Maternal use of antihypertensive drugs in early pregnancy and delivery outcome, notably the presence of congenital heart defects in the infants
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
To investigate the association between maternal use of antihypertensives in early pregnancy and delivery outcome, notably infant congenital malformations.
A cohort study of 1,418 women who had used antihypertensive drugs in early pregnancy but had no diabetes diagnosis were identified from the Swedish Medical Birth Register.
There was an excess risk for placental abruption, caesarean section, delivery induction, and post-delivery hemorrhage in women taking hypertensives. Infants were more often than expected born preterm, were small for gestational age, and had an excess of various neonatal symptoms. Cardiovascular defects occurred with an adjusted odds ratio of 2.59 (95% CI 1.92–3.51). The results were similar when the woman had used ACE inhibitors or other antihypertensives, notably beta blockers. Stillbirth rate was increased (risk ratio 1.87, 95% CI 1.02–3.02), again without any clear drug specificity.
There seems to be little drug specificity in the association between maternal use of antihypertensives and an increased risk for infant cardiovascular defects.
- Rey E, Couturier A (1994) The prognosis of pregnancy in women with chronic hypertension. Am J Obst Gynecol 181:410–416
- McCowan LM, Buist RG, North RA et al (1996) Perinatal morbidity in chronic hypertension. Br J Obstet Gynecol 103:123–129
- Sibal BM, Caritis SN, Hauth JC et al (2000) Preterm delivery in women with pregestational diabetes or chronic hypertension relative to women with uncomplicated pregnancies. The National Institute of Child Health and Human Development – Fetal Medicine Units Network. Am J Obst Gynecol 183:1520–1524 CrossRef
- Ray JG, Burrows RF, Burrows E et al (2001) McMaster outcome study of hypertension in pregnancy. Early Hum Dev 64:129–143 CrossRef
- Abalos E, Duley L, Steyn DW et al (2007) Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database of Systematic Reviews 1: CD002252. doi:10.1002/14651858.CD002252.pub2.
- Heinonen OP, Slone D, Shapiro S (1977) Birth defects and drugs in pregnancy. Publishing Sciences Group, Littleton, MA
- Källén B, Otterblad Olausson P (2003) Maternal drug use in early pregnancy and infant cardiovascular defect. Reprod Toxicol 17:255–261 CrossRef
- Cooper WO, Hernandez-Diaz S, Arbogast P et al (2006) Major congenital malformations after first-trimester exposure to ACE inhibitors. New Engl J Med 354:2443–2451 CrossRef
- National Board of Health and Welfare, Centre for Epidemiology (2003) The Swedish Medical Birth Register – a summary of content and quality. http://www.sos.se/FULLTEXT/112/2003-112-3/2003-112-3.pdf. Accessed May 12, 2008
- Källén B (1995) A birth weight for gestational age standard based on data in the Swedish Medical Birth Registry 1985-1989. Eur J Epidemiol 11:601–606 CrossRef
- National Board of Health and Welfare, Centre for Epidemiology (2004) Registration of congenital malformations in Swedish health registers. http://www.socialstyrelsen.se/Publicerat/2004/5120/2004-112-1.htm. Accessed May 12, 2008
- Källén B, Otterblad Olausson P (2001) Monitoring of maternal drug use and infant congenital malformations. Does loratadine cause hypospadias? Int J Risk Safety Med 14:115–119
- Åberg A, Westbom L, Källén B (2001) Congenital malformations among infants whose mothers had gestational or preexisting diabetes. Early Hum Develop 61:85–95 CrossRef
- Scialli AR, Lione A (2006) ACE inhibitors and major congenital malformations (letter). New Engl J Med 355:1280 CrossRef
- Briggs GG, Freeman RK, Yaffe SJ (2005) Drugs in pregnancy and lactation, 7th edn. Lippincott Williams and Wilkins, Philadelphia
- Barr M Jr (1994) Teratogen update: angiotensin-converting enzyme inhibitors. Teratology 50:399–409 CrossRef
- Harewood WJ, Phippard AF, Duggin G et al (1994) Fetotoxicity of angiotensin-converting enzyme inhibition in primate pregnancy: a prospective, placebo-controlled study in baboons (Papio hamadryas). Am J Obstet Gynecol 171:633–642
- Buttar HS (1997) An overview of the influence of ACE inhibitors on fetal-placental circulation and perinatal development. Mol Cell Biochem 176:61–71 CrossRef
- Tabacova S (2005) Mode of action: angiotensin-converting enzyme inhibition—developmental effects associated with exposure to ACE inhibitors. Crit Rev Toxicol 35:747–755 CrossRef
- Maternal use of antihypertensive drugs in early pregnancy and delivery outcome, notably the presence of congenital heart defects in the infants
European Journal of Clinical Pharmacology
Volume 65, Issue 6 , pp 615-625
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- ACE inhibitors
- Beta-blocking agents
- Cardiovascular defects
- Congenital malformations
- Industry Sectors
- Author Affiliations
- 1. Department of Clinical Pharmacology, University of Umeå, Umeå, Sweden
- 2. Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden
- 3. Tornblad Institute, University of Lund, Biskopsgatan 7, SE-223 62, Lund, Sweden