Gwiritsani Ntchito Pa Trimester Yoyamba Kuwonjezera Zofooka za Kubadwa
Ngakhale mankhwala ambiri omwe amagwiritsidwa ntchito pochizira matendawa angatengedwe mosamala kwa amayi omwe ali ndi mimba, mitundu iwiri yoyandikana nayo ya mankhwala a magazi imayenera kupeĊµa. Awa ndi angiotensin omwe amatembenuza mavitamini (ACE) inhibitors ndi mankhwala a angiotensin a receptor blocker (ARB). Mankhwala amtundu wina amachititsa kuti mwanayo akule bwino, ndipo sayenera kugwiritsidwa ntchito nthawi iliyonse pamene ali ndi mimba.
Kumvetsetsa ACE Zizindikiro ndi ma ARB
ACE inhibitors ndi mankhwala a ARB onse amagwira ntchito potseka zigawo za njira ya renin-angiotensin , imodzi mwa njira zazikulu za thupi zothandizira kuthamanga kwa magazi. Mwa kuletsa mbali zina za mamolekyulu wotetezedwa ndi renin-angiotensin njira, ACE inhibitors ndi ARBs amachepetsa kuthamanga kwa magazi kwa odwala ambiri omwe ali ndi matenda oopsa .
Chifukwa Chake Mankhwalawa Sayenera Kugwiritsidwa Ntchito Pakati pa Mimba
Kafukufuku wochokera ku Tennessee mu 2006 adayamba kuzindikira vuto la ACE poletsa akazi oyembekezera. Pa kubadwa pafupifupi 30,000 kuchokera ku deta yosungidwa ndi Tennessee Medicaid, ana 411 anapezeka ndi mankhwala osokoneza bongo m'nthawi ya trimester yoyamba. Anthu omwe anadziwika ndi ACE inhibitors (ana 209) anali ndi chiopsezo cholephereka kubadwa komwe kanali katatu katatu kusiyana ndi omwe sanadziwitse kwa ACE zivomezi: asanu ndi anayi anali ndi malingaliro a mtima, atatu anali ndi machitidwe aakulu a mitsempha ya ubongo, ndipo asanu ndi limodzi anali ndi zobadwa zina zolakwika.
Zonsezi, ana asanu ndi awiri mwa ana asanu ndi awiri alionse omwe anapezeka kuti ali ndi HIV m'thupi lachitatu m'thupi lawo anali ndi vuto linalake lobadwa, poyerekeza ndi chiwopsezo cha 2.6% pakati pa makanda omwe sankadziwa mankhwala aliwonse oletsa kumwa mankhwala. Ana amene anali ndi mankhwala osokoneza bongo kusiya ACE inhibitors sanasonyeze kuwonjezeka kwa chiopsezo.
Kuyambira kafukufuku woyamba, maphunziro ena angapo atsimikizira kuti ACE inhibitors panthawi yomwe ali ndi pakati amakhala ndi chiopsezo chowonjezeka cha zolephereka kubadwa ndi mavuto ena.
Kuphatikiza apo, kufufuza kwotsatira kwasonyeza kuti kugwiritsa ntchito ma ARB pa nthawi yoyamwitsa mimba kumayanjanitsidwa ndi zofanana zolephereka kubadwa. Ngati chili chonse, chiopsezo cha ARBs chimawoneka chokwera kuposa chomwe chili ndi ACE inhibitors.
Kugwiritsira ntchito ACE inhibitors ndi ma ARB pa nthawi yachiwiri ndi yachitatu ya mimba imabweretsa mavuto aakulu, ngakhale a mitundu yosiyanasiyana.
Amagwiritsidwa ntchito panthawi yomwe ali ndi mimba, mankhwalawa amachititsa mavuto aakulu a impso mwa mwana, kuphatikizapo kupwetekedwa kwa nkhumba kapena matenda a impso . Mankhwalawa amatha kuchepetsa kuchepa, kuchepetsa kuchepa, komanso kubereka msanga.
Mfundo Yofunika Kwambiri
Chifukwa cha ngozi zazikulu zomwe ana awo omwe amayi awo amatenga ACE ziwalo kapena ma ARB nthawi iliyonse panthawi ya mimba, ndipo chifukwa magulu ena ambiri a mankhwala ndi otetezeka komanso ogwira mtima pochiza matenda oopsa a amayi apakati, madokotala ambiri amalimbikitsa kuti mankhwalawa asagwiritsidwe ntchito onse mwa akazi a msinkhu wobereka.
Ngati kuchiza matenda oopsa kwambiri sikungatheke popanda kuwonjezera ACE inhibitors kapena ARBs, akazi a msinkhu wopereka ayenera kusamala kuti asatenge mimba. Ayenera kusiya kumwa mankhwala nthawi iliyonse yomwe amayamba kuchedwa ndi maola oposa 48, ndipo ayese kuyeretsa mimba.
Zotsatira
Cooper WO, Hernandez-Diaz S, Arbogast PG, et al. Zovuta zazikulu zoberekera kumayambiriro pambuyo poyambira kwa trimester kwa ACE inhibitors. N Engl J Med 2006; 354: 2443-24511.
Friedman JM. ACE inhibitors ndi congenital anomalies. N Engl J Med 2006; 354: 2498-2500.
Bullo M, Tschumi S, Bucher BS, ndi al. Zotsatira za mimba pambuyo poyang'aniridwa ndi angiotensin-kutembenuza mavitamini a inhibitors kapena otsutsa a angiotensin: ndondomeko yowonongeka. Kuthamanga kwa magazi 2012; 60: 444.