alexa The Use of Angiotensin Converting Enzyme Inhibitors during the First Trimester of Pregnancy
ISSN: 2329-6887

Journal of Pharmacovigilance
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Research Article

The Use of Angiotensin Converting Enzyme Inhibitors during the First Trimester of Pregnancy

Lyn Colvin1*, Barry NJ Walters2, Andrew W Gill3, Linda Slack-Smith4, Fiona J Stanley1, Lolkje TW De Jong-Van De Berg5 and Carol Bower1,6
1Telethon Kids Institute, The University of Western Australia, Australia
2School of Women’s and Infants’ Health, King Edward Memorial Hospital, The University of Western Australia, Australia
3Centre for Neonatal Research and Education, The University of Western Australia, Australia
4School of Dentistry, The University of Western Australia, Australia
5Department of Pharmacoepidemiology and Pharmacotherapy, University Institute for Drug Exploration, University of Groningen, The Netherlands
6Western Australian Register of Developmental Anomalies, Australia
Corresponding Author : Lyn Colvin
Telethon Kids Institute
The University of Western Australia
100 Roberts Road, Subiaco Western Australia 6008, Australia
Tel: +61 8 9489 7777
Fax: +61 8 9489 7700
E-mail: [email protected]
Received March 06, 2014; Accepted March 28, 2014; Published April 04, 2014
Citation: Colvin L, Walters BNJ, Gill AW, Slack-Smith L, Stanley FJ, et al. (2014) The Use of Angiotensin Converting Enzyme Inhibitors during the First Trimester of Pregnancy. J Pharmacovigilance 2:129. doi: 10.4172/2329-6887.1000129
Copyright: © 2014 Colvin L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

Background: The direct effects of angiotensin converting enzyme inhibitor (ACEI) medications on the fetus are difficult to determine since these medicines are usually administered to women presenting with high-risk pregnancies. The aim of this study was to provide an overview of the dispensing patterns, demographic characteristics and pregnancy outcomes of women dispensed an ACEI during pregnancy. Methods: Exposed pregnancies were all births in Western Australia, 2002-2005 where the mother was dispensed an ACEI under the Australian Pharmaceutical Benefits Scheme, compared with all other births during the same period. Result: From 2002 to 2005, there were 96,698 births in Western Australia. At least one form of ACEI was dispensed to 95 pregnant women (0.1%) and a further 677 pregnant women (0.7%) were dispensed an antihypertensive medication that was not an ACEI. Women dispensed an ACEI in the first trimester were more likely to be obese (aOR 33.4; 95% CI: 19.5-57.2), to have gestational diabetes (aOR 2.6; 1.3-5.4), to have a preterm delivery (aOR 2.8; 1.4-5.6), and to have smoked during their pregnancy (aOR 1.9; 1.2-3.0). The children of women dispensed an ACEI were more likely to have a major birth defect (aOR 2.6; 1.3-5.2). The risk of a major uro-genital birth defect (aOR 4.8; 2.0-11.7) was increased. Conclusion: Although ACEIs are contraindicated, pregnant women continue to be dispensed these medications. This study provides a profile of these women and their pregnancy outcomes. A clear change in the pattern of dispensing ACEIs later in pregnancy was apparent for these women. A greater number of women were dispensed ACEIs during trimester 1, followed by a marked reduction in dispenses in trimester 2 and trimester 3. Although the number of children affected is small, our data suggests that an increased risk of uro-genital defects may arise with maternal ACEI use in the first trimester.

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