A coroner has warned against a type of medication that can be used to treat migraines during pregnancy after the death of a four-day-old baby.
On 13 November 2024 in Sunderland, Baby Avery Hall, died with lung damage, low oxygen levels and reduced blood flow – complications known to arise when prescription drug Candesartan is used throughout pregnancy, particularly in the second and third trimester.
Avery’s development in pregnancy was compromised by reduced amniotic fluid, leading to poor lung development and impairment of urine production by the kidneys.
His mother was prescribed Candesartan, a medication that relaxes blood vessels, to treat her recurring migraines before she became pregnant.
But in April 2024 when she fell pregnant, doctors gave her “unclear and indecisive advice”, and she was not told specifically to stop using Candesartan, despite the known risks.
David Place, a senior coroner for the City of Sunderland, issued a prevention of future deaths report on Monday. He concluded that Avery died from complications known to arise when Candesartan is used throughout pregnancy and that “action should have been taken”.
“His mother had continued to use this medication which had been prescribed to her since 2022 being unaware of the risks it posed due to a combination of unclear and indecisive advice at the outset and no additional advice about the safety of the medication from clinicians involved in her antenatal care,” Mr Place said.
Avery’s mother suffered from migraines and was prescribed Candesartan 4mg by her GP shortly before her 22nd birthday. This was to be taken daily and was placed on a repeat prescription of 28 tablets.
But no advice was provided at this time on the risks of the medication if she were to get pregnant. This is despite the National Institute for Health and Care Excellence (NICE) guidance warning against its effects on foetal development.
Following a positive pregnancy test in April 2024, Avery’s mother asked her GP which of her prescribed medications were safe to use during pregnancy. During a telephone consultation with her GP she was given specific advice to avoid using three of six prescriptions.
However, the coroner raised concerns that she was not given specific advice to stop using Candesartan.
A repeat prescription for the drug was issued and continued to be approved until only 12 days prior to Avery’s birth.
She continued to suffer migraines throughout her pregnancy, still unaware of the risks of taking the medication.
“Despite advice from the GP that it was best to stop all medication during pregnancy, Candesartan remained as a repeat prescription,” Mr Place said.
“There were no warnings placed on the system which would have alerted the clinician approving the request for the repeat prescription that the patient was pregnant thus necessitating a review,” he added.
NHS England has been contacted for a comment.
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