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

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 p...

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Published in:Birth defects research. A Clinical and molecular teratology 2012-08, Vol.94 (8), p.576-598
Main Author: Polifka, Janine E.
Format: Article
Language:English
Subjects:
angiotensin
Angiotensin Receptor Antagonists - administration & dosage
Angiotensin Receptor Antagonists - adverse effects
Angiotensin-Converting Enzyme Inhibitors - administration & dosage
Angiotensin-Converting Enzyme Inhibitors - adverse effects
Animals
Antihypertensive Agents - administration & dosage
Antihypertensive Agents - adverse effects
birth defects
Female
Fetal Diseases - chemically induced
Fetal Diseases - prevention & control
Humans
hypertension
Hypertension - drug therapy
Maternal Exposure - adverse effects
medications
Pregnancy
Pregnancy Trimester, First - drug effects
prenatal
Renin-Angiotensin System - drug effects
Risk
teratogenicity
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Summary: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. Birth Defects Research (Part A) 94:576–598, 2012. © 2012 Wiley Periodicals, Inc.
ISSN:1542-0752
1542-0760
DOI:10.1002/bdra.23027