Surveillance for Angiotensin - Converting Enzyme Inhibitor Use During the First Trimester of Pregnancy -- United States, Canada, and Israel
Centers for Disease Control and Prevention, March 21, 1997 / 46(11);240-242
Angiotensin-converting enzyme inhibitors (ACEIs) are effective antihypertensive drugs, but use of ACEIs during the second and third trimesters of pregnancy has been associated with a pattern of defects known as ACEI fetopathy. The predominant feature of the fetopathy is renal tubular dysplasia. Other associated conditions include hypocalvaria, intrauterine growth retardation (IUGR), and patent ducts arteriosus (PDA). These features may be related to fetal hypotension secondary to ACEI-induced decreases in fetal angiotensin or increased dradykinin (1,2) … Of 79 women enrolled, 66 (84%) had ACEI exposure limited to the first trimester of pregnancy (less than or equal to 14 weeks' gestation, as measured since the time of their last menstrual periods). These women had 48 live births from 1987 through 1995 (Table_1). The rate of spontaneous abortion among these women was 23%. Among the 48 live births, three cases of IUGR were documented. One infant with IUGR was from twins delivered at 36 weeks' gestation; the other two were full-term. Another child had a PDA that required surgical ligation at age 18 months. That infant was born at 40 weeks' gestation to a woman who discontinued therapy with an ACEI at 71/2 weeks' gestation. She also was treated with digoxin … There were no children with renal tubular dysplasia who had been exposed to ACEIs exclusively during the first trimester …

uso de inhibidores de la enzima convertidora de la angiotensina como tratamiento antihipertensivo en el primer trimestre de la gestación
Cooper WO, Hernández-Díaz S et al., N Engl J Med. 2006; 354: 2443-51
[Spanish]
... se diagnosticaron un total de 856 DCM (2,9%), de los cuales 203 tenían más de una malformación ... 305 cardiovasculares, 195 musculoesqueléticas, 169 urogenitales, 119 gastrointestinales y 83 del sistema nervioso central ... la proporción de niños con DCM en cada una de las tres cohortes de exposición, en el que los cálculos de porcentajes y RR están ajustados frente a potenciales factores de confusión ... un aumento en el riesgo de DCM (RR: 2,71; intervalo de confianza del 95% [IC95%]: 1,72 a 4,27) en relación con la cohorte que no utilizó antihipertensivos durante la gestación, principalmente en base al aumento de riesgo en malformaciones cardiovasculares ... Conclusión: la exposición a IECA durante el primer trimestre de la gestación no puede considerarse segura y, por tanto, debe evitarse ...

________________________________________________________________________________________________

Last Updated: 2008/2/18

________________________________________________________________________________________________