University of Mississippi Medical Center, Departments of Obstetrics & Gynecology , 2500 North State Street, Jackson MS 39216 , USA +1 601 984 5358 ;
Expert Opin Drug Saf. 2013 Nov;12(6):857-64. doi: 10.1517/14740338.2013.823945. Epub 2013 Aug 6.
Blood pressure management is recommended to avoid maternal cerebrovascular or cardiovascular compromise during pregnancy. Current antihypertensive treatment during pregnancy with positive safety profiles includes labetalol, hydralazine, methyldopa and nifedipine.
Many earlier animal and human studies indicate that angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are associated with fetopathy; therefore, these drugs are contraindicated during pregnancy, especially if these medications were taken during the second and third trimesters. The role of the RAS is quite complex, with fetal development heavily dependent on its appropriate expression and function. New findings indicate that the placental unit expresses its own RAS in order to regulate angiogenesis. Multiple studies have shown that women with abnormal uterine doppler sonography produce an agonistic autoantibody to the angiotensin I receptor, implicating a role for RAS function and regulation in abnormal pregnancies. Importantly, interruption of a normal RAS compromises fetal development.
Traditional medications that inhibit components of RAS for long-term hypertension control are not appropriate for use before or during pregnancy. Further study and drug discovery are needed to find alternative pathways for treatment of hypertensive disorders when pregnancy is present or a possibility.
为避免妊娠期间产妇的脑血管或心血管受损，建议控制血压。目前，降压治疗在妊娠期间具有积极安全性的药物包括拉贝洛尔、肼屈嗪、甲基多巴和硝苯地平。
许多早期的动物和人体研究表明，血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）与胎儿畸形有关；因此，这些药物在怀孕期间是禁用的，尤其是在妊娠第二和第三个三个月期间使用过这些药物的情况下。肾素-血管紧张素系统（RAS）的作用相当复杂，胎儿的发育严重依赖于其适当的表达和功能。新的发现表明，胎盘单位会表达自己的 RAS 以调节血管生成。多项研究表明，子宫动脉多普勒超声异常的女性会产生一种血管紧张素 I 受体的激动性自身抗体，表明 RAS 功能和调节在异常妊娠中起作用。重要的是，正常 RAS 的中断会影响胎儿发育。
用于长期高血压控制的抑制 RAS 成分的传统药物并不适合在妊娠前或妊娠期间使用。当妊娠存在或可能存在时，需要进一步研究和药物发现来寻找治疗高血压疾病的替代途径。
