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Sender's message: Antihypertensive meds. in pregnancy
Exposure to amlodipine in the first trimester
of pregnancy and during breastfeeding.
Ahn
HK, Nava-Ocampo
AA, Han
JY, Choi
JS, Chung
JH, Yang
JH, Koong
MK, Park
CT.
The Korean Motherisk Program, Cheil Hospital & Women's
Health-care Center, Kwandong University School of Medicine, Seoul,
Korea.
OBJECTIVE: To assess the fetal outcome of three hypertensive women
exposed to amlodipine. 5 mg/day, in the first trimester of
pregnancy. CASE 1: The patient was treated with amlodipine until 7
weeks of gestation. She was also exposed to levosulpiride,
aluminum hydroxide gel, magnesium carbonate, and Ginkgo biloba. At
38(+3) weeks of pregnancy, she delivered a 3750 g healthy female
baby, and restarted taking amlodipine, 5 mg/day, while exclusively
breastfeeding her daughter. At three months of age, the infant was
healthy. CASE 2: The patient was treated with amlodipine from
2(+2) to 3(+4) weeks of pregnancy. Her treatment was modified to
atenolol until the week 6(+4 weeks), when she declined any
antihypertensive treatment. At 39(+4) weeks of pregnancy, the
patient delivered a 2600 g baby. At 20 months old, the baby
presented with intellectual delay and weakness in the left arm and
hand grasp. These neurological alterations were not attributed to
her exposure to amlodipine early in utero. CASE 3: The patient was
treated with amlodipine from 7(+6) to 12 weeks of pregnancy. She
was also taking sucralfate and lorazepam. At 12 weeks of
amenorrhea, ultrasound revealed a 15.3 mm, single fetal pole in
the gestational sac without cardiac activity. She underwent
dilatation and evacuation of a dead embryo. CONCLUSION: As
reported with other calcium-channel blockers, amlodipine does not
appear to be teratogenic and it appears to be compatible with
breastfeeding.
Publication Types:
- Case Reports
- Research Support, Non-U.S. Gov't
PMID: 17469008 [PubMed - indexed for MEDLINE]
-
Cardiovascular pharmacotherapeutic
considerations during pregnancy and lactation.
Qasqas
SA, McPherson
C, Frishman
WH, Elkayam
U.
Departments of Medicine, Washington University School of
Medicine/Barnes-Jewish Hospital, St. Louis, Missouri, USA.
Table 2 summarizes the recommendations regarding the use of
cardiovascular drugs during pregnancy and lactation.
Publication Types:
PMID: 15316305 [PubMed - indexed for MEDLINE]
-
Treatment of hypertension in pregnancy: effect
of atenolol on maternal disease, preterm delivery, and fetal
growth.
Easterling
TR, Carr
DB, Brateng
D, Diederichs
C, Schmucker
B.
Department of Obstetrics and Gynecology, University of Washington,
Seattle, 98195, USA. easter@u.washington.edu
OBJECTIVE: To assess the impact of antihypertensive therapy
initiated early in pregnancy on maternal and fetal outcomes.
METHODS: A retrospective review of patients treated in early
pregnancy with atenolol was conducted. Therapy was directed by
measurements of cardiac output. Fetal growth was analyzed with
reference to prior pregnancy outcome, treatment inconsistent with
standards present at the end of the study period, and year of
treatment. Data were analyzed by paired and unpaired t-test,
analysis of variance for multiple comparisons, and linear
regression. RESULTS: Two hundred thirty-five pregnancies at risk
for preeclampsia were studied. Ten percent (n = 22) received
additional therapy with furosemide; 20% (n = 48) with hydralazine.
Six and one half percent had treatment inconsistencies. Fifty-five
percent had greater than 100 mg of proteinuria at baseline. One
patient developed severe preeclampsia. Only 2.1% delivered before
32 weeks; 4.7% delivered before 34 weeks. Low percentile birth
weight was strongly associated with a prior pregnancy with
intrauterine growth restriction (P = 0.001), treatment
inconsistency (P <.001), and a pregnancy earlier in our
treatment experience (P <.001). Percentile birth weight
increased from the 20th at the beginning of the study period to
the 40th by the end (P = 0.002). CONCLUSION: Early intervention
with antihypertensive therapy was associated with a low rate of
severe maternal hypertension and preterm delivery. The failure to
adjust therapy in response to an excessive fall in cardiac output
or increase in vascular resistance was associated with reduced
fetal growth.
PMID: 11530124 [PubMed - indexed for MEDLINE]
-
Comment on:
Angiotensin-II-receptor inhibitors in
pregnancy.
Chung
NA, Lip
GY, Beevers
M, Beevers
DG.
Publication Types:
PMID: 11386316 [PubMed - indexed for MEDLINE]
-
-
Comment on:
Angiotensin-II-receptor inhibitors in
pregnancy.
Hinsberger
A, Wingen
AM, Hoyer
PF.
Publication Types:
- Case Reports
- Comment
- Letter
PMID: 11386315 [PubMed - indexed for MEDLINE]
-
-
Angiotensin-II-receptor inhibitors in
pregnancy.
Lambot
MA, Vermeylen
D, Noël
JC.
Publication Types:
PMID: 11386314 [PubMed - indexed for MEDLINE]
-
Antihypertensive treatment decreased serum
leptin levels in severe preeclampsia during pregnancy.
Anato
V, Garmendia
JV, Bianco
NE, De
Sanctis JB.
Instituto de Inmunología, Facultad de Medicina, Universidad
Central de Venezuela, Caracas 1050-A, Venezuela.
BACKGROUND: Plasma leptin levels in preeclamptic patients have
been reported to be similar compared to those of normotensive
pregnant women. Nonetheless, no reports have dealt with the effect
of antihypertensive treatment and leptin in preeclamptic patients.
METHODS: The study involved three groups of a similar age, body
mass index and weeks of gestation. The groups were 30 normal
pregnant women and 23 pregnant women with severe preeclampsia (SPE).
The SPE patients were not treated prior to admission and the
treatment was a single dose of alpha-methyldopa or hydralazine
alone or in combination. The samples were taken at random in the
afternoon (isotonic saline or pharmacological treatment) and 1 h
before and after the treatment was given. Leptin serum levels were
determined by a commercial sandwich ELISA assay. RESULTS: Leptin
levels of the SPE group prior to the treatment were similar to the
levels recorded for the normal pregnant women. However, after 1 h
leptin levels were significantly higher (p < 0.001) in the
nontreated patients (8.0 +/- 1.5) compared with those treated
(5.15 +/- 0.9). CONCLUSION: These marked differences between
treated and nontreated patients suggest that leptin levels may be
modulated by a single antihypertensive treatment in preeclamptic
patients with a discrete increase in blood pressure. Copyright
2001 S. Karger AG, Basel
PMID: 11585975 [PubMed - indexed for MEDLINE]
-
Guidelines on high blood pressure in pregnancy
give new classifications of disease.
Rollins
G.
Publication Types:
PMID: 11902247 [PubMed - indexed for MEDLINE]
-
Twin pregnancy in a woman on long-term
epoprostenol therapy for primary pulmonary hypertension. A case
report.
Badalian
SS, Silverman
RK, Aubry
RH, Longo
J.
Department of Obstetrics and Gynecology, State University of New
York Health Sciences Center at Syracuse 13210, USA.
BACKGROUND: Pregnancy associated with primary pulmonary
hypertension is an uncommon observation, with maternal mortality
> 50%. Experience treating this condition is limited. Past
reports have emphasized the need for pregnancy termination. In the
last few years there has been considerable interest in long-term
intravenous use of epoprostenol (prostacyclin) in patients with
primary pulmonary hypertension. CASE: A woman with severe primary
pulmonary hypertension who was on long-term epoprostenol therapy
became pregnant with twins and was treated with high doses of
epoprostenol and nitric oxide during delivery and the postpartum
period. She was well six months later on continuous epoprostenol
therapy. The one viable infant was alive and still hospitalized at
this writing. CONCLUSION: Epoprostenol therapy may be continued
during pregnancy in patients with severe primary pulmonary
hypertension for long-term pulmonary vasodilatation.
Publication Types:
PMID: 10710749 [PubMed - indexed for MEDLINE]
-
Transplacental distribution of labetalol
stereoisomers at delivery.
Boulton
DW, Dakers
JM, Fawcett
JP, Fiddes
TM.
Publication Types:
PMID: 10400466 [PubMed - indexed for MEDLINE]
-
-
Ketanserin versus dihydralazine in the
management of severe early-onset preeclampsia: maternal outcome.
Bolte
AC, van
Eyck J, Kanhai
HH, Bruinse
HW, van
Geijn HP, Dekker
GA.
Divisions of Maternal-Fetal Medicine, Departments of Obstetrics
and Gynecology, Free University Hospital, Amsterdam, The
Netherlands.
OBJECTIVE: An open, randomized, prospective, multicenter trial was
conducted to compare the efficacy and safety of intravenous
ketanserin, a selective serotonin 2 receptor blocker, with that of
intravenous dihydralazine in the management of severe early-onset
(<32 weeks' gestation) preeclampsia. End points of this study
were blood pressure control and maternal outcome. STUDY DESIGN:
Patients with a diastolic blood pressure >110 mm Hg were
randomly assigned to receive either ketanserin (n = 22) or
dihydralazine (n = 22) as initial therapy. Plasma volume expansion
preceded antihypertensive treatment, which was administered
according to a fixed schedule. RESULTS: The reductions in blood
pressure with the 2 drugs were similar; however, adequate blood
pressure control was reached significantly earlier with ketanserin
(84 +/_ 63 vs 171 +/- 142 minutes, P = .017). Occurrence of
maternal complications was significantly lower among patients who
received ketanserin than among patients who received dihydralazine
(n = 6 vs n = 18, P =.0007). A significant difference in favor of
ketanserin was noted in daily fluid balance. CONCLUSION:
Antihypertensive efficacies of ketanserin and dihydralazine were
comparable, but significantly fewer maternal complications were
noted among the patients receiving ketanserin. Ketanserin is an
attractive alternative in the management of severe early-onset
preeclampsia.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 9988803 [PubMed - indexed for MEDLINE]
-
The addition of a diuretic to anti-hypertensive
therapy for early severe hypertension in pregnancy.
Hall
DR, Odendaal
HJ.
Department of Obstetrics and Gynecology, Tygerberg Hospital and
the University of Stellenbosch, South Africa.
Publication Types:
PMID: 9506418 [PubMed - indexed for MEDLINE]
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