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Teratogen update: angiotensin-converting enzyme inhibitors
1Department of Pediatrics, University of Michigan, Ann Arbor 48109, USA.
Teratology
|December 1, 1994
Summary
Angiotensin-converting enzyme inhibitors (ACEIs) use during pregnancy is linked to severe fetal harm, including renal dysplasia and hypocalvaria. Restriction is advised due to specific adverse outcomes observed in mammalian models and case reports.
Area of Science:
- Pharmacology
- Teratology
- Maternal-Fetal Medicine
Background:
- Angiotensin-converting enzyme inhibitors (ACEIs) are widely prescribed medications.
- Concerns exist regarding their safety profile during pregnancy.
- Specific adverse fetal outcomes have been anecdotally linked to ACEI exposure.
Purpose of the Study:
- To evaluate the potential fetotoxicity associated with ACEI use during pregnancy.
- To highlight the specific pattern of adverse outcomes observed.
- To advocate for restricted use of ACEIs in pregnant individuals.
Main Methods:
- Review of existing mammalian models demonstrating ACEI fetotoxicity.
- Analysis of reported cases of ACEI-related adverse pregnancy outcomes.
- Examination of plausible biological mechanisms underlying observed effects.
Main Results:
- Mammalian models indicate dose-related fetotoxicity from ACEIs.
- A consistent pattern of adverse outcomes includes oligohydramnios-anuria, neonatal hypotension, renal dysplasia, and hypocalvaria.
- A plausible biological mechanism involving fetal hypotension is identified.
Conclusions:
- The specific syndrome of ACEI fetopathy warrants attention and suggests potential risks.
- ACEIs appear particularly liable to cause adverse fetal renal effects and hypocalvaria.
- Restricting ACEI use in pregnancy is recommended prior to definitive epidemiological proof.