Pregnancy outcome after in utero exposure to angiotensin converting enzyme inhibitors or angiotensin receptor blockers

Reprod Toxicol. 2011 May;31(4):540-5. doi: 10.1016/j.reprotox.2011.02.008. Epub 2011 Feb 18.

Abstract

Objective: To examine first trimester safety of angiotensin-converting-enzyme-inhibitors (ACEIs) or angiotensin-receptor-blockers (ARBs).

Study design: Prospective observational cohort regarding pregnancy ACEI/ARBs-exposure including contacts to two Teratology Information Services in Israel (1994-2007) and Italy (1990-2008), with two comparison groups: (1) exposed to other antihypertensives (OAH) (2) after non-teratogenic exposure (NTE) in similar time frames.

Results: 252 ACEI/ARBs-exposed, 256 OAH-exposed and 495 NTE-exposed pregnancies were followed-up. The rate of major congenital anomalies was comparable between the groups (8/190, 4.2%, ACEI/ARB; 9/212, 4.2%, OAH; 18/471, 3.8% NTE; p = 0.954) among first trimester exposed pregnancies. The median gestational age at delivery was two weeks earlier, rate of preterm deliveries more than 2-fold higher, and median birth weight more than 200 g lower in the ACEI/ARB and OAH groups compared to the NTE group.

Conclusion: The present study suggests that ACEI/ARBs are not major teratogens when used in the first trimester, and can reassure women with similar exposures.

Publication types

  • Multicenter Study

MeSH terms

  • Abnormalities, Drug-Induced / etiology
  • Adult
  • Analysis of Variance
  • Angiotensin II Type 1 Receptor Blockers / administration & dosage
  • Angiotensin II Type 1 Receptor Blockers / adverse effects*
  • Angiotensin-Converting Enzyme Inhibitors / administration & dosage
  • Angiotensin-Converting Enzyme Inhibitors / adverse effects*
  • Antihypertensive Agents / administration & dosage
  • Antihypertensive Agents / adverse effects*
  • Birth Weight / drug effects
  • Chi-Square Distribution
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Israel / epidemiology
  • Italy / epidemiology
  • Maternal Exposure*
  • Maternal-Fetal Exchange
  • Pregnancy
  • Pregnancy Complications / chemically induced*
  • Pregnancy Complications / epidemiology
  • Pregnancy Trimester, First
  • Premature Birth / chemically induced
  • Prospective Studies
  • Risk Assessment
  • Risk Factors

Substances

  • Angiotensin II Type 1 Receptor Blockers
  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents