Rhabbour M, Lenoir S, Bouissou F, Rolland M, Fournié A
Service de médecine infantile B, hôpital Purpan, Toulouse, France.
Arch Pediatr. 1994 May;1(5):497-500.
BACKGROUND. Exposure of pregnant women to angiotensin converting enzyme inhibitor may have side effects on the fetus or newborn, mainly oligoamnios and impaired renal function. CASE REPORT N zero 1. A 34 year-old woman was given enalapril from the onset of her pregnancy because of hypertension from the age of 18 years. Oligoamnios was diagnosed in the fetus on gestational week 28; enalapril was then replaced by nifedipine but this drug was badly tolerated so that the woman was again given enalapril 8 days later. The baby (1700 g) was born by cesarean section at gestational week 34 because of acute distress syndrome; he developed hypotension, anuria, generalized oedema and was placed in intensive care. Treatment included ventilation, sympathomimetic agents, and diuretics. An exchange-transfusion followed by peritoneal dialysis was performed a few hours later. Renal function returned to normal between the 3rd and 5th day. Unilateral kidney hypoplasia was diagnosed at the age of 2 years. CASE N zero 2. A 24 year-old woman was given enalapril at the third trimester of a twin pregnancy. Delivery was full term at 37 weeks. The first baby, a boy weighing 2610 g, suffered from hypoglycemia and vomiting followed by hypotension and oliguria that required exchange-transfusion and repeated peritoneal dialysis. This boy has developed moderate chronic renal failure and hypertension. The second baby, a girl weighing 2,165 g, suffered from respiratory distress syndrome followed by hypotension and oliguria, but her renal function returned to normal within a few days. CONCLUSIONS. The use of angiotension converting enzyme inhibitor by pregnant women places the fetus at severe risk: treatment with this type of drug should be stopped as soon as pregnancy is confirmed.
背景。孕妇接触血管紧张素转换酶抑制剂可能会对胎儿或新生儿产生副作用，主要是羊水过少和肾功能受损。病例报告1。一名34岁女性自18岁起患有高血压，孕期一开始就服用依那普利。妊娠28周时诊断出胎儿羊水过少；随后用硝苯地平替代依那普利，但该药物耐受性差，8天后该女性再次服用依那普利。由于急性窘迫综合征，婴儿（1700克）于妊娠34周时通过剖宫产出生；他出现低血压、无尿、全身水肿，并被送入重症监护室。治疗包括通气、拟交感神经药和利尿剂。数小时后进行了换血输血，随后进行了腹膜透析。肾功能在第3天至第5天恢复正常。2岁时诊断为单侧肾发育不全。病例2。一名24岁女性在双胎妊娠晚期服用依那普利。妊娠37周时足月分娩。第一个婴儿是一名体重2610克的男孩，患有低血糖和呕吐，随后出现低血压和少尿，需要进行换血输血和反复腹膜透析。这个男孩已发展为中度慢性肾衰竭和高血压。第二个婴儿是一名体重2165克的女孩，患有呼吸窘迫综合征，随后出现低血压和少尿，但她的肾功能在几天内恢复正常。结论。孕妇使用血管紧张素转换酶抑制剂会使胎儿面临严重风险：一旦确诊怀孕，就应停止使用这类药物。
