FETAL AND NEONATAL EFFECTS OF TREATING PR EGNANT-WOMEN WITH ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS

Background. - Exposure of pregnant women to angiotensin converting enz yme inhibitor may have side effects on the fetus or newborn, mainly ol igoamnios and impaired renal function. Case report n(o) 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 i n the fetus on gestational week 28; enalapril was then replaced by nif edipine 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 s ection at gestational week 34 because of acute distress syndrome; he d eveloped hypotension, anuria, generalized oedema and was placed in int ensive care. Treatment included ventilation, sympathomimetic agents, a nd diuretics. An exchange-transfusion followed by peritoneal dialysis was performed a few hours later. Renal function returned to normal bet ween the 3(rd) and 5(th) day. Unilateral kidney hypoplasia was diagnos ed at the age of 2 years. Case n(o) 2. - A 24 gear-old woman was given enalapril at the third trimester of a twin pregnancy. Delivery was fu ll term at 37 weeks. The first baby, a boy weighing 2610 g, suffered f rom hypoglycemia and vomiting followed by hypotension and oliguria tha t required exchange-transfusion and repeated peritoneal dialysis. This boy has developed moderate chronic renal failure and hypertension. Th e second baby, a girl weighing 2165 g, suffered from respiratory distr ess syndrome followed by hypotension and oliguria, but her renal funct ion returned to normal within a few days. Conclusions. - The use of an giotension converting enzyme inhibitor by pregnant women places the fe tus at severe risk: treatment with this type of drug should be stopped as soon as pregnancy is confirmed.