Increasing exposure to angiotensin-converting enzyme inhibitors in pregnancy

Objective

The objective of the study was to identify angiotensin-converting enzyme (ACE) inhibitor prescription-filling trends in pregnant women.

Study Design

This was a retrospective cohort study in women continuously enrolled in Tennessee Medicaid during pregnancy who delivered a live infant or had a fetal death between 1986-2003 (n = 262,179).

Results

ACE inhibitor exposures increased more than 4-fold: from 11.2 per 10,000 pregnancies in 1986-1988 to 58.9 per 10,000 pregnancies by 2003 (adjusted risk ratio [RR], 4.49; 95% confidence interval [CI], 2.78-7.25). Exposures in the second and third trimesters nearly tripled (RR, 2.88; 95% CI, 1.45-5.75) and did not decrease following a US Food and Drug Administration black box warning against such use in 1992. Exposures were most common among women 35 years of age or older.

Conclusion

Despite evidence of fetal complications associated with ACE inhibitor use during pregnancy, the number of pregnant women with pregnancy-related ACE inhibitor exposures increased steadily between 1986-2003. Better methods are needed to reduce fetal exposure to potentially teratogenic prescribed medications.

Key words: angiotensin-converting enzyme inhibitor, pregnancy, prescription, teratogen