RAAS inhibitors in pregnancy, breastfeeding and women of childbearing potential: a review of national and international clinical practice guidelines

IF 2.7 4区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of Human Hypertension Pub Date : 2025-03-05 DOI:10.1038/s41371-025-01001-z

Caitlin Greenlees, Christian Delles

{"title":"RAAS inhibitors in pregnancy, breastfeeding and women of childbearing potential: a review of national and international clinical practice guidelines","authors":"Caitlin Greenlees, Christian Delles","doi":"10.1038/s41371-025-01001-z","DOIUrl":null,"url":null,"abstract":"Globally prevalent conditions such as hypertension, heart failure, ischaemic heart disease (IHD) and chronic kidney disease (CKD) are frequently and effectively treated with blockers of the renin-angiotensin-aldosterone system (RAAS) as a first line treatment in the UK and worldwide. RAAS blockers are prohibited in pregnancy due to their adverse fetal effects. We reviewed clinical guidelines from the National Institute of Health and Care Excellence (NICE) on the management of cardiovascular and kidney disease with RAAS blockers in pregnancy, with other UK, European and American guidance as comparators. Whilst guidelines agree on the strict avoidance of RAAS blockers in pregnancy, nuanced considerations regarding prescription in women of childbearing potential, contraception, timing of RAAS blocker withdrawal and breastfeeding are not consistently addressed in clinical guidelines. We call for consistent wording and more explicit advice on RAAS blocker prescription in women of childbearing potential, in pregnancy and in the postpartum period in future iterations of clinical guidelines.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 5","pages":"315-319"},"PeriodicalIF":2.7000,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-025-01001-z.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Human Hypertension","FirstCategoryId":"3","ListUrlMain":"https://www.nature.com/articles/s41371-025-01001-z","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}

引用次数: 0

Abstract

Globally prevalent conditions such as hypertension, heart failure, ischaemic heart disease (IHD) and chronic kidney disease (CKD) are frequently and effectively treated with blockers of the renin-angiotensin-aldosterone system (RAAS) as a first line treatment in the UK and worldwide. RAAS blockers are prohibited in pregnancy due to their adverse fetal effects. We reviewed clinical guidelines from the National Institute of Health and Care Excellence (NICE) on the management of cardiovascular and kidney disease with RAAS blockers in pregnancy, with other UK, European and American guidance as comparators. Whilst guidelines agree on the strict avoidance of RAAS blockers in pregnancy, nuanced considerations regarding prescription in women of childbearing potential, contraception, timing of RAAS blocker withdrawal and breastfeeding are not consistently addressed in clinical guidelines. We call for consistent wording and more explicit advice on RAAS blocker prescription in women of childbearing potential, in pregnancy and in the postpartum period in future iterations of clinical guidelines.

查看原文本刊更多论文

RAAS抑制剂在妊娠、哺乳和育龄妇女中的应用：国家和国际临床实践指南综述

在英国和世界范围内，高血压、心力衰竭、缺血性心脏病（IHD）和慢性肾病（CKD）等全球流行的疾病经常有效地使用肾素-血管紧张素-醛固酮系统（RAAS）阻滞剂作为一线治疗。由于RAAS阻滞剂对胎儿的不良影响，妊娠期禁用。我们回顾了英国国家健康与护理卓越研究所（NICE）关于妊娠期使用RAAS阻滞剂治疗心血管和肾脏疾病的临床指南，并以英国、欧洲和美国的其他指南作为对照。虽然指南一致同意在怀孕期间严格避免使用RAAS阻滞剂，但临床指南中并没有一致地解决有关生育潜力妇女的处方，避孕，RAAS阻滞剂停药时间和母乳喂养的细致考虑。我们呼吁在未来的临床指南中，对育龄妇女、孕期和产后的RAAS阻滞剂处方进行一致的措辞和更明确的建议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Human Hypertension 医学-外周血管病

CiteScore

5.20

自引率

3.70%

发文量

126

审稿时长

6-12 weeks

期刊介绍： Journal of Human Hypertension is published monthly and is of interest to health care professionals who deal with hypertension (specialists, internists, primary care physicians) and public health workers. We believe that our patients benefit from robust scientific data that are based on well conducted clinical trials. We also believe that basic sciences are the foundations on which we build our knowledge of clinical conditions and their management. Towards this end, although we are primarily a clinical based journal, we also welcome suitable basic sciences studies that promote our understanding of human hypertension. The journal aims to perform the dual role of increasing knowledge in the field of high blood pressure as well as improving the standard of care of patients. The editors will consider for publication all suitable papers dealing directly or indirectly with clinical aspects of hypertension, including but not limited to epidemiology, pathophysiology, therapeutics and basic sciences involving human subjects or tissues. We also consider papers from all specialties such as ophthalmology, cardiology, nephrology, obstetrics and stroke medicine that deal with the various aspects of hypertension and its complications.