Document Detail


Fetal toxic effects of angiotensin II receptor antagonists: case report and follow-up after birth.
MedLine Citation:
PMID:  15590878     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To report a child born with renal impairment following severe anhydramnios due to maternal exposure to an angiotensin II receptor type 1 (AT1) antagonist, valsartan, and hydrochlorothiazide during the first 28 weeks of pregnancy. CASE SUMMARY: A hypertensive woman treated with valsartan 80 mg/day, hydrochlorothiazide 12.5 mg/day, prazosin 10 mg/day, lysine acetylsalicylate 100 mg/day, and levothyroxine 250 microg/day became pregnant. At 28 weeks' gestational age, severe anhydramnios associated with high beta2-microglobulin levels in the fetal blood cord was observed. Upon discontinuation of valsartan, fetal renal prognosis improved. In this case, using the Naranjo probability scale, the renal insufficiency of the child was probably related to valsartan. At the age of 2.5 years, the child presented with only mild chronic renal insufficiency. Growth parameters were within the normal range, and there was no evidence of developmental delay. DISCUSSION: Exposure to AT1 antagonists during the second part of pregnancy can lead to abnormalities similar to those observed after exposure to angiotensin-converting enzyme inhibitors, that is, reduced fetal kidney perfusion that may result in oligoamnios and neonatal renal insufficiency. Fourteen previous reports of maternal exposure to AT1 antagonists during this period have been published. In 6 cases, fetal or neonatal death occurred; in 2 cases, pregnancy was terminated because of complete anhydramnios or fetal abnormalities; in 1 case, renal insufficiency persisted at 8 months of age; in 2 cases, kidney function was fairly normal at birth; and in 4 cases, including the one described here, neonatal renal failure improved in the first year of life. CONCLUSIONS: AT1 antagonists should be avoided throughout pregnancy. If these agents are prescribed accidentally to a pregnant woman, monitoring of amniotic fluid volume and beta2-microglobulin fetal blood levels after discontinuation of the AT1 antagonist can provide critical data for advising parents on pregnancy and fetal outcome.
Authors:
Marie-Andrée Bos-Thompson; Dominique Hillaire-Buys; Françoise Muller; Hervé Dechaud; Evelyne Mazurier; Pierre Boulot; Denis Morin
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Publication Detail:
Type:  Case Reports; Journal Article; Review     Date:  2004-12-08
Journal Detail:
Title:  The Annals of pharmacotherapy     Volume:  39     ISSN:  1060-0280     ISO Abbreviation:  Ann Pharmacother     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2004-12-22     Completed Date:  2005-03-29     Revised Date:  2006-10-13    
Medline Journal Info:
Nlm Unique ID:  9203131     Medline TA:  Ann Pharmacother     Country:  United States    
Other Details:
Languages:  eng     Pagination:  157-61     Citation Subset:  IM    
Affiliation:
Department of Medical Pharmacology and Toxicology, Lapeyronie Hospital, Montpellier, France. ma-thompson@chu-montpellier.fr
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MeSH Terms
Descriptor/Qualifier:
Amniotic Fluid
Angiotensin II Type 1 Receptor Blockers / adverse effects*
Antihypertensive Agents / adverse effects*
Child, Preschool
Female
Follow-Up Studies
Gestational Age
Humans
Hypertension / drug therapy
Infant
Infant, Newborn
Kidney Failure / chemically induced*
Male
Pregnancy
Pregnancy Complications, Cardiovascular / drug therapy
Prenatal Exposure Delayed Effects*
Tetrazoles / adverse effects*
Valine / adverse effects*,  analogs & derivatives*
beta 2-Microglobulin / blood
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Antihypertensive Agents; 0/Tetrazoles; 0/beta 2-Microglobulin; 137862-53-4/valsartan; 7004-03-7/Valine
Comments/Corrections
Erratum In:
Ann Pharmacother. 2005 Feb;39(2):389

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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