A study appearing in the June 8 issue of the New England Journal of Medicine indicates that ACE inhibitors - a popular class of drugs used for hypertension - are associated with birth defects affecting the cardiovascular system and the central nervous system.
Investigators from Vanderbilt University used the database maintained by Tennessee Medicaid to study information from nearly 30,000 births. Of these, 411 infants had been exposed to antihypertensive drugs during the first trimester. Those who were exposed to ACE inhibitors (209 babies) had a risk of birth defects that was almost 3 times higher than those not exposed to ACE inhibitors: 9 had cardiovascular malformations, 3 had central nervous system malformations, and 6 had other kinds of birth defects. Overall, 7% of infants exposed to ACE inhibitors in the first trimester had some form of birth defect, compared to a 2.6% risk among babies who had no exposure to any antihypertensive medication. Babies who had exposure to antihypertensive drugs other than ACE inhibitors showed no increase in risk.
DrRich Comments:
ACE inhibitors are already known to be dangerous to babies during the second two trimesters of pregancy, since they can cause impaired fetal growth, kidney disorders, and other problems. This new study - while it is a retrospective analysis and not strongly suggests that ACE inhibitors ought to be avoided during the first trimester as well. It is not likely that more definitive information will be forthcoming any time soon. This being the case, hypertensive women who are pregnant or who might become pregnant should avoid ACE inhibitors. Other antihypertensive drugs - diuretics, beta blockers, or calcium channel blockers - should probably be used instead.
ACE inhibitors include the following drugs: benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), Lisinopril (Prinivil, Zestril), moexipril (Univasc), erindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik).
Sources:
Cooper WO, Hernandez-Diaz S, Arbogast PG, et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med 2006; 354:2443-24511.
Friedman JM. ACE inhibitors and congenital anomalies. N Engl J Med 2006; 354:2498-2500.
