Angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) are contraindicated in pregnancy. Their use in the second half of pregnancy has been associated with oligohydramnios (probably resulting from impaired fetal renal function) and neonatal anuria, growth abnormalities, skull hypoplasia, and fetal death.23-26 ACE inhibitors have also been associated with potential teratogenic effects. In a retrospective cohort study that included women who had been exposed to ACE inhibitors in the first trimester, the risk ratio associated with exposure to ACE inhibitors, as compared with exposure to other antihypertensive agents, was 4.0 (95% confidence interval [CI], 1.9 to 7.3) for cardiovascular defects and 5.5 (95% CI, 1.7 to 17.6) for central-nervous-system defects.3 Although the observational nature of the study makes it impossible to rule out confounding by other factors associated with the use of ACE inhibitors, it is recommended that women taking ACE inhibitors and, by extrapolation, other blockers of the renin–angiotensin system (e.g., ARBs and renin inhibitors) be switched to another antihypertensive class of drugs before conception whenever possible.
Angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) are contraindicated in pregnancy. Their use in the second half of pregnancy has been associated with oligohydramnios (probably resulting from impaired fetal renal function) and neonatal anuria, growth abnormalities, skull hypoplasia, and fetal death.23-26 ACE inhibitors have also been associated with potential teratogenic effects. In a retrospective cohort study that included women who had been exposed to ACE inhibitors in the first trimester, the risk ratio associated with exposure to ACE inhibitors, as compared with exposure to other antihypertensive agents, was 4.0 (95% confidence interval [CI], 1.9 to 7.3) for cardiovascular defects and 5.5 (95% CI, 1.7 to 17.6) for central-nervous-system defects.3 Although the observational nature of the study makes it impossible to rule out confounding by other factors associated with the use of ACE inhibitors, it is recommended that women taking ACE inhibitors and, by extrapolation, other blockers of the renin–angiotensin system (e.g., ARBs and renin inhibitors) be switched to another antihypertensive class of drugs before conception whenever possible.
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