Ukusetyenziswa Ngethuba lokuQala kweTrimester lwandisa ukukhubazeka kozalo
Ngelixa ezininzi iziyobisi ezisetyenziselwa ukunyanga ingcinezelo ingathathwa ngokukhuselekileyo kubasetyhini abakhulelweyo, iindidi ezibini ezinxulumene nomxinzelelo wegazi kufuneka zigwenywe. Ezi zi-angiotensin ziguqula i-enzyme (ACE) inhibitors kunye ne-angiotensin II receptor blocker (ARB). Izihlobo zonyango zibeka ingozi enkulu kumntwana okhulayo, kwaye akufanele isetyenziswe naliphi na ixesha ngexesha lokukhulelwa.
Ukuqonda i-ACE Inhibitors kunye nee-ARB
I-ACE inhibitors kunye neziyobisi ze-ARB zombini zisebenza ngokuthintela izixhobo zendlela ye- renin-angiotensin , enye yeenkqubo ezinkulu zomzimba zokucwangcisa uxinzelelo lwegazi. Ngokuzivimbela ngokuthe ngqo ezinye iamolekyuli ezixhaswa yi-renin-angiotensin endleleni, i-ACE inhibitors kunye nee-ARB zinganciphisa uxinzelelo lwegazi kwizigulane ezininzi ezinegazi legazi .
Kutheni Lezi Ziyobisi Akufanele Zisetyenziswe Ngethuba Lokukhulelwa
Uphando olusuka eTennessee ngo-2006 luqale lufumanisa ingxaki nge-ACE inhibitors kwabasetyhini abakhulelweyo. Kule minyaka engama-30 000 yokuzalwa evela kwiziko ledatha elondolozwe yiTennessee Medicaid, abantwana abangama-411 babesetyenziselwa iziyobisi ezingekho emthethweni ngexesha lokuqala lokuqala. Abo babecala kwi-ACE inhibitors (iintsana ezingama-209) babe nomngcipheko weziphene zokuzalwa ezaba ziphindwe kathathu eziphezulu kunezo ezingabonakali kwi-ACE inhibitors: ezithoba zineentlungu zentliziyo, zintathu zineentlobo zeentlobo zesifo senzwa, kwaye ezithandathu zinezinye iintlobo zokuzalwa i ziphene.
Ngokubanzi, i-7% yeintsana ezibonakaliswe kwi-ACE inhibitors kwi-trimester yokuqala inesimo esithile sokukhubazeka kokuzalwa, xa kuthelekiswa nobungozi obu-2.6% phakathi kweentsana ezingenakho ukutyhila nakweyiphi na imishanguzo yokulwa ne-antihypertensive. Iintsana eziye zafumana iziyobisi ezingaphiliyo ngaphandle kwe-ACE inhibitors azibonanga ukwanda kwengozi.
Ukususela kuhlalutyo lokuqala, ezinye izifundo ezininzi ziqinisekisile ukuba i-ACE inhibitors ngexesha lokukhulelwa lidibene neengozi enkulu yokukhulelwa kwezilwanyana kunye nezinye iingxaki.
Ukongezelela, uphando olulandelayo lubonise ukuba ukusebenzisa i-ARB ngexesha lokukhulelwa kwangaphambili lidibene neentlobo ezifanayo zokukhubazeka kokuzalwa. Ukuba nantoni na, ingozi nge-ARB ibonakala iphakamileyo kunokuba i-ACE inhibitors.
Ukusetyenziswa kwe-ACE inhibitors kunye nee-ARB ngexesha lekota yesibini neyesithathu zokukhulelwa kwakhona kubangela iingxaki ezinzulu, nangona uhlobo oluthile.
Esetyenzisiwe emva kokukhulelwa, ezi ziyobisi zidala iingxaki ezinzulu zengqondo emntwaneni, kubandakanywa umsebenzi wokuguqulwa kwengqondo okanye ukungaphumeleli kwezintso . Ukusetyenziswa kwexesha elide lokusetyenziswa kwezidakamizwa kunokubangela ukuba nesisindo sokuzalwa esincinci, ukuphuculwa kwexesha lokukhula kunye nokuhanjiswa kwangaphambi kwesikhathi.
Ngaphantsi
Ngenxa yemingcipheko enkulu ebantwini abanomama abathatha i-ACE inhibitors okanye i-ARB nanini na ngexesha lokukhulelwa, kwaye ngenxa yokuba ezinye iindidi zamachiza zikhuselekile kwaye zisebenza ngokugqithiseleyo ekuphatheni umfutho wegazi ophezulu kwabasetyhini abakhulelweyo, oogqirha abaninzi bancomela ukuba le mithi ingasetyenziswanga bonke abasetyhini bexesha lokuzala.
Ukuba unyango lwe-hypertension ngokwaneleyo alikwazi ukufezwa ngaphandle kokungeza ii-inhibitors ze-ACE okanye ii-ARB, abafazi beminyaka yobudala kufuneka bathathe amanyathelo okukhusela ukukhulelwa. Bafanele bayeke ukuthabatha amayeza abo naliphi ixesha ixesha labo lokuya esikhathini lilibaziseka kwiiyure ezingama-48, kwaye benze uvavanyo lokukhulelwa.
Imithombo
Cooper WO, Hernandez-Diaz S, Arbogast PG, et al. Iintsholongwane ezinkulu zomntwana emva kokuqala kwe-trimester ku-ACE inhibitors. N Engl J Med 2006; 354: 2443-24511.
Friedman JM. I-ACE inhibitors kunye ne-anomalies yokuzalwa. N Engl J Med 2006; 354: 2498-2500.
Bullo M, Tschumi S, Bucher BS, et al. Ukukhulelwa kwesiphumo emva kokungena kwi-angiotensin-ukuguqula i-inhibitors ye-enzyme okanye i-angiotensin i-receptor antagonists: ukuhlaziywa okucwangcisiweyo. Uxinzelelo lwe-2012; 60: 444.