Chronic Medical Conditions:  Hypertension                         

Page 5 of 15   

 

Reminder . . .

 

Several of the most commonly used antihypertensive agents (ACE inhibitors, ARBs, and any combination drug that contains one of the previous two) are contraindicated in pregnancy. Patients who take these medicines should be informed about their teratogenicity. Risk is predominantly from use in the second and third trimester, but recent studies are showing potential risk even for use in the first trimester. Major complications from first trimester use are primarily cardiac and CNS in nature, but a vast range of anomalies are seen.

 

 

Teratogenicity of ACE Inhibitors and ARBs:

 

These agents cross the placenta and can result in profound fetal hypotension. Fetal hypotension, is thought to result in:

fetal renal failure

tubular dysgenesis

These are thought to result in oligohydramnios, which can lead to:

pulmonary hypoplasia

poor skull ossification

Women who are on these medicines should be advised to use contraception if they are not planning to become pregnant. These patients should be advised to make a doctor’s appointment to adjust their medication regimen should they begin thinking about pregnancy and certainly as soon as they realize they are pregnant (if an unplanned pregnancy occurs).