Increased risk of major congenital malformations in early pregnancy use of angiotensin-converting-enzyme inhibitors and angiotensin-receptor-blockers: a meta-analysis
| Autor: | Denice S. Feig, George Tomlinson, Jennifer Fu |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Angiotensins Endocrinology Diabetes and Metabolism 030209 endocrinology & metabolism Angiotensin-Converting Enzyme Inhibitors 030204 cardiovascular system & hematology 03 medical and health sciences Angiotensin Receptor Antagonists 0302 clinical medicine Endocrinology Pregnancy Diabetes mellitus Internal Medicine medicine Maternal hypertension Humans biology Obstetrics business.industry Angiotensin-converting enzyme Odds ratio medicine.disease Confidence interval Pregnancy Trimester First Systematic review Meta-analysis biology.protein Female business Systematic Reviews as Topic |
| Zdroj: | Diabetes/metabolism research and reviewsREFERENCES. 37(8) |
| ISSN: | 1520-7560 |
| Popis: | Aims To evaluate the risk of adverse fetal outcomes after exposure to angiotensin converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) in first trimester of pregnancy, by conducting a systematic review and meta-analysis. Materials and methods A systematic literature search was conducted using Medline, Embase, Cochrane and PubMed from inception to 25 November 2019. Studies were included if they evaluated pregnancies exposed to ACE-Is or ARBs, reported fetal outcomes, and compared these outcomes with a control group. Pooled odds ratios (ORs) were estimated using inverse variance-weighted random effects model. The protocol was registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42020160566). Results Studies reporting on 6234 pregnancies exposed to ACE-Is or ARBs, 4104 pregnancies exposed to other oral antihypertensives, and 1,872,733 pregnancies without exposure were included in the meta-analysis. ACE-I or ARB exposed pregnancies, compared to non-exposed controls, had higher risk of major congenital malformations (OR 1.82; 95% confidence interval [CI]: 1.42-2.34), cardiovascular malformations (OR 2.50; 95% CI: 1.62-3.87) and stillbirths (OR 1.75; 95% CI: 1.21-2.53). There was no difference in congenital malformations observed between pregnancies exposed to other antihypertensives compared to non-exposed controls (OR 0.96; 95% CI: 0.69-1.33). Conclusions Women exposed to ACE-Is or ARBs during early pregnancy had higher risk of adverse fetal outcomes, including malformations and stillbirths, than non-exposed controls. This increased risk was independent of underlying maternal hypertension, as those exposed to other antihypertensives did not exhibit a higher risk than healthy controls. Women planning for pregnancy using these medications, including those with diabetic nephropathy, should be counselled appropriately. |
| Databáze: | OpenAIRE |
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