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Cited by 300Pregnancy and Medication ImpactPregnancy and preeclampsia studiesCardiovascular Issues in Pregnancy

Risks of angiotensin-converting enzyme inhibition during pregnancy: experimental and clinical evidence, potential mechanisms, and recommendations for use

Shotan, Avraham, Widerhorn, Josef, Hurst, Agneta, Elkayam, Uri·1994·The American Journal of Medicine
DOI 10.1016/0002-9343(94)90172-4
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Abstract

Objective To review reports on the use of angiotensin-converting enzyme inhibitors (ACE-I) during pregnancy in order to determine the incidence, nature, and potential mechanisms of fetal complications in an attempt to establish recommendations related to the use of these drugs during gestation. Data sources Relevant English-language articles identified through a Medline search and bibliographies found in recent articles. Study selection Large number of reports both on animals and on humans have consistently shown a high degree of morbidity and even mortality in fetuses or newborns exposed to ACE-I during pregnancy. The reported complications include oligohydramnios, intrauterine growth retardation, premature labor, fetal and neonatal renal failure, bony malformations, limb contractures, persistent patent ductus arteriosus, pulmonary hypoplasia, respiratory distress syndrome, prolonged hypotension, and neonatal death. A high incidence of fetal complications was related to the use of ACE-I at all trimesters of pregnancy. Conclusion The gestational use of ACE-I may be associated with a high degree of fetal and newborn morbidity and even mortality. The use of these drugs should be avoided at all trimesters of pregnancy.

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Crossref · 10.1016/0002-9343(94)90172-4

Cites

41 of 41 references verified0 citation errors · 0 not checkable

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  • The use of drugs that block the RAS is associated with adverse fetal and neonatal effects, especially with exposure during the second and third trimester.

    “The use of drugs that block the RAS is associated with adverse fetal and neonatal effects, especially with exposure during the second and third trimester.”

    From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [66]

  • The most common complications are related to impaired fetal or neonatal kidney function resulting in oligohydramnios during pregnancy and kidney failure after delivery.

    “The most common complications are related to impaired fetal or neonatal kidney function resulting in oligohydramnios during pregnancy and kidney failure after delivery. 65,66”

    From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [66]

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Related

Authors
Shotan, A., Widerhorn, J., Hurst, A., & Elkayam, U.
Affiliations
University of Southern California (US)
Corresponding author
Elkayam, Uri
ORCID
Elkayam, Uri
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
1994-05
Volume
96
Issue
5
Pages
451-456
ISSN
0002-9343 (ISSN-L)
DOI
10.1016/0002-9343(94)90172-4
OpenAlex
W1980087524
Cited by
300
References
42
Citations by year
2026: 1 · 2024: 4 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 12 · 2019: 10 · 2018: 5 · 2017: 60 · 2016: 12 · 2015: 9 · 2014: 11 · 2013: 6 · 2012: 10
FWCI
2.60
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The American Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Issues in Pregnancy
Keywords
ACE inhibitors, pregnancy, fetal complications, drug safety in pregnancy, oligohydramnios, fetal growth restriction, neonatal renal failure, persistent patent ductus arteriosus, pulmonary hypoplasia, respiratory distress syndrome, neonatal death, limb contractures, premature labor, antihypertensive drugs
MeSH terms
Abnormalities, Drug-Induced, Animals, Blood Pressure, Captopril, Ductus Arteriosus, Patent, Enalapril, Female, Fetal Death, Fetus, Goats, Kidney, Maternal-Fetal Exchange, Pregnancy, Rabbits, Regional Blood Flow, Risk Factors, Sheep, Uterus, Vascular Resistance, Oligohydramnios, Renal Insufficiency

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