Prognosis and outcome of pregnancies exposed to renin-angiotensin system blockers.

OBJECTIVE

To study pregnancy outcomes and fetal renal prognosis markers in cases of exposure to renin-angiotensin system blockers.

METHODS

We conducted a retrospective study of a series of 21 patients exposed to blockers of the renin-angiotensin system during pregnancy. Two markers were prenatally studied, fetal serum β2-microglobulin and amniotic fluid volume. Poor renal prognosis evaluation was based on postnatal glomerular filtration rate or on the presence of renal histologic lesions.

RESULTS

Of the 21 fetuses, only one had a normal postnatal renal function at birth (oligohydramnios regression and normal β2-microglobulin). All fetuses with persistent oligohydramnios or β2-microglobulin ≥ 5 mg/L presented an adverse renal outcome.

CONCLUSION

Exposure to renin-angiotensin system blockers complicated by oligohydramnios is associated with a very poor outcome. We propose a prenatal management based on amniotic fluid volume monitoring and fetal serum β2-microglobulin. However, our preliminary results have to be confirmed by a larger study.