Once thought to be safe to use during the first trimester, angiotensin-converting–enzyme (ACE) inhibitors should be avoided during all trimesters of pregnancy, say researchers from Vanderbilt University School of Medicine in Nashville, Tennessee, and Boston University in Massachusetts.
ACE inhibitors are antihypertensive medications, which relax the blood vessels in the body and lower blood pressure. Using data from 1985 to 2000, researchers examined the birth and pharmacy records of 29,507 infants and their moms enrolled in a Tennessee health care program. They identified 209 infants exposed to ACE inhibitors during the first trimester and 202 infants exposed to other antihypertensive drugs and compared them with infants not exposed to the medications.
The results showed that babies exposed to ACE inhibitors during the first trimester had 2.7 times the risk of birth defects compared with babies not exposed to antihypertensive medications. The most common malformations due to ACE inhibitor exposure included problems with the formation of the heart, blood vessels, and central nervous system.
Using other types of antihypertensive medicines during the first trimester did not increase a woman's risk of giving birth to a baby with congenital malformations.
What This Means to You. The authors of this study conclude that taking ACE inhibitors during any trimester of pregnancy shouldn't be considered safe and carries an increased risk of birth defects. If you take these drugs and are pregnant or considering becoming pregnant, talk to your doctor about the best medication choices to protect your baby's health and your own.
Source: William O. Cooper, MD, MPH; Sonia Hernandez-Diaz, MD, DrPH; Patrick G. Arbogast, PhD; Judith A. Dudley, BS; Shannon Dyer, BS; Patricia S. Gideon, RN; Kathi Hall, BS; Wayne A. Ray, PhD; New England Journal of Medicine, June 8, 2006.
Reviewed by: Steven Dowshen, MD
Date reviewed: June 2006