毒理性
◈ 什么是ACE抑制剂？
血管紧张素转换酶（ACE）抑制剂是用来描述一组用于治疗高血压的药物的名称。它们也被用于治疗心脏和肾脏的问题。ACE抑制剂有许多名称，例如：苯那普利（Lotensin®），卡托普利（Capoten®），西拉普利（Inhibace®），依那普利（Vasotec®, Epaned®），福辛普利（Monopril®），赖诺普利（Listril®, Lopril®, Novatec®, Prinivil®, Zestril®），培哚普利（Aceon®），喹那普利（Accupril®），雷米普利（Altace®）和trandolapril（Mavik®）。研究一类药物是困难的。与您的医疗保健提供者或MotherToBaby专家讨论您的特定药物，看看是否有针对该特定药物的研究。有时当人们发现自己怀孕了，他们会考虑改变服用药物的方式，或者完全停止服用药物。然而，在做出任何改变之前，与您的医疗保健提供者交谈是非常重要的。您的医疗保健提供者可以与您讨论治疗您病情的好处以及怀孕期间未治疗疾病的风险。
◈ 我服用ACE抑制剂。它会让我更难怀孕吗？
尚未进行过研究以查看ACE抑制剂是否会使怀孕变得更加困难。
◈ 孕期高血压会引起问题吗？
孕期未经控制的高血压可能会影响胎盘（在孕期帮助将食物和氧气输送到婴儿的器官）。这可能会导致发育中的婴儿出现问题，例如：生长缓慢（婴儿整体较小），低出生体重（出生时体重不足5磅8盎司[2500克]）或早产（怀孕37周前出生）。孕期未经控制的高血压还可能通过损害器官（如肾脏和心脏）影响怀孕的人。
◈ 服用ACE抑制剂会增加流产的风险吗？
任何怀孕都可能出现流产。尚不清楚ACE抑制剂是否会增加流产的风险。
◈ 孕早期服用ACE抑制剂会增加出生缺陷的风险吗？
每个怀孕开始时都有3-5%的出生缺陷风险。这被称为背景风险。没有证据表明孕早期使用ACE抑制剂会增加出生缺陷的风险。大多数研究并未发现那些在孕早期服用或被开出ACE抑制剂的怀孕中出现出生缺陷的频率更高。由于ACE抑制剂虽然作用方式相似，但个体药物之间存在一些差异，因此研究作为整体的药物是困难的。当药物作为整体研究时，可能会错过个体药物的差异。此外，研究中报告的问题可能与大血压本身有关，而不一定是由于药物。
◈ 孕中晚期服用ACE抑制剂会引起其他怀孕并发症吗？
应避免在孕中晚期使用ACE抑制剂。在孕早期之后使用，ACE抑制剂可能会导致羊水过少（围绕婴儿的液体）。羊水过少可能会导致发育中的婴儿出现健康问题。一些问题包括肺发育不良、生长缓慢、颅骨发育不良、出生缺陷、肾脏发育问题和在最严重的情况下，发育中的婴儿死亡。
◈ 我服用ACE抑制剂，刚刚发现自己怀孕了。可以做哪些检查来检查宝宝？
如果您在怀孕期间服用了ACE抑制剂，请与您的医疗保健提供者讨论筛查选择，例如胎儿超声检查。您的医疗保健提供者可以帮助安排任何适当的监测。
◈ 服用ACE抑制剂时哺乳：
根据具体药物，哺乳时可能可以服用ACE抑制剂。联系MotherToBaby了解您的特定药物更多信息。务必与您的医疗保健提供者和您孩子的儿科医生讨论您的药物和所有哺乳问题。
◈ 如果男性服用ACE抑制剂，会影响生育能力（使伴侣怀孕的能力）或增加出生缺陷的风险吗？
没有证据表明男性使用ACE抑制剂会导致不育或任何出生缺陷。一般来说，父亲和精子捐献者的暴露不太可能增加怀孕的风险。更多信息，请参阅MotherToBaby事实表《父亲暴露与怀孕》https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/。
◈ What is an ACE inhibitor?
Angiotensin-converting-enzyme (ACE) inhibitor is the name used to describe a group of medications used to treat high blood pressure. They have also been used for treating problems with the heart and kidneys.ACE inhibitors are sold under many names, such as: benazepril (Lotensin®), captopril (Capoten®), cilazapril (Inhibace®), enalapril (Vasotec ®, Epaned®), fosinopril (Monopril®), lisinopril (Listril®, Lopril®, Novatec®, Prinivil®, Zestril®), perindopril (Aceon®), quinapril (Accupril®), ramipril (Altace®), and trandolapril (Mavik®). It is difficult to study a class of medications. Discuss your specific medication with your healthcare provider or a MotherToBaby specialist to see if there are studies for that particular medication.Sometimes when people find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take this medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.
◈ I take an ACE inhibitor. Can it make it harder for me to get pregnant?
Studies have not been done to see if ACE inhibitors could make it harder to get pregnant.
◈ Can high blood pressure during my pregnancy cause problems?
Uncontrolled high blood pressure in pregnancy could affect the placenta (organ that develops in pregnancy to help get food and oxygen to the baby). This can then cause problems for the developing baby, such as: slow growth (infant smaller overall), low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), or preterm delivery (birth before 37 weeks of pregnancy). Uncontrolled high blood pressure in pregnancy can also affect the person who is pregnant, by damaging organs, such as kidneys and heart.
◈ Does taking ACE inhibitors increase the chance for miscarriage?
Miscarriage can occur in any pregnancy. It is not known if ACE inhibitors increase the chance for miscarriage.
◈ Does taking ACE inhibitors in the first trimester increase the chance of birth defects?
Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. There is no proven risk of birth defects with first trimester use of ACE inhibitors. The majority of studies have not found birth defects to occur more often in those who took or were prescribed an ACE inhibitor in the first trimester of their pregnancy. It is difficult to study medications as a group because even though the ACE inhibitors work in similar ways, there are some differences among the individual medications. When drugs are studied as a group, differences for individual drugs could be missed. Also, problems reported in studies may be related to high blood pressure itself, and might not be due to the medication.
◈ Could taking ACE inhibitors in the second or third trimester cause other pregnancy complications?
ACE inhibitors should be avoided during the second and third trimester of pregnancy. When used after the first trimester, ACE inhibitors can cause low levels of amniotic fluid (fluid that surrounds the baby). Low levels of amniotic fluid can lead to health problems for the developing baby. Some of these problems include poor lung development, poor growth, poor development of the skull bones, birth defects, problems with the development of the kidneys and in the most severe cases, death of the developing baby.
◈ I take an ACE inhibitor and just found out that I am pregnant. What tests can be done to check the baby?
If you took an ACE inhibitor during pregnancy, talk to your healthcare provider about screening options, such as a fetal ultrasound. Your healthcare provider can help to arrange any appropriate monitoring.
◈ Breastfeeding while taking ACE Inhibitors:
It may be possible to breastfeed while taking an ACE inhibitor, depending on the specific medication. Contact MotherToBaby to learn more about your specific mediation(s). Be sure to talk to your healthcare provider and your child’s pediatrician about your medications and all of your breastfeeding questions.
◈ If a male takes ACE Inhibitors, could it affect fertility (ability to get partner pregnant) or increase the chance of birth defects?
There is no evidence to suggest that a man’s use of an ACE inhibitor causes infertility or any birth defects. In general, exposures that fathers and sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.
来源:Mother To Baby Fact Sheets
