Piper J M, Ray W A, Rosa F W
Department of Preventive Medicine, Vanderbilt University, Nashville, Tennessee.
Obstet Gynecol. 1992 Sep;80(3 Pt 1):429-32.
Case reports of suspected adverse pregnancy outcomes associated with prenatal exposure to angiotensin-converting enzyme inhibitors, particularly oligohydramnios, prolonged neonatal anuria, and defects of ossification of the skull dome, prompted us to examine pregnancy outcome in a large cohort of pregnant women for whom complete drug exposure information was known.
We studied the prescribed drug exposure histories and pregnancy outcomes of all women aged 15-44 years enrolled in Tennessee Medicaid who delivered a live-born or stillborn infant between January 1, 1983 and December 31, 1988.
Of the 106,813 women enrolled in Tennessee Medicaid who delivered either a live-born or stillborn infant during the study period, 19 were exposed to an angiotensin-converting enzyme inhibitor during pregnancy. All 19 women delivered live infants. Among the 19 newborns, one preterm infant had prolonged anuria necessitating dialysis and a second preterm infant had microcephaly and a large occipital encephalocele.
These outcomes represent a systematic follow-up of all angiotensin-converting enzyme inhibitor-exposed pregnancies. Despite the small number of exposures, there were two outcomes previously linked to prenatal use of these drugs, suggesting that the absolute risk may be high. In light of these findings and the case reports of others, it is prudent to avoid the use of angiotensin-converting enzyme inhibitors in pregnancy.
有病例报告怀疑产前接触血管紧张素转换酶抑制剂会导致不良妊娠结局，尤其是羊水过少、新生儿无尿期延长以及颅顶骨化缺陷，这促使我们对一大群已知完整药物接触信息的孕妇的妊娠结局进行研究。
我们研究了1983年1月1日至1988年12月31日期间在田纳西州医疗补助计划登记的所有15 - 44岁分娩活产或死产婴儿的妇女的处方药接触史和妊娠结局。
在研究期间，田纳西州医疗补助计划登记的106,813名分娩活产或死产婴儿的妇女中，有19名在孕期接触了血管紧张素转换酶抑制剂。所有19名妇女均分娩出活婴。在这19名新生儿中，一名早产儿无尿期延长需要透析，另一名早产儿患有小头畸形和巨大枕部脑膨出。
这些结局代表了对所有接触血管紧张素转换酶抑制剂的妊娠进行的系统随访。尽管接触药物的人数较少，但有两种结局此前与产前使用这些药物有关，这表明绝对风险可能很高。鉴于这些发现以及其他病例报告，孕期避免使用血管紧张素转换酶抑制剂是谨慎的做法。
