title: Outcomes of 83 fetuses exposed to angiotensin receptor blockers during the second or third trimesters: a literature review.
abstract: This literature review was conducted to provide better counsel to pregnant women who erroneously took angiotensin receptor blockers (ARBs) during the second and/or third trimesters regarding infant outcomes. Information was available on 83 fetuses in 34 literature reports, including one that we encountered recently. Fourteen pregnancies were terminated, and six were unknown regarding status of amniotic fluid volume (AFV). Fifty-eight and five fetuses did and did not show oligohydramnios, respectively, after being exposed to ARBs. Of the 58 fetuses that presented with oligohydramnios, 57 were exposed to ARBs at gestational week (GW) ⩾ 20, and 19 exhibited resolution of oligohydramnios 1-6 weeks after cessation of ARBs. The 24 mothers without oligohydramnios at delivery ceased taking ARBs earlier (GW of 26.8 ± 5.1 vs. 31.8 ± 4.0, respectively, P = 0.000) and had longer duration of gestation after cessation of ARBs (8.4 ± 5.2 vs. 0.7 ± 2.3 weeks, respectively, P = 0.000). The mothers without oligohydramnios also had better outcomes in terms of favorable infant outcomes (63% (15/24) vs. 15% (6/39), respectively, P = 0.000) and infant mortality rates (13% (3/24) vs. 56% (22/39), respectively, P = 0.001) than the 39 with oligohydramnios. Thus, a favorable outcome may be feasible if the fetuses are not indicated for prompt delivery at presentation and exhibit normal AFV or resolution of oligohydramnios after cessation of ARBs. Although the prevalence rate of oligohydramnios was high in this study, it may have been due to publication bias. A prospective study suggested a lower prevalence rate than that reported in the present study.
authors.affiliation: Center for Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Chisa
authors.initials: C
authors.lastname: Shimada
authors.affiliation: Center for Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Rina
authors.initials: R
authors.lastname: Akaishi
authors.affiliation: Center for Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Cho
authors.affiliation: Center for Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Morikawa
authors.affiliation: Center for Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Kaneshi
authors.affiliation: Center for Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamda
authors.affiliation: Center for Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Hisanori
authors.initials: H
authors.lastname: Minakami
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016104:Oligohydramnios / Q000139:chemically induced*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third
chemical_list: D057911:Angiotensin Receptor Antagonists