Ukusebenzisa Ngesikhathi Sokuqala Kwezinyanga Zokuqala Kukhulisa Izinkinga Zokuzalwa
Nakuba izidakamizwa eziningi ezisetshenziselwa ukwelapha umfutho wegazi ophezulu zingathathwa ngokuphepha kwabesifazane abakhulelwe, izigaba ezimbili ezihlobene eduze kwemithi yomshoshaphansi wegazi kufanele zigwenywe. Lezi zi-angiotensin eziguqula i-enzyme (ACE) inhibitors kanye nezidakamizwa ze-angiotensin II receptor blocker (ARB). Izinhlobo ezidakamizwa zifaka izingozi ezinkulu ezinganeni ezikhulayo, futhi akufanele zisetshenziswe noma nini ngesikhathi sokukhulelwa.
Ukuqonda i-ACE Inhibitors nama-ARB
I-ACE inhibitors kanye nezidakamizwa ze-ARB zombili zisebenza ngokuvimbela izingxenye ze- renin-angiotensin endleleni, enye yezinhlelo ezinkulu zomzimba zokumisa ukucindezela kwegazi. Ngokuvimbela kancane ezinye ze-molecule ezikhulunywe yi-renin-angiotensin endleleni, ama-inhibitors e-ACE nama-ARB anganciphisa ukucindezelwa kwegazi ezigulini eziningi ezine- hypertension .
Okwenza lezi zidakamizwa akufanele zisetshenziswe ngesikhathi sokukhulelwa
Ucwaningo oluvela eTennessee ngo-2006 luqale lwaveza inkinga nge-ACE inhibitors kwabesifazane abakhulelwe. Ezinganeni ezingaba ngu-30 000 ezivela ku-database ezigcinwe yi-Tennessee Medicaid, izingane ezingu-411 zazitholele izidakamizwa ezinamandla ngesikhathi sokuqala kwe-trimester. Labo abakwa-ACE inhibitors (abantwana abangu-209) babe nobungozi bokukhubazeka okubeletha okwakuphindwe kathathu kunalabo abangabonakali kuma-ACE inhibitors: ayisishiyagalolunye babenenkinga yezinhliziyo, ezintathu zinezinzwa zokukhubazeka zesistimu, kanti eziyisithupha zazinamanye izinhlobo zokuzalwa amaphutha.
Ngokubanzi, izingane ezingu-7% ezitholakala kuma-ACE inhibitors e-trimester yokuqala zinezinkinga ezithile zokuzalwa, uma kuqhathaniswa nengozi engama-2.6% phakathi kwabantwana abangenakho ukuvezwa kunoma imuphi imishanguzo ye-antihypertensive. Amantombazane ayenesifo semithi engekho emzimbeni ngaphandle kwe-ACE inhibitors awabonanga ukwanda kwengozi.
Kusukela kuhlaziywa kokuqala, ezinye izifundo eziningana ziqinisekisile ukuthi i-ACE inhibitors ngesikhathi sokukhulelwa ihlotshaniswa nobungozi obukhulu kakhulu bokukhubazeka kokuzalwa nezinye izinkinga.
Ngaphezu kwalokho, izifundo ezalandela zibonise ukuthi ukusetshenziswa kwama-ARB ngesikhathi sokukhulelwa kokuqala kuhlotshaniswa nezinhlobo ezifanayo zokukhubazeka kokuzalwa. Uma ngabe kukhona, ingozi nge-ARB ibonakala iphakeme nakakhulu kune-ACE inhibitors.
Ukusetshenziswa kwe-ACE inhibitors nama-ARB ngesikhathi sezinyanga ezintathu nesithathu zokukhulelwa futhi kubangela izinkinga ezinkulu, noma yiziphi izinhlobo ezahlukene.
Isetshenziselwa ukukhulelwa kamuva, lezi zidakamizwa zibangela izinkinga ezinkulu zezinso emntwaneni, kuhlanganise nokukhubazeka komzimba noma ukuhluleka kwezinso . Ukusebenzisa isikhathi eside ukukhulelwa kwezidakamizwa kungabangela nesisindo sokuzalwa esincane, ukuphuza ukukhula, nokulethwa ngaphambi kwesikhathi.
Okubalulekile
Ngenxa yezingozi ezinkulu ezibangelwa izingane ezinomama ezithatha i-ACE inhibitors noma ama-ARB nganoma isiphi isikhathi ngesikhathi sokukhulelwa, futhi ngoba ezinye izigaba zemithi ziphephile futhi zisebenza kahle ekuphatheni umfutho wegazi okhukhumayo kwabesifazane abakhulelwe, odokotela abaningi bancoma ukuthi le mithi ingasetshenziswanga bonke besifazane abaneminyaka yobudala bokubeletha.
Uma ukwelapha umfutho wegazi ophezulu ngokwanele awukwazi ukufeza ngaphandle kokungeza ama-inhibitors e-ACE noma ama-ARB, abesifazane besifo sokubeletha kufanele bathathe izinyathelo zokugwema ukukhulelwa. Kufanele bayeke ukuphuza imithi yabo noma nini lapho isikhathi sabo sokuya esikhathini sephuzile ngamahora angaphezu kwama-48, futhi benze ukuhlolwa kokukhulelwa.
Imithombo
Cooper WO, Hernandez-Diaz S, Arbogast PG, et al. Izinkinga ezinkulu zokubeletha emva kokungena kwe-first-trimester kuma-ACE inhibitors. N Engl J Med 2006; 354: 2443-24511.
UFriedman JM. Ama-inhibitors e-ACE kanye nokuhlukunyezwa okuzalwa. N Engl J Med 2006; 354: 2498-2500.
UBollo M, Tschumi S, Bucher BS, et al. Ukukhulelwa komphumela ngemuva kokungena kuma-angiotensin-okuguqula i-enzyme inhibitors noma abaphikisi be-angiotensin abamukelayo: ukubuyekezwa okuhlelekile. I-hypertension ka-2012; 60: 444.