Derleme
Yıl 2023,
Cilt: 32 Sayı: 2, 61 - 67, 30.06.2023
Öz
Gebelikte hipertansif bozukluklar, dünya çapında gebeliklerin en yaygın tıbbi komplikasyonlarındandır. Gebelik sırasında hipertansiyonu tedavi etme kararı, hem anne hem de fetüs için riskleri ve yararları göz önünde bulundurularak alınmalıdır. Hipertansiyon tedavisinin amacı maternal riski azaltmak olsa da, seçilen ajanlar fetüs için güvenli olmalıdır. Uzun vadeli prognoz, tahmini maternal risk ve beklenen fetal sonuçlar multidisipliner bir yönetim planı oluşturularak hasta ile paylaşılmalıdır. Bu çalışmada, gebelik sırasında hipertansiyon tedavisine ilişkin kılavuzlar, antihipertansif ilaçların gebelikte maruziyeti ile ilgili hayvan çalışmaları ve insan gebelik raporları incelenmiştir. Antihipertansif ilaçların gebelikte kullanımının güvenliliği ve oluşabilecek potansiyel teratojenik etkileri derlenmiştir.
Anahtar Kelimeler
Destekleyen Kurum
Yok
Kaynakça
- 1. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39:3165-241.
- 2. Fitton CA, Steiner MFC, Aucott L, Pell JP, Mackay DF, Fleming M et al. In-utero exposure to antihypertensive medication and neonatal and child health outcomes: a systematic review. J Hypertens 2017; 35:2123.
- 3. Boesen EI. Consequences of in-utero exposure to antihypertensive medication: the search for definitive answers continues. J Hypertens 2017; 35:2161.
- 4. Ramakrishnan A, Lee LJ, Mitchell LE, Agopian AJ. Maternal Hypertension During Pregnancy and the Risk of Congenital Heart Defects in Offspring: A Systematic Review and Meta-analysis. Pediatr Cardiol 2015; 36:1442.
- 5. Booker WA, Siddiq Z, Huang Y, Ananth CV, Wright JD, Cleary KL et al. Use of Antihypertensive Medications and Uterotonics During Delivery Hospitalizations in Women With Asthma. Obstet Gynecol 2018; 132:185-92.
- 6. Clark JA, Zimmerman HJ, Tanner LA. Labetalol hepatotoxicity. Ann Intern Med 1990; 113:210.
- 7. Tanaka K, Tanaka H, Kamiya C, Katsuragi S, Sawada M, Tsuritani M et al. Beta-Blockers and Fetal Growth Restriction in Pregnant Women With Cardiovascular Disease. Circ J 2016; 80:2221.
- 8. Sibai BM. Chronic hypertension in pregnancy. Obstet Gynecol 2002; 100:369.
- 9. Kayser A, Beck E, Hoeltzenbein M, Zinke S, Meister R, Weber-Schoendorfer C et al. Neonatal effects of intrauterine metoprolol/bisoprolol exposure during the second and third trimester: a cohort study with two comparison groups. J Hypertens. 2020;38:354-61.
- 10. Fisher SC, Van Zutphen AR, Werler MM, Lin AE, Romitti PA, Druschel CM et al. Maternal Antihypertensive Medication Use and Congenital Heart Defects: Updated Results From the National Birth Defects Prevention Study. Hypertension 2017; 69:798.
- 11. Duan L, Ng A, Chen W, Nguyen J, Shen AY, Lee MS. β-Blocker Exposure in Pregnancy and Risk of Fetal Cardiac Anomalies. JAMA Intern Med 2017; 177:885.
- 12. Bateman BT, Heide-Jørgensen U, Einarsdóttir K, Engeland A, Furu K, Gissler M et al. β-Blocker Use in Pregnancy and the Risk for Congenital Malformations: An International Cohort Study. Ann Intern Med 2018; 169:665.
- 13. Bergman JEH, Lutke LR, Gans ROB, Addor MC, Barisic I, Cavero-Carbonell C et al. Beta-Blocker Use in Pregnancy and Risk of Specific Congenital Anomalies: A European Case-Malformed Control Study. Drug Saf 2018; 41:415.
- 14. Yakoob MY, Bateman BT, Ho E, Hernandez-Diaz S, Franklin JM, Goodman JE et al. The risk of congenital malformations associated with exposure to β-blockers early in pregnancy: a meta-analysis. Hypertension 2013; 62:375.
- 15. Easterling T, Mundle S, Bracken H, Parvekar S, Mool S, Magee LA, von Dadelszen P et al. Oral antihypertensive regimens (nifedipine retard, labetalol, and methyldopa) for management of severe hypertension in pregnancy: an open-label, randomised controlled trial. Lancet 2019; 394:1011.
- 16. Sridharan K, Sequeira RP. Drugs for treating severe hypertension in pregnancy: a network meta-analysis and trial sequential analysis of randomized clinical trials. Br J Clin Pharmacol 2018; 84:1906.
- 17. Qi H, Qin J, Ren L, Li L, Lan L, Yan Y et al. Efficacy of low-dose nicardipine for emergent treatment of severe postpartum hypertension in maternal intensive care units: An observational study. Pregnancy Hypertens 2020; 21:43.
- 18. Nij Bijvank SW, Hengst M, Cornette JC, Huigen S, Winkelen AV, Edens MA et al. Nicardipine for treating severe antepartum hypertension during pregnancy: Nine years of experience in more than 800 women. Acta Obstet Gynecol Scand 2022; 101:1017.
- 19. Mito A, Murashima A, Wada Y, Miyasato-Isoda M, Kamiya CA, Waguri M et al. Safety of Amlodipine in Early Pregnancy. J Am Heart Assoc 2019; 8:e012093.
- 20. Magee LA, CHIPS Study Group, von Dadelszen P, Singer J, Lee T, Rey E et al. Do labetalol and methyldopa have different effects on pregnancy outcome? Analysis of data from the Control of Hypertension In Pregnancy Study (CHIPS) trial. BJOG 2016; 123:1143.
- 21. Magee LA, Cham C, Waterman EJ, Ohlsson A, von Dadelszen P. Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis. BMJ 2003; 327:955.
- 22. Rothberger S, Carr D, Brateng D, Hebert M, Easterling TR. Pharmacodynamics of clonidine therapy in pregnancy: a heterogeneous maternal response impacts fetal growth. Am J Hypertens 2010; 23:1234.
- 23. Lydakis C, Lip GY, Beevers M, Beevers DG. Atenolol and fetal growth in pregnancies complicated by hypertension. Am J Hypertens 1999; 12:541.
- 24. Cooper WO, Hernandez-Diaz S, Arbogast PG, Dudley JA, Dyer S, Gideon PS et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med 2006; 354:2443.
- 25. Hecker A, Hasan SH, Neumann F. Disturbances in sexual differentiation of rat foetuses following spironolactone treatment. Acta Endocrinol (Copenh) 1980; 95:540.
- 26. Morton A, Laurie J. Eplerenone in the management of resistant hypertension with obstructive sleep apnoea in pregnancy. Pregnancy Hypertens 2017; 7:54.
- 27. Caretto A, Primerano L, Novara F, Zuffardi O, Genovese S, Rondinelli M. A Therapeutic Challenge: Liddle's Syndrome Managed with Amiloride during Pregnancy. Case Rep Obstet Gynecol 2014; 2014:156250.
- 28. Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P; Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can 2014; 36:416.
- 29. Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de Paco Matallana C et al. Aspirin versus placebo in pregnancies at high-risk for preterm preeclampsia. N Engl J Med 2017;377:613–22.
- 30. Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2014;6:CD001059.
- 31. Xu H, Perez-Cuevas R, Xiong X, Reyes H, Roy C, Julien P et al. An international trial of antioxidants in the prevention of preeclampsia (INTAPP). Am J Obstet Gynecol 2010;202:239.e1–239.e10.
- 32. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 2020; 135:e237.
- 33. Lindheimer MD, Taler SJ, Cunningham FG. ASH position paper: Hypertension in pregnancy. J Clin Hypertens (Greenwich) 2009;11:214–25.
- 34. Shekhar S, Gupta N, Kirubakaran R, Pareek P. Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: A systematic review and meta-analysis. BJOG 2016;123:40–7.
- 35. Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: A randomised placebo-controlled trial. Lancet 2002;359:1877–90.
- 36. Beardmore KS, Morris JM, Gallery ED. Excretion of antihypertensive medication into human breast milk: A systematic review. Hypertens Pregnancy 2002;21:85–95.
Yıl 2023,
Cilt: 32 Sayı: 2, 61 - 67, 30.06.2023
Öz
Hypertensive disorders in pregnancy are among the most common medical complications of pregnancies worldwide. The decision to treat hypertension during pregnancy should be made considering the risks and benefits for both mother and fetus. Although the goal of hypertension treatment is to reduce the maternal risk, the agents chosen should be safe for the fetus. Long-term prognosis, estimated maternal risk, and expected fetal outcomes should be shared with the patient by a multidisciplinary management plan. In this study, the guidelines for the treatment of hypertension during pregnancy, the animal studies involving exposure to the antihypertensive drugs during pregnancy, and human pregnancy reports were examined. The safety and potential teratogenic effects of antihypertensive drugs during pregnancy have been reviewed.
Kaynakça
- 1. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39:3165-241.
- 2. Fitton CA, Steiner MFC, Aucott L, Pell JP, Mackay DF, Fleming M et al. In-utero exposure to antihypertensive medication and neonatal and child health outcomes: a systematic review. J Hypertens 2017; 35:2123.
- 3. Boesen EI. Consequences of in-utero exposure to antihypertensive medication: the search for definitive answers continues. J Hypertens 2017; 35:2161.
- 4. Ramakrishnan A, Lee LJ, Mitchell LE, Agopian AJ. Maternal Hypertension During Pregnancy and the Risk of Congenital Heart Defects in Offspring: A Systematic Review and Meta-analysis. Pediatr Cardiol 2015; 36:1442.
- 5. Booker WA, Siddiq Z, Huang Y, Ananth CV, Wright JD, Cleary KL et al. Use of Antihypertensive Medications and Uterotonics During Delivery Hospitalizations in Women With Asthma. Obstet Gynecol 2018; 132:185-92.
- 6. Clark JA, Zimmerman HJ, Tanner LA. Labetalol hepatotoxicity. Ann Intern Med 1990; 113:210.
- 7. Tanaka K, Tanaka H, Kamiya C, Katsuragi S, Sawada M, Tsuritani M et al. Beta-Blockers and Fetal Growth Restriction in Pregnant Women With Cardiovascular Disease. Circ J 2016; 80:2221.
- 8. Sibai BM. Chronic hypertension in pregnancy. Obstet Gynecol 2002; 100:369.
- 9. Kayser A, Beck E, Hoeltzenbein M, Zinke S, Meister R, Weber-Schoendorfer C et al. Neonatal effects of intrauterine metoprolol/bisoprolol exposure during the second and third trimester: a cohort study with two comparison groups. J Hypertens. 2020;38:354-61.
- 10. Fisher SC, Van Zutphen AR, Werler MM, Lin AE, Romitti PA, Druschel CM et al. Maternal Antihypertensive Medication Use and Congenital Heart Defects: Updated Results From the National Birth Defects Prevention Study. Hypertension 2017; 69:798.
- 11. Duan L, Ng A, Chen W, Nguyen J, Shen AY, Lee MS. β-Blocker Exposure in Pregnancy and Risk of Fetal Cardiac Anomalies. JAMA Intern Med 2017; 177:885.
- 12. Bateman BT, Heide-Jørgensen U, Einarsdóttir K, Engeland A, Furu K, Gissler M et al. β-Blocker Use in Pregnancy and the Risk for Congenital Malformations: An International Cohort Study. Ann Intern Med 2018; 169:665.
- 13. Bergman JEH, Lutke LR, Gans ROB, Addor MC, Barisic I, Cavero-Carbonell C et al. Beta-Blocker Use in Pregnancy and Risk of Specific Congenital Anomalies: A European Case-Malformed Control Study. Drug Saf 2018; 41:415.
- 14. Yakoob MY, Bateman BT, Ho E, Hernandez-Diaz S, Franklin JM, Goodman JE et al. The risk of congenital malformations associated with exposure to β-blockers early in pregnancy: a meta-analysis. Hypertension 2013; 62:375.
- 15. Easterling T, Mundle S, Bracken H, Parvekar S, Mool S, Magee LA, von Dadelszen P et al. Oral antihypertensive regimens (nifedipine retard, labetalol, and methyldopa) for management of severe hypertension in pregnancy: an open-label, randomised controlled trial. Lancet 2019; 394:1011.
- 16. Sridharan K, Sequeira RP. Drugs for treating severe hypertension in pregnancy: a network meta-analysis and trial sequential analysis of randomized clinical trials. Br J Clin Pharmacol 2018; 84:1906.
- 17. Qi H, Qin J, Ren L, Li L, Lan L, Yan Y et al. Efficacy of low-dose nicardipine for emergent treatment of severe postpartum hypertension in maternal intensive care units: An observational study. Pregnancy Hypertens 2020; 21:43.
- 18. Nij Bijvank SW, Hengst M, Cornette JC, Huigen S, Winkelen AV, Edens MA et al. Nicardipine for treating severe antepartum hypertension during pregnancy: Nine years of experience in more than 800 women. Acta Obstet Gynecol Scand 2022; 101:1017.
- 19. Mito A, Murashima A, Wada Y, Miyasato-Isoda M, Kamiya CA, Waguri M et al. Safety of Amlodipine in Early Pregnancy. J Am Heart Assoc 2019; 8:e012093.
- 20. Magee LA, CHIPS Study Group, von Dadelszen P, Singer J, Lee T, Rey E et al. Do labetalol and methyldopa have different effects on pregnancy outcome? Analysis of data from the Control of Hypertension In Pregnancy Study (CHIPS) trial. BJOG 2016; 123:1143.
- 21. Magee LA, Cham C, Waterman EJ, Ohlsson A, von Dadelszen P. Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis. BMJ 2003; 327:955.
- 22. Rothberger S, Carr D, Brateng D, Hebert M, Easterling TR. Pharmacodynamics of clonidine therapy in pregnancy: a heterogeneous maternal response impacts fetal growth. Am J Hypertens 2010; 23:1234.
- 23. Lydakis C, Lip GY, Beevers M, Beevers DG. Atenolol and fetal growth in pregnancies complicated by hypertension. Am J Hypertens 1999; 12:541.
- 24. Cooper WO, Hernandez-Diaz S, Arbogast PG, Dudley JA, Dyer S, Gideon PS et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med 2006; 354:2443.
- 25. Hecker A, Hasan SH, Neumann F. Disturbances in sexual differentiation of rat foetuses following spironolactone treatment. Acta Endocrinol (Copenh) 1980; 95:540.
- 26. Morton A, Laurie J. Eplerenone in the management of resistant hypertension with obstructive sleep apnoea in pregnancy. Pregnancy Hypertens 2017; 7:54.
- 27. Caretto A, Primerano L, Novara F, Zuffardi O, Genovese S, Rondinelli M. A Therapeutic Challenge: Liddle's Syndrome Managed with Amiloride during Pregnancy. Case Rep Obstet Gynecol 2014; 2014:156250.
- 28. Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P; Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can 2014; 36:416.
- 29. Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de Paco Matallana C et al. Aspirin versus placebo in pregnancies at high-risk for preterm preeclampsia. N Engl J Med 2017;377:613–22.
- 30. Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2014;6:CD001059.
- 31. Xu H, Perez-Cuevas R, Xiong X, Reyes H, Roy C, Julien P et al. An international trial of antioxidants in the prevention of preeclampsia (INTAPP). Am J Obstet Gynecol 2010;202:239.e1–239.e10.
- 32. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 2020; 135:e237.
- 33. Lindheimer MD, Taler SJ, Cunningham FG. ASH position paper: Hypertension in pregnancy. J Clin Hypertens (Greenwich) 2009;11:214–25.
- 34. Shekhar S, Gupta N, Kirubakaran R, Pareek P. Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: A systematic review and meta-analysis. BJOG 2016;123:40–7.
- 35. Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: A randomised placebo-controlled trial. Lancet 2002;359:1877–90.
- 36. Beardmore KS, Morris JM, Gallery ED. Excretion of antihypertensive medication into human breast milk: A systematic review. Hypertens Pregnancy 2002;21:85–95.
Toplam 36 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Derleme |
| Yazarlar | |
| Erken Görünüm Tarihi | 23 Haziran 2023 |
| Yayımlanma Tarihi | 30 Haziran 2023 |
| Kabul Tarihi | 28 Nisan 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 32 Sayı: 2 |
