Abstract
Angiotensin converting enzyme (ACE) inhibitors are extensively used for the treatment of hypertension, to decrease proteinuria, and to mitigate hyperfiltration. These drugs now have been shown to be fetotoxic causing profound fetal hypotension, renal tubular dysplasia, anuria-oligohydramnios, growth restriction, hypocalvaria, and death when used in the second and third trimesters of pregnancy. We recommend that ACE inhibitors not be used in pregnancy. However, if a child is born with ACE inhibitor fetopathy, aggressive therapy with dialysis to remove the inhibitor may mitigate the profound hypotensive effects. Therapy will depend on the specific ACE inhibitor, and care recommendations cannot be generalized for the entire class of drugs as their protein binding and volume of distribution differ substantially.
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References
Materson BJ, Preston RA (1994) Angiotensin-converting enzyme inhibitors in hypertension. Arch Intern Med 154: 513–523
Viberti G, Mogensen CE, Groop LC, Pauls JF (1994) Effect of captopril on progression to clinical proteinuria in patients with insulin-dependent diabetes-mellitus and microalbuminuria. JAMA 271: 275–279
Yosipiv IV, Dipp S, Eldahr SS (1994) Ontogeny of somatic angiotensin-converting enzyme. Hypertension 23: 369–374
Broughton-Pipkin F, Turner SR, Symonds EM (1980) Possible risk with captopril during pregnancy: some animal data. Lancet II: 1256
Guignard JP (1982) Renal function in the newborn infant. Pediatr Clin North Am 29: 777–790
Boutroy MJ, Vent P, Hunault de Ligny B, Milton A (1984) Captopril administration in pregnancy impairs fetal angiotensin converting enzyme activity and neonatal adaptation. Lancet II: 935–936
Caraman PL, Miton A, Hurualt de Ligny B, Kessler M, Boutroy MJ, Schweitzer M, Brocard O, Raggage JP, Netter P (1984) Grossesses sous captopril. Therapie 39: 59–62
Rothberg AD, Lorenz R (1984) Can captopril cause fetal and neonatal renal failure? Pediatr Pharmacol 4: 189–192
Broughton-Pipkin F, Symonds EM, Turner SR (1982) The effect of captopril (SQ 14,225) upon mother and fetus in the chronically cannulated ewe in the pregnant rabbit. J Physiol 323: 415–422
Keith IM, Will JA, Weir EK (1982) Captopril: association with fetal death and pulmonary vascular changes in the rabbit. Proc Soc Exp Biol Med 170: 378–383
Harewood WJ, Phippard AF, Duggin GG, Horvath JS, Tiller DJ (1994) Fetotoxicity of angiotensin-converting enzyme inhibition in primate pregnancy: a prospective, placebo-controlled study in baboon (Papio Hamadryas). Am J Obstet Gynecol 171: 633–642
Duminy PC, Burger P du T (1981) Fetal abnormality associated with the use of captopril during pregnancy. S Afr Med J 60: 805
Pryde PG, Sedman AB, Nugent CE, Barr M (1993) Angiotensin-converting enzyme inhibitor fetopathy. J Am Soc Nephrol 3: 1575–1582
Piper JM, Ray WA, Rosa FW (1992) Pregnancy outcome following exposure to angiotensin-converting enzyme inhibitors. Obstet Gynecol 80: 429–432
Barr M, Cohen MM (1991) ACE inhibitor fetopathy and hypocalvaria: the kidney-skull connection. Teratology 44: 485–495
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Sedman, A.B., Kershaw, D.B. & Bunchman, T.E. Invited Review Recognition and management of angiotensin converting enzyme inhibitor fetopathy. Pediatr Nephrol 9, 382–385 (1995). https://doi.org/10.1007/BF02254221
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DOI: https://doi.org/10.1007/BF02254221