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Birth defects may be linked to hypertension, not ACE inhibitor use in early pregnancy
Lee DK. BMJ. 2011;doi:10.1136/bmj.d5931.
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Women who take ACE inhibitors to treat hypertension during the first trimester of pregnancy appear to be at no greater risk for having babies with birth defects than women who take other types or no antihypertension medication, according to a new study from the US Department of Health and Human Services’ Agency for Healthcare Research and Quality.
The results suggest that the underlying hypertension itself may increase the risk for birth defects, rather than antihypertensive medications taken during the first trimester of pregnancy.
Researchers conducted a population-based, retrospective cohort study that linked automated clinical and pharmacy databases from 1995 to 2008 that yielded more than 465 mother-infant pairs in the Northern California region.
The prevalence of ACE inhibitor use during the first trimester was just 0.9/1,000, and the use of other antihypertensive medications was 2.4/1,000, according to the results. When the researchers adjusted for maternal age, ethnicity, parity and obesity, ACE inhibitor use during the first trimester only was associated with increased risk for congenital heart defects in offspring compared with women who did not have hypertension or take related medications while pregnant (3.9% vs. 1.6%; OR=1.54; 95% CI, 0.90-2.62). A similar association was observed with use of other antihypertensives (2.6% cases of congenital heart defects; OR=1.52; 95% CI, 1.04-2.21).
Compared with women with a diagnosis of hypertension who did not use antihypertensives (2.4% cases of congenital heart defects), ACE inhibitor or other antihypertensive use during the first trimester was not associated with increased risk for congenital heart defects (OR=1.14; 95% CI, 0.65-1.95, and OR=1.12; 95% CI, 0.76-1.64).
Prior research, including a 2006 study of 30,000 births during 15 years to mothers in Tennessee, has reported a link between ACE inhibitor use early in pregnancy and subsequent birth defects. However, researchers concluded that this study, which was based on a much larger population, found that birth defects occurred at the same rate among all hypertensive women, regardless of use of ACE inhibitors or other antihypertensive medications or no medication.
It remains to be determined whether hypertension is to blame for the increased birth defects; however, taking steps to reduce BP before pregnancy may reduce the risk.
“Maternal use of ACE inhibitors in the first trimester has a risk profile similar to the use of other antihypertensives regarding malformations in live born offspring,” the researchers concluded. “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.”
Disclosure: The researchers report no relevant financial disclosures.
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