Erin H. Burnett, MD, FACOG reviewing Bateman BT et al. Obstet Gynecol 2017 Jan.

First-trimester ACE inhibitor use did not appear to be associated with excess risk for major congenital malformations.

Among U.S. women of childbearing age with chronic hypertension (CHTN), about 40% receive angiotension-converting enzyme (ACE) inhibitors. Although the teratogenicity of ACE inhibitor exposure during the second and third trimesters is well known (e.g., renal failure, fetal skull hypoplasia, neonatal hypotension), the fetal safety of this medication class during the first trimester is debated. Researchers used a database of Medicaid claims from 2002 to 2010 to construct a cohort of some 1.3 million pregnancies resulting in live-born neonates; they then evaluated risk for fetal malformations in those pregnancies complicated by CHTN with or without claims for ACE inhibitor treatment during the first trimester. As the database did not include pregnancies lost due to miscarriage, stillbirth, or abortion, the authors also estimated the effects of such events on assessment of risk for malformations.

In 14% of the 18,515 pregnancies complicated by CHTN, mothers received ACE inhibitors during the first trimester (most commonly lisinopril [54.6%]). Women who received ACE inhibitors were more likely to be 40 or older, to be black, and to have higher prevalence of diabetes, renal disease, ischemic heart disease, congestive heart failure, and dyslipidemia. In adjusted analysis, ACE inhibitors dispensed during the first trimester did not increase risk for fetal defects (overall, cardiac, or central nervous system malformations).

CITATION(S):

Bateman BT et al. Angiotensin-converting enzyme inhibitors and the risk of congenital malformations. Obstet Gynecol 2017 Jan; 129:174.

JWatch