Do ACE Inhibitors early in pregnancy increase risk of birth defects?
This study by Bateman et al. (Obstetrics and Gynecology, 2017) aimed to determine if exposure to angiotensin-converting enzyme (ACE) inhibitors during the first trimester is associated with risk of congenital, cardiac, and central nervous system malformations.
Observational Cohort study
The study examined 1,333,624 pregnancies, 4,107 of which were exposed to ACE inhibitors in the first trimester. When the study was restricted to pregnancies complicated with chronic hypertension and after accounting for other confounding factors, there was no increased risk found for congenital malformations between women exposed to ACE inhibitors and those not exposed. A major strength of this study is the cohort size, which is one of the largest ever developed for the study of drugs in pregnancy.
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