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ACE Inhibitors Increase Risk for Congenital Anomalies in the First Trimester, Too

The risk more than doubled.

Use of angiotensin-converting–enzyme (ACE) inhibitors during the second and third trimesters of pregnancy is associated with increased risk for major congenital anomalies. To determine whether it is safe to take ACE inhibitors during the first trimester, investigators linked infant birth and medical data with maternal prescription and medical records using the Tennessee Medicaid database.

The researchers identified nearly 30,000 infants born between 1985 and 2000 whose mothers had no evidence of diabetes. During the first trimester, ACE inhibitors were prescribed to 209 mothers, other antihypertensive drugs were prescribed to 202 mothers, and no antihypertensive drugs were prescribed to 29,096 mothers. Compared with the unexposed infants, infants exposed to ACE inhibitors in the first trimester had a significantly higher risk for major anomalies (risk ratio, 2.7), such as atrial septal defect, patent ductus arteriosus, and renal dysplasia. Infants who were exposed to other antihypertensive medications during the first trimester did not have an increased risk for malformations.

Comment: Large data sets allow us to quantify small but important risks. Increasingly, pediatricians need to be aware of the risks associated with medications, particularly when they are prescribed during pregnancy. It appears that use of ACE inhibitors during any trimester is unsafe.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine August 9, 2006

Citation(s):

Cooper WO et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med 2006 Jun 8; 354:2443-51.

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