as retrospective cases with AT₁-antagonist treatment during the second or third trimester of pregnancy. METHODS Patients were enrolled by the Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy between 1999 and 2011 through risk consultation. Symptoms defined as indicative of AT₁-antagonist fetopathy were: oligo-/anhydramnios, renal insufficiency, lung hypoplasia, joint contractures, skull hypoplasia and fetal/neonatal death. RESULTS In 5/29 (17%) prospectively enrolled cases with AT₁-antagonist exposure beyond the first trimester oligo-/anhydramnios was diagnosed. Two infants showed additional symptoms of fetopathy. The risk is more than 30% if treatment continues beyond the 20th week of pregnancy. Oligo-/anhydramnios was reversible after AT₁-antagonist withdrawal. Among 16 retrospective case reports, three infants presented with a thrombosis of the inferior vena cava in the vicinity of the renal veins. Four out of 13 live births did not survive. CONCLUSIONS Our survey suggests that the risk increases with duration of AT₁-antagonist treatment into late pregnancy and oligo-/anhydramnios may be reversible after AT₁-antagonist discontinuation. Thrombosis of inferior vena cava may be a new feature of AT₁-antagonist fetopathy. AT₁-antagonist medication during pregnancy constitutes a considerable risk and must be discontinued immediately. In case of indicative diagnostic findings in either the fetus or newborn, previous maternal AT₁-antagonist exposure should be considered.
Collapse
Affiliation(s)
- Marc Oppermann
- Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy, Charité-Universitätsmedizin Berlin, 14050 Berlin, Germany
| | | | | | | | | |
Collapse
|
41
|
Darby M, Martin JN, LaMarca B. A complicated role for the renin-angiotensin system during pregnancy: highlighting the importance of drug discovery. Expert Opin Drug Saf 2013; 12:857-64. [PMID: 23915333 DOI: 10.1517/14740338.2013.823945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Blood pressure management is recommended to avoid maternal cerebrovascular or cardiovascular compromise during pregnancy. Current antihypertensive treatment during pregnancy with positive safety profiles includes labetalol, hydralazine, methyldopa and nifedipine. AREAS COVERED Many earlier animal and human studies indicate that angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are associated with fetopathy; therefore, these drugs are contraindicated during pregnancy, especially if these medications were taken during the second and third trimesters. The role of the RAS is quite complex, with fetal development heavily dependent on its appropriate expression and function. New findings indicate that the placental unit expresses its own RAS in order to regulate angiogenesis. Multiple studies have shown that women with abnormal uterine doppler sonography produce an agonistic autoantibody to the angiotensin I receptor, implicating a role for RAS function and regulation in abnormal pregnancies. Importantly, interruption of a normal RAS compromises fetal development. EXPERT OPINION Traditional medications that inhibit components of RAS for long-term hypertension control are not appropriate for use before or during pregnancy. Further study and drug discovery are needed to find alternative pathways for treatment of hypertensive disorders when pregnancy is present or a possibility.
Collapse
Affiliation(s)
- Marie Darby
- University of Mississippi Medical Center, Departments of Obstetrics & Gynecology , 2500 North State Street, Jackson MS 39216 , USA +1 601 984 5358 ;
| | | | | |
Collapse
|
42
|
Cassina M, Dilaghi A, Di Gianantonio E, Cesari E, De Santis M, Mannaioni G, Pistelli A, Clementi M. Pregnancy outcome in women exposed to antiepileptic drugs: teratogenic role of maternal epilepsy and its pharmacologic treatment. Reprod Toxicol 2013; 39:50-7. [PMID: 23591043 DOI: 10.1016/j.reprotox.2013.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 04/03/2013] [Accepted: 04/04/2013] [Indexed: 11/30/2022]
Abstract
Infants born to epileptic women treated with antiepileptic drugs (AEDs) have an increased risk of major congenital malformations (MCMs). In order to determine the role of maternal epilepsy we conducted a prospective cohort study on three cohorts of pregnant women: (i) 385 epileptic women treated with AEDs, (ii) 310 non-epileptic women treated with AEDs, (iii) 867 healthy women not exposed to AEDs (control group). The rate of MCMs in the epileptic group (7.7%) was not statistically higher than in the non-epileptic one (3.9%) (p=0.068). The rate in the first group was higher compared to the control group (p=0.001), while the rate in the second one was not (p=0.534). Our data confirm that AEDs therapy is the main cause of the increased risk of malformations in the offspring of epileptic women; however a teratogenic role of the maternal epilepsy itself cannot be excluded.
Collapse
Affiliation(s)
- Matteo Cassina
- Teratology Information Service, Clinical Genetics Unit, Department of Woman and Child Health, University of Padova, Padova, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Vasilakis-Scaramozza C, Aschengrau A, Cabral HJ, Jick SS. Antihypertensive drugs and the risk of congenital anomalies. Pharmacotherapy 2013; 33:476-82. [PMID: 23553869 DOI: 10.1002/phar.1212] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY OBJECTIVE To estimate the prevalence of congenital anomalies among the offspring of women exposed and unexposed to antihypertensive drugs during early pregnancy. DESIGN Matched cohort study. DATABASE The United Kingdom's General Practice Research Database. SUBJECTS Women exposed to antihypertensive drugs during early pregnancy and a sample of matched unexposed pregnant women. MEASUREMENTS AND MAIN RESULTS The prevalence of any anomaly among unexposed and exposed women was 23.5 (95% confidence interval [CI] 14.4-38.3) and 20.9 (95% CI 10.0-43.8) per 1000 pregnancies, respectively (relative risk [RR] 0.9, 95% CI 0.4-2.2). The relative risk of limb anomalies among women exposed to β-blockers was 6.4 (95% CI 0.6-70.1). Exposure to angiotensin-converting enzyme (ACE) inhibitors, β-blockers, and calcium channel blockers increased the risk of genital anomalies (RR 3.8, 95% CI 0.9-16.0; RR 2.8, 95% CI 0.7-11.9; RR 1.3, 95% CI 0.1-12.4, respectively). CONCLUSION ACE inhibitors prescribed in the first trimester of pregnancy appeared to increase the risk of congenital anomalies among the offspring of exposed women (RR 2.5, 95% CI 0.5-13.5). These drugs should be avoided in women planning to become pregnant. A marginally increased risk was also found with exposure to β-blockers (RR 1.4, 95% CI 0.6-3.3). These findings are based on small numbers and are not statistically significant.
Collapse
|
44
|
Affiliation(s)
- Tara Sedlak
- Women's Heart Center and Advanced Heart Disease Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - C. Noel Bairey Merz
- Women's Heart Center and Advanced Heart Disease Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Chrisandra Shufelt
- Women's Heart Center and Advanced Heart Disease Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kimberly D Gregory
- Division of Maternal Fetal Medicine and Women's Health Services Research, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michele Hamilton
- Women's Heart Center and Advanced Heart Disease Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
45
|
Bullo M, Tschumi S, Bucher BS, Bianchetti MG, Simonetti GD. Pregnancy Outcome Following Exposure to Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Antagonists. Hypertension 2012; 60:444-50. [DOI: 10.1161/hypertensionaha.112.196352] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marina Bullo
- From the Department of Pediatrics and Division of Pediatric Nephrology, University Hospital (Inselspital), Berne, Switzerland (M.B., S.T., B.S.B., G.D.S.); Division of Pediatrics, Hospitals Bellinzona and Mendrisio, Bellinzona, Switzerland (M.G.B.)
| | - Sibylle Tschumi
- From the Department of Pediatrics and Division of Pediatric Nephrology, University Hospital (Inselspital), Berne, Switzerland (M.B., S.T., B.S.B., G.D.S.); Division of Pediatrics, Hospitals Bellinzona and Mendrisio, Bellinzona, Switzerland (M.G.B.)
| | - Barbara S. Bucher
- From the Department of Pediatrics and Division of Pediatric Nephrology, University Hospital (Inselspital), Berne, Switzerland (M.B., S.T., B.S.B., G.D.S.); Division of Pediatrics, Hospitals Bellinzona and Mendrisio, Bellinzona, Switzerland (M.G.B.)
| | - Mario G. Bianchetti
- From the Department of Pediatrics and Division of Pediatric Nephrology, University Hospital (Inselspital), Berne, Switzerland (M.B., S.T., B.S.B., G.D.S.); Division of Pediatrics, Hospitals Bellinzona and Mendrisio, Bellinzona, Switzerland (M.G.B.)
| | - Giacomo D. Simonetti
- From the Department of Pediatrics and Division of Pediatric Nephrology, University Hospital (Inselspital), Berne, Switzerland (M.B., S.T., B.S.B., G.D.S.); Division of Pediatrics, Hospitals Bellinzona and Mendrisio, Bellinzona, Switzerland (M.G.B.)
| |
Collapse
|
46
|
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. ACTA ACUST UNITED AC 2012; 94:576-98. [PMID: 22807387 DOI: 10.1002/bdra.23027] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 03/23/2012] [Accepted: 04/11/2012] [Indexed: 11/06/2022]
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.
Collapse
Affiliation(s)
- Janine E Polifka
- Department of Pediatrics, University of Washington, Seattle, Washington, USA.
| |
Collapse
|
47
|
Bismuth E, Bouche C, Caliman C, Lepercq J, Lubin V, Rouge D, Timsit J, Vambergue A. Management of pregnancy in women with type 1 diabetes mellitus: Guidelines of the French-Speaking Diabetes Society (Société francophone du diabète [SFD]). DIABETES & METABOLISM 2012; 38:205-16. [DOI: 10.1016/j.diabet.2012.02.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 02/17/2012] [Indexed: 12/11/2022]
|
48
|
|
49
|
Walker KM, Pope J. Treatment of systemic sclerosis complications: what to use when first-line treatment fails--a consensus of systemic sclerosis experts. Semin Arthritis Rheum 2012; 42:42-55. [PMID: 22464314 DOI: 10.1016/j.semarthrit.2012.01.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 01/11/2012] [Accepted: 01/16/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVES There is a need for standardization in systemic sclerosis (SSc) management. METHODS SSc experts (n = 117) were sent 3 surveys to gain consensus for SSc management. RESULTS First-line therapy for scleroderma renal crisis (SRC) was an angiotensin-converting enzyme inhibitor (ACEi). For SRC there were not many differences between treating mild or severe SRC. In general, Second-line was to add either a calcium channel blocker (CCB) or angiotensin receptor blocker (ARB) and then an alpha-blocker (66% agreed). Endothelin receptor agonists (ERAs) were the first treatment in mild pulmonary arterial hypertension (PAH) (72%), followed by adding a phosphodiesterase-5 inhibitor (PDE5i) (77%) and then a prostanoid (73%). For severe PAH, initial treatment was 1 of the following: a prostanoid (49%), combination of a ERA and a PDE5i (18%), or combination of a ERA and a prostanoid (16%) (71% agreed). For mild Raynaud's phenomenon (RF), after a CCB and adding a PDE5i (35%), trying an ARB (32%) and finally a prostanoid (23%) was suggested. For more severe RF, 54% agreed on adding a PDE5i (45%) or prostanoid (32%) to a CCB. In the prevention of digital ulcers (DU), initial treatment was a CCB (73%), then adding a PDE5i, then use of a ERA, and then a prostanoid (44% agreed). In interstitial lung disease/pulmonary fibrosis, for induction, usually intravenous cyclophosphamide and mycophenolate mofetil (MMF) or azathioprine were chosen. For maintenance, MMF was chosen by three-fourths (56% agreed). For gastroesophageal reflux disease, >50% would exceed the maximum recommended proton pump inhibitor dose if required (72% agreed). For skin involvement after methotrexate, MMF was usually chosen (37% agreement). For SSC-related inflammatory arthritis, methotrexate therapy (60%) was followed by adding corticosteroids (37%) or hydroxychloroquine (31%) (62% agreed). CONCLUSIONS Discrepancies in drug choices occurred in treatment after first line in SSc. Not all algorithms had good agreement. This study provides some guidance for SSc management.
Collapse
|
50
|
Abstract
UNLABELLED As a result of delayed childbearing and increasingly sophisticated assisted reproductive technologies, pregnancy in women aged ≥45 years is becoming more common. Women in this age-group should receive thorough preconception evaluation and counseling about their specific risks in pregnancy. Although many pregnancies in women >45 years old are achieved via assisted reproductive technologies with associated preconception counseling, as many as 45% may be spontaneously conceived. It is therefore important for obstetrician-gynecologists to incorporate education for older women about the risks of pregnancy into routine office visits, and to ask women in this age-group about pregnancy planning. Additionally, many pregnancies in women aged >45 years may be safely managed in a nontertiary care center, avoiding the need for referral and transfer of care to an unfamiliar setting. This review addresses preconception evaluation and counseling, real and perceived risks in older mothers, common pregnancy complications and management of pregnancy in women >45 years old. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader should be better able to counsel women about the risks of pregnancy for women aged ≥45, evaluate older women for common risk factors that may further increase risk in pregnancy, assess pregnancy complications that are more common in women aged >45, and manage otherwise uncomplicated pregnancies in women in this age-group.
Collapse
|