Recognition and management of angiotensin converting enzyme inhibitor fetopathy.
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.
Sedman
A B
AB
Pediatric Nephrology Service, University of Michigan Medical Center, Ann Arbor 48109-0297, USA.
Kershaw
D B
DB
Bunchman
T E
TE
D000014:Abnormalities, Drug-Induced; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000493:pharmacokinetics; D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D005315:Fetal Diseases / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007231:Infant, Newborn; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy
D000806:Angiotensin-Converting Enzyme Inhibitors