Maternal ACE Inhibitor Use Not Tied to Congenital Defects

First trimester use of ACE inhibitors has a similar risk profile to use of other antihypertensives

WEDNESDAY, Oct. 19 (HealthDay News) -- For pregnant women with hypertension, use of angiotensin-converting enzyme (ACE) inhibitors in the first trimester does not increase the risk of congenital heart defects in offspring compared to no treatment, according to a study published online Oct. 18 in BMJ.

De-Kun Li, M.D., Ph.D., M.P.H., from Kaiser Permanente in Oakland, Calif., and colleagues investigated the association between use of ACE inhibitors during the first trimester and the risk of malformations in offspring. Participants included 465,754 mother-infant pairs from 1995 to 2008. The main outcome was congenital malformations in live births.

The investigators found that, compared to those with neither hypertension nor ACE inhibitor use in the first trimester, use of ACE inhibitors in the first trimester only was associated with an increased risk of congenital heart defects in offspring (odds ratio [OR], 1.54; 95 percent confidence interval [CI], 0.9 to 2.62), after adjusting for confounders. A similar association was seen for use of other antihypertensive agents (OR, 1.52). Compared with those diagnosed with hypertension who did not use antihypertensives, use of ACE inhibitors or other antihypertensives was not significantly associated with the risk of congenital heart defect risk (OR, 1.14; 95 percent CI, 0.65 to 1.98 and OR, 1.12; 95 percent CI, 0.76 to 1.64, respectively).

"The apparent increased risk of malformations associated with use of ACE inhibitors (and other antihypertensives) in the first trimester is likely due to the underlying hypertension rather than the medications," the authors write.

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