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Pregnancy: avoid some antihypertensives

Some antihypertensives (ACE inhibitors and angiotensin-II receptor antagonists) expose unborn babies to the risk of severe malformation. There are numerous other antihypertensives which should be prescribed instead.

We should be cautious about prescribing ACE inhibitors and angiotensin-II receptor antagonists to hypertensive women of childbearing age.

Prescrire has been sounding the alarm for several years on the risks associated with exposing the mother to these antihypertensives. Severe adverse effects on the unborn child have been documented and known for more that 20 years: renal failure, cranio-facial, pulmonary and cardiac malformation.

At the beginning of January 2008, the European and national drug regulatory agencies announced their intention to standardise their information on the risks associated with the administration of these antihypertensives during pregnancy: maintaining the contra-indication during the 2nd and 3rd trimesters of pregnancy, and advising against use during the first trimester.

It is unacceptable that the drug regulatory agencies do not advise more strongly against prescribing ACE inhibitors and angiotensin-II receptor antagonists to hypertensive women of childbearing age, in order to protect their unborn babies. It is all the more feasible since there are plenty of other antihypertensives that are safer for unborn babies.

©Prescrire March 2009

Source: " Pas d'IEC ni de sartans pendant la grossesse : RCP uniformisés ", Rev Prescrire 2009; 29 (304): 103.

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