In Utero Exposure to Antihypertensive Medication during the First Trimester: Is the Risk Worth Taking?

Abstract

The aim of this study is to evaluate and present the evidence so far, regarding fetal outcomes after in utero exposure to antihypertensive medication. Hypertensive disorders during pregnancy constitute a significant risk factor for maternal and fetal outcomes, necessitating antihypertensive treatment. However, current data concerning the safety of in utero exposure to antihypertensive medication are controversial. While some studies recommend the administration of certain agents, others underline the possible adverse effects on fetal development. This review aims to summarize the outcomes of studies published during the last decade, referring to first trimester in utero exposure to antihypertensive agents. In general, a-methyldopa, β-blockers and calcium channel blockers are the first or second treatment line for hypertension during pregnancy. However, ACEIs, ARBs and diuretics are mostly contraindicated, as the potential risk outweighs the benefits of their administration. Additionally, several drugs should be avoided, due to the lack of data regarding their safety.

Conclusion. As current studies are restricted for ethical reasons, there is a significant lack of evidence concerning diverse antihypertensive agent use. In utero exposure to antihypertensive medication needs to be carefully evaluated and supported by further research.