title: Human fetal malformations associated with the use of an angiotensin II receptor antagonist: case report.
abstract: BACKGROUND
  The potential risks related to drug exposure during pregnancy represent a vast chapter in modern obstetrics and data regarding the safety of antihypertensive drugs during pregnancy are relatively scarce.
  
  
  METHODS
  A 37-year-old patient discovered her fifth pregnancy at our hospital after 26 weeks and 4 days of gestation. She reported a history of hypertension and was currently being treated with Losartan. Hospitalization was recommended for the patient and further evaluation of fetal vitality was performed. On the fourth day an ultrasound was performed, resulting in a severe oligohydramnios, fetal centralization and abnormal ductus venosus. After 36 hours, the newborn died. Pathologic evaluation: At autopsy, the skullcap had large fontanels and deficient ossification. The kidneys were slightly enlarged. A microscopic examination detected underdevelopment of the tubules and the presence of some dilated lumens. Immunohistochemical detection of epithelial membrane antigen was positive. Immunoreactivity of CD 15 was also assayed to characterize the proximal tubules, and lumen collapse was observed in some regions.
  
  
  CONCLUSIONS
  Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor antagonists (ARAs) are among the most widely prescribed drugs for hypertension. They are often used by hypertensive women who are considering become pregnant. While their fetal toxicity in the second or third trimesters has been documented, their teratogenic effect during the first trimester has only recently been demonstrated.
  
  
  CONCLUSIONS
  Constant awareness by physicians and patients should be encouraged, particularly in regard to the prescription of antihypertensive drugs in women of childbearing age who are or intend to become pregnant.
authors.affiliation: Universidade Federal de São Paulo.
authors.forename: Henri Augusto
authors.initials: HA
authors.lastname: Korkes
authors.affiliation: Universidade Federal de São Paulo.
authors.forename: Leandro Gustavo
authors.initials: LG
authors.lastname: de Oliveira
authors.affiliation: Maternidade Escola de Vila Nova Cachoeirinha.
authors.forename: Livia
authors.initials: L
authors.lastname: Berlinck
authors.affiliation: Hospital Servidor Publico Estadual de São Paulo.
authors.forename: Fernanda Sampaio
authors.initials: FS
authors.lastname: Goes
authors.affiliation: Maternidade Escola de Vila Nova Cachoeirinha.
authors.forename: Antonio Fernando Allemand
authors.initials: AF
authors.lastname: Borges
authors.affiliation: Universidade de São Paulo.
authors.forename: Gianna Mastroianni
authors.initials: GM
authors.lastname: Kirsztajn
authors.affiliation: Universidade Federal de São Paulo.
authors.forename: Nelson
authors.initials: N
authors.lastname: Sass
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000000981:diagnostic imaging* / Q000209:etiology*; D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D019808:Losartan / Q000009:adverse effects* / Q000627:therapeutic use; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy; D016216:Ultrasonography, Prenatal
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D019808:Losartan