Klinik farmakoloji teratoloji risk analizi ile gebelikte kardiyovasküler ilaç kullanımının güvenilirliği

Amaç: Maternal kardiyak hastalık, non-obstetrik maternal morbidite ve mortalitenin ana nedenlerinden biridir. Hamilelik sırasında kardiyovasküler hastalıkların tedavisinde, maternal hastalığı kontrol eden ilaçların reçetelenmesi ve fetusa karşı potansiyel ilaca bağlı risklerin en aza indirilmesi önemlidir. Bu çalışmanın amacı gebelikte kardiyovasküler ilaçların teratojenik açıdan güvenilirliğini değerlendirmektir.Gereç ve Yöntem: 2014-2018 yılları arasında kardiyovasküler hastalıklar sebebiyle ilaç kullanan ve ilaç analizi için birimimize başvuran gebelerin verilerini topladık. Teratoloji Bilgi Servisi ilaçların teratojenik riskini değerlendirdi. Doğumdan sonra, infantta olası konjenital malformasyon veya nörogelişimsel bozuklukları saptamak için ailelerle irtibata geçildi.Bulgular: Hamileliğin ilk altı haftasında ramipril kullanımı 10. haftada spontan abortus ile sonuçlandı. İlk 12 haftada warfarin kullanımı postnatal dördüncü günde eksitusa neden oldu. İlk altı haftada telmisartan maruziyeti 18. gebelik haftasında intrauterin ölümle sonuçlandı.Sonuç: Gebelik tespit edildiğinde renin-anjiyotensin sistemi üzerine etki eden ilaçlar kesilmelidir. Varfarin, birinci trimester maruziyetinde kumarin embriyopatisi ve sinir sistemi anomalilerine yol açtığı için, yüksek tromboembolizm riski taşıyan mekanik kalp kapakçığı olan gebeler dışında gebelikte kullanım için kontrendikedir. Gebe kadınlar teratojenik ilaç analizine yönlendirilmeli ve erken gebelik döneminde ilaçla ilişkili konjenital malformasyon risklerindeki olası artış için değerlendirilmelidir. Teratojenik risk danışmanlığı ve takibi, hamilelik sırasında ilaç güvenliği konusunda güvenilir veriler sağlar.

Anahtar Kelimeler:

Teratoloji, Kardiyovasküler ajanlar, Gebelik, Farmakoloji

Reliability of cardiovascular drug use in pregnancy with clinical pharmacology teratology risk analysis

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.

Keywords:

Teratology, Cardiovascular agents, Pregnancy, Pharmacology,

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