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Valsartan exposure in pregnancy with resultant anhydramnios and chronic kidney disease in a late preterm infant
  1. Sarah Petch1,
  2. Emily O'Connor1,
  3. Ailbhe McGrath2,3 and
  4. Sean Daly4
  1. 1Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
  2. 2Molecular, Genetic and Population Health Science, The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
  3. 3General Paediatrics, Children's Health Ireland at Crumlin, Dublin, Ireland
  4. 4Maternal Fetal Medicine, Coombe Women and Infants University Hospital, Dublin, Ireland
  1. Correspondence to Dr Ailbhe McGrath; ailbhemcgrath{at}


In utero exposure to angiotensin II receptor blockers (ARBs) has fetotoxic effects including renal failure, oligohydramnios and lung hypoplasia. We present the case of a 24-year-old woman who presented to the maternity services in the 34th week of her first pregnancy. She was taking valsartan for hypertension. Ultrasound showed a structurally normal fetus with anhydramnios. The patient was admitted and valsartan was discontinued. She had spontaneous preterm delivery at 35 weeks’ gestation of a baby girl. The baby’s urine output was minimal in the first week of life and she was transferred to a paediatric hospital for specialist nephrology input. At 6 months of age, she requires ongoing nephrology follow-up and she remains on treatment for hypertension and anaemia. This case demonstrates the serious adverse effects resulting from ARB exposure in utero, and highlights the importance of avoiding fetotoxic medications in women of childbearing age.

  • drugs: obstetrics and gynaecology
  • neonatal and paediatric intensive care
  • materno-fetal medicine

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  • Contributors SP and EO’C, Specialist Registrars in Obstetrics and Gynaecology, were involved in planning and data collection. SP wrote the background and discussion. EO’C collected the information needed for the maternal outcome. AM, Specialist Registrar in Paediatrics, was involved in planning of the article and contributed to the paediatric outcome section. SD was involved in the planning and reporting of the paper and approved the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.