RECOGNITION AND MANAGEMENT OF ANGIOTENSIN-CONVERTING ENZYME-INHIBITORFETOPATHY

Angiotensin converting enzyme (ACE) inhibitors are extensively used fo r the treatment of hypertension, to decrease proteinuria, and to mitig ate hyperfiltration. These drugs now have been shown to be fetotoxic c ausing profound fetal hypotension, renal tubular dysplasia, anuria-oli gohydramnios, growth restriction, hypocalvaria, and death when used in the second and third trimesters of pregnancy. We recommend that ACE i nhibitors not be used in pregnancy. However, if a child is born with A CE inhibitor fetopathy, aggressive therapy with dialysis to remove the inhibitor may mitigate the profound hypotensive effects. Therapy will depend on the specific ACE inhibitor, and care recommendations cannot be generalized for the entire class of drugs as their protein binding and volume of distribution differ substantially.