title: Decrease of the incidence of renin-angiotensin-system inhibitor induced oligohydramnios-sequence in Germany in 2011.
abstract: OBJECTIVE
  to assess whether the incidence of angiotensin II-receptor type 1 antagonist (AT1-antagonist)– or ACE-inhibitor induced cases of oligohydramnios sequence (OHS) in 2011 was reduced after intensive alerts as to the causal association between AT1-antagonist /ACE-inhibitor and OHS in the German medical literature.
  
  
  METHODS
  3 sources of information were used: A nationwide active surveillance of OHS in German paediatric hospitals (ESPED); Embryotox, (Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy) and screening of pubmed (AT1-antagonist/ACE-inhibitor induced OHS).
  
  
  RESULTS
  45 cases of OHS were identified, no case due to maternal AT1-antagonist/ACE-inhibitor treatment. Causes for OHS were: premature rupture of membranes (PPROM) (n = 28), congenital anomalies of fetal kidneys and urinary tract(CAKUT (n = 15), placental insufficiency (n = 1),unknown cause (n = 1). Mortality until discharge was 37.8 % (32.1 % PPROM, 57.1 % CAKUT). Embryotox identified 3 exposures to AT1-antagonists in pregnancy, no case was associated with OHS. The pubmed search did not identify any case of OHS related to AT1-antagonist/ACE-inhibitor in pregnancy in Germany in 2011.
  
  
  CONCLUSIONS
  Treatment of pregnant women with ACE inhibitors or AT1-antagonists still occurs but no cases of AT1-antagonist- or ACE-inhibitor induced OHS were reported in 2011 in Germany most likely due to repeated published alerts underlining the importance of consequent education. OHS remains a serious condition with high mortality despite modern intensive care.
authors.affiliation: Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Cologne, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Hünseler
authors.affiliation: Institute of Social Paediatrics and Adolescent Medicine, Ludwig Maximilian University, Munich.
authors.forename: R
authors.initials: R
authors.lastname: von Kries
authors.affiliation: Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Cologne, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Roth
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D005858:Germany; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D016104:Oligohydramnios / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D010927:Placental Insufficiency / Q000175:diagnosis / Q000401:mortality; D011159:Population Surveillance; D011247:Pregnancy; D018570:Risk Assessment; D016019:Survival Analysis; D014564:Urogenital Abnormalities; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000401:mortality
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers