Key result
Early pregnancy exposure to RAAS inhibitors and warfarin is linked to severe adverse fetal outcomes.
Why the study?
It is important to evaluate the teratogenic safety of cardiovascular drugs used during pregnancy to balance maternal disease control and fetal risk.
Does exposure to cardiovascular drugs cause adverse pregnancy outcomes or birth defects in pregnant women with cardiac disorders?
Observational (n=12)
No
Does exposure to cardiovascular drugs cause adverse pregnancy outcomes or birth defects in pregnant women with cardiac disorders?
Exposure to RAAS inhibitors and warfarin during early pregnancy carries significant teratogenic and fetotoxic risks, highlighting the need for pre-pregnancy counseling and prompt medication substitution.
May warrant caution with RAAS inhibitors and warfarin in early pregnancy; case report leaves open risk quantification in cardiac patients.
Purpose: Maternal cardiac disease is one of the major causes of non-obstetric maternal morbidity and mortality. In the treatment of cardiovascular diseases during pregnancy, it is important to prescribe the drugs that control maternal disease and to minimize potential drug-related risk to the fetus. The aim of this study is to evaluate the teratogenic safety of cardiovascular drugs in pregnancy.Materials and Methods: We collected data of pregnant women who used drugs for cardiovascular disorders and admitted to our unit for drug analysis between 2014 and 2018. Teratology Information Service assessed the teratogenic risk of drugs. After delivery, a follow-up was conducted with families to obtain the presence of any congenital malformations or adverse neurodevelopmental effects in the infant. Results: Use of ramipril in the first six weeks of pregnancy resulted in spontaneous abortus at the 10th week. Use of warfarin in the first 12 weeks resulted in exitus at the postnatal fourth day. Telmisartan exposure in the first six weeks resulted in intrauterine death in the 18th gestational week.Conclusion: Drugs acting on renin-angiotensin system should be discontinued when pregnancy is detected. Warfarin is contraindicated for use in pregnancy except mechanical heart valve pregnancies with high risk of thromboembolism, as it leads to coumarin embryopathy and nervous system anomalies in the first trimester exposures. Pregnant women should be directed to the teratogenic drug analysis and evaluated for possible increase in drug-related congenital malformation risks at early gestational period. Teratogenic risk counselling and follow-up ensures reliable data on drug safety during pregnancy.
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Aykan et al. (2019) conducted an observational in Cardiovascular disorders in pregnancy (n=12). Cardiovascular drugs (RAAS inhibitors, warfarin, beta blockers, anti-lipidemic agents) was evaluated on Risk of major birth defects and adverse fetal outcomes. Exposure to renin-angiotensin system inhibitors and warfarin during early pregnancy resulted in severe adverse fetal outcomes, including spontaneous abortion, intrauterine death, and postnatal death.
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