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Use of angiotensin II receptor blocker during pregnancy: A case report

BACKGROUND: Drugs that affect the renin-angiotensin system, such as angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors are not typically recommended for pregnant women because of their potential fetal toxicity. CASE STUDY: A 32-year-old pregnant woman with nephrotic...

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Autores principales: Wei, Qiang, Zhang, Li, Duan, Mei-fan, Wang, Yue-mei, Huang, Nan, Song, Chun-rong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837885/
https://www.ncbi.nlm.nih.gov/pubmed/33546057
http://dx.doi.org/10.1097/MD.0000000000024304
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author Wei, Qiang
Zhang, Li
Duan, Mei-fan
Wang, Yue-mei
Huang, Nan
Song, Chun-rong
author_facet Wei, Qiang
Zhang, Li
Duan, Mei-fan
Wang, Yue-mei
Huang, Nan
Song, Chun-rong
author_sort Wei, Qiang
collection PubMed
description BACKGROUND: Drugs that affect the renin-angiotensin system, such as angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors are not typically recommended for pregnant women because of their potential fetal toxicity. CASE STUDY: A 32-year-old pregnant woman with nephrotic syndrome lasting more than 5 years became pregnant for the first time. She had been taking losartan tablets before and during pregnancy. Ultrasound at 24(+2) weeks of pregnancy showed oligohydramnios, and the maximum vertical depth of amniotic fluid volume was 1.4 cm. Follow-up ultrasound examinations every 2 weeks showed persistent oligohydramnios [amniotic fluid volume: 1.1–3.4 cm, amniotic fluid index 1.9–6.9 cm]. B-ultrasound at 30(+2) weeks showed slightly enhanced fetal renal cortex echo. The patient was treated at 32(+2) weeks of pregnancy at our hospital. DIAGNOSES: Nephrotic syndrome and oligohydramnios. INTERVENTIONS: Losartan was discontinued and replaced by nifedipine controlled-release tablets to lower blood pressure. The amount of amniotic fluid gradually increased to normal levels within 8 days. The patient was discharged at 33(+2) weeks of pregnancy for follow-up. At 34(+4) weeks, blood pressure had increased to 177/113 mm Hg and the patient was re-hospitalized with nephrotic syndrome complicated by preeclampsia. Due to progression of severe preeclampsia, elective cesarean section was performed at 35(+3) weeks. After delivery, losartan and nifedipine were prescribed to continue lowering blood pressure. The patient was discharged 4 days after surgery. OUTCOMES: Losartan use was terminated at 32(+2) weeks of pregnancy. Amniotic fluid returned to normal after 8 days and the baby was delivered after 22 days. At last follow-up, the infant was 24 months old and healthy. CONCLUSION: Although ARBs are effective for treating hypertension, they should be replaced by other classes of anti-hypertensive drugs in pregnant women. Pregnant women who elect to continue using ARBs should be informed about risks, they should be carefully monitored during pregnancy, and their pregnancy should be allowed to proceed as long as clinically feasible in order to optimize maternal and infant outcomes.
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spelling pubmed-78378852021-01-27 Use of angiotensin II receptor blocker during pregnancy: A case report Wei, Qiang Zhang, Li Duan, Mei-fan Wang, Yue-mei Huang, Nan Song, Chun-rong Medicine (Baltimore) 5600 BACKGROUND: Drugs that affect the renin-angiotensin system, such as angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors are not typically recommended for pregnant women because of their potential fetal toxicity. CASE STUDY: A 32-year-old pregnant woman with nephrotic syndrome lasting more than 5 years became pregnant for the first time. She had been taking losartan tablets before and during pregnancy. Ultrasound at 24(+2) weeks of pregnancy showed oligohydramnios, and the maximum vertical depth of amniotic fluid volume was 1.4 cm. Follow-up ultrasound examinations every 2 weeks showed persistent oligohydramnios [amniotic fluid volume: 1.1–3.4 cm, amniotic fluid index 1.9–6.9 cm]. B-ultrasound at 30(+2) weeks showed slightly enhanced fetal renal cortex echo. The patient was treated at 32(+2) weeks of pregnancy at our hospital. DIAGNOSES: Nephrotic syndrome and oligohydramnios. INTERVENTIONS: Losartan was discontinued and replaced by nifedipine controlled-release tablets to lower blood pressure. The amount of amniotic fluid gradually increased to normal levels within 8 days. The patient was discharged at 33(+2) weeks of pregnancy for follow-up. At 34(+4) weeks, blood pressure had increased to 177/113 mm Hg and the patient was re-hospitalized with nephrotic syndrome complicated by preeclampsia. Due to progression of severe preeclampsia, elective cesarean section was performed at 35(+3) weeks. After delivery, losartan and nifedipine were prescribed to continue lowering blood pressure. The patient was discharged 4 days after surgery. OUTCOMES: Losartan use was terminated at 32(+2) weeks of pregnancy. Amniotic fluid returned to normal after 8 days and the baby was delivered after 22 days. At last follow-up, the infant was 24 months old and healthy. CONCLUSION: Although ARBs are effective for treating hypertension, they should be replaced by other classes of anti-hypertensive drugs in pregnant women. Pregnant women who elect to continue using ARBs should be informed about risks, they should be carefully monitored during pregnancy, and their pregnancy should be allowed to proceed as long as clinically feasible in order to optimize maternal and infant outcomes. Lippincott Williams & Wilkins 2021-01-22 /pmc/articles/PMC7837885/ /pubmed/33546057 http://dx.doi.org/10.1097/MD.0000000000024304 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 5600
Wei, Qiang
Zhang, Li
Duan, Mei-fan
Wang, Yue-mei
Huang, Nan
Song, Chun-rong
Use of angiotensin II receptor blocker during pregnancy: A case report
title Use of angiotensin II receptor blocker during pregnancy: A case report
title_full Use of angiotensin II receptor blocker during pregnancy: A case report
title_fullStr Use of angiotensin II receptor blocker during pregnancy: A case report
title_full_unstemmed Use of angiotensin II receptor blocker during pregnancy: A case report
title_short Use of angiotensin II receptor blocker during pregnancy: A case report
title_sort use of angiotensin ii receptor blocker during pregnancy: a case report
topic 5600
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837885/
https://www.ncbi.nlm.nih.gov/pubmed/33546057
http://dx.doi.org/10.1097/MD.0000000000024304
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