Fetal angiotensin II receptor antagonist exposure during pregnancy is associated with major congenital malformations including premature birth, oligohydramnios, acute renal failure, pulmonary hypoplasia and hypocalvaria. Fetopahty is mainly caused by renal insufficiency due to severe hypotension and disturbance of renal development. Therefore administration during the second and third trimester of pregnancy is contraindicated.
We report on a 35 year-old woman with arterial hypertension who was referred to our obstetrical department because of oligohydramnios. She reported to receive treatment with Olmesartanmedoxomil (5mg/day). The condition resolved after changing anti-hypertensive treatment to metoprolol at 26 6/7 weeks of pregnancy. The patient was born at term by C-section and showed the following signs of fetopathy: hyperechogenic multicystic kidneys and hypocalvaria. Renal function was normal, nevertheless arterial hypertension was present but treatment was not required. Discharge from hospital was possible at the age of 9 days. Regularly follow-up visits are necessary to monitor renal function and to evaluate long term effects.
Incidence of sartan-related fetopathy is unknown, therefore consistent reporting is mandatory. We present a case with mild presentation of symptoms, probably related to low therapeutic dosage and early change of antihypertensive treatment.