Angiotensin II receptor blockers in pregnancy: a case report and systematic review of the literature.
ABSTRACT To describe the case of a woman exposed to angiotensin-II receptor blockers (ARBs) in the preconceptional period and to systematically review the literature on the safety of these drugs when used by pregnant women.
The case was identified at the Korean Motherisk Program (Seoul). For the systematic review, we searched the PubMed for case reports, case series, and post-marketing surveys.
A hypertensive woman was exposed to irbesartan prior to conception. The embryo had delayed development of upper and lower extremities and decreased digital groove. A karyotype identified a 45,XO Turner syndrome. The patient had a spontaneous abortion. Including the case reported here, 64 published cases were identified in total; 57.8% had favorable and 42.2% had unfavorable outcomes. Duration of treatment during pregnancy among women who had adverse fetal outcomes was 26.3 +/- 10.5 weeks (mean +/- SD), compared with 17.3 +/- 11.6 weeks in those who had favorable outcomes (p = 0.04).
Exposure to ARBs for a period longer than the first trimester of pregnancy appears to be associated with a high risk for adverse fetal outcomes.
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ABSTRACT: Hypertensive disorders of pregnancies remain a central public health concern throughout the world, and are a major cause of maternal mortality in the developing world. Although treatment options have not significantly changed in recent years, insight on the pathogenesis of preeclampsia/eclampsia has been remarkable. With improved animal models of preeclampsia and large-scale human trials, we have embarked upon a new era where angiogenic biomarkers based on mechanism of disease can be designed to assist in early diagnosis and treatment. There is also a growing recognition of how elusive the diagnosis of eclampsia can be, especially in the postpartum period. Proper treatment of these patients depends heavily on the correct diagnosis, especially by the emergency physician. Finally, large epidemiologic studies have revealed that preeclampsia, once thought to be a self-limited entity, now appears to portend real damage to the cardiovascular and other organ systems in the long term. This review will present the latest update on our understanding of the various hypertensive disorders of pregnancies and their treatment options.Cardiology in review 18(4):178-89. DOI:10.1097/CRD.0b013e3181c60ca6 · 3.24 Impact Factor
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ABSTRACT: More than 19 million Americans are affected by type 2 diabetes mellitus, which is undiagnosed in one third of these persons. In addition, it is estimated that more than 54 million adults have prediabetes. Debate continues over the benefits and harms of screening and then treating adults who have asymptomatic diabetes or prediabetes. To update the 2003 U.S. Preventive Services Task Force review on the evidence for potential benefits and harms of screening adults for type 2 diabetes and prediabetes in primary care settings. MEDLINE and the Cochrane Library for relevant studies and systematic reviews published in English between March 2001 and July 2007. Trials and observational studies that directly addressed the effectiveness and adverse effects of screening interventions were included. Randomized, controlled trials were used to assess the effectiveness of diabetes and prediabetes treatments. For diabetes interventions, trials of patients with disease for 1 year or less were included, as well as trials comparing outcomes among diabetic and nondiabetic patients. Relevant data were abstracted in duplicate into a standardized template. Data were synthesized in a qualitative manner, and a random-effects meta-analysis of the effects of interventions in prediabetes on the incidence of diabetes was performed. Most of the data on diabetes treatment were not from primary trial data but from subgroup analyses. Participants in intensive lifestyle interventions for prediabetes may not be representative of general prediabetic populations. Direct evidence is lacking on the health benefits of detecting type 2 diabetes by either targeted or mass screening, and indirect evidence also fails to demonstrate health benefits for screening general populations. Persons with hypertension probably benefit from screening, because blood pressure targets for persons with diabetes are lower than those for persons without diabetes. Intensive lifestyle and pharmacotherapeutic interventions reduce the progression of prediabetes to diabetes, but few data examine the effect of these interventions on long-term health outcomes.Annals of internal medicine 06/2008; 148(11):855-68. · 16.10 Impact Factor
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ABSTRACT: To present cases exhibiting possible effects of angiotensin II receptor blockers (ARBs) received in pregnancy on the fetus. Retrospective analysis included women who delivered between 2002 and 2006 at Department of Obstetrics and Gynaecology Ljubljana. Antihypertensive medications were prescribed to 346 of the 26,735 women. ARBs were given in only five pregnancies: two women received losartan, and three irbesartan. The therapy was stopped between 5 and 23 weeks of gestation. Two women delivered healthy babies at term; another term baby had one additional finger and toe. Other two pregnancies were complicated with oligohydramnios and ended in preterm delivery. One preterm infant had transient abnormal renal function tests. Women should be informed that ARB-antihypertensive therapy must be replaced/stopped before planning their pregnancy or at least as soon as the pregnancy is confirmed. Fetal morphology scan and monitoring of amniotic fluid volume should be obligatory, if ARBs are prescribed accidentally.Reproductive Toxicology 08/2009; 28(1):109-12. DOI:10.1016/j.reprotox.2009.02.004 · 2.77 Impact Factor