ACE Inhibitor and Angiotensin Receptor Blocker use during Pregnancy: data from the ESC Registry Of Pregnancy And Cardiac disease (ROPAC).

Details

Serval ID
serval:BIB_6983B349F887
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
ACE Inhibitor and Angiotensin Receptor Blocker use during Pregnancy: data from the ESC Registry Of Pregnancy And Cardiac disease (ROPAC).
Journal
The American journal of cardiology
Author(s)
van der Zande J.A., Ramlakhan K.P., Prokselj K., Muñoz-Ortiz E., Baroutidou A., Lipczynska M., Nagy E., Rutz T., Franx A., Hall R., Johnson M.R., Roos-Hesselink J.W.
Working group(s)
ROPAC investigators
ISSN
1879-1913 (Electronic)
ISSN-L
0002-9149
Publication state
In Press
Peer-reviewed
Oui
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Abstract
Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are not recommended during the second and third trimester due to the significant risk of congenital anomalies associated with their use. However, data are scarce, especially regarding their use in the first trimester and about the impact of stopping just before pregnancy. Our study illustrates the profile of the women who used ACE-Is or ARBs during pregnancy and evaluates the impact on perinatal outcomes. The Registry of Pregnancy and Cardiac disease (ROPAC) is a prospective, global registry of pregnancies in women with structural heart disease. Outcomes were compared between women who used ACE-Is or ARBs and those who did not. Multivariable regression analysis was performed to assess the effect of ACE-I or ARB use on the occurrence of congenital anomalies. ACE-I (n=35) and/or ARB (n=8) were used in 42 (0.7%) of the 5739 ROPAC pregnancies. Women who used ACE-Is or ARBs more often came from a low-or-middle-income country (57% vs 40%, p=0.021), had chronic hypertension (31% vs 6%, p<0.001), or a left ventricular ejection fraction <40% (33% vs 4%, p<0.001). In the multivariable analysis, ACE-I use during the first trimester was associated with an increased risk of congenital anomaly (OR 3.2; 95% CI 1.0-9.6). Therefore, ACE-Is should be avoided during pregnancy, also in the first trimester, due to a higher risk of congenital anomalies. However, there is no need to stop long before pregnancy. Preconception counseling is crucial to discuss the potential risks of these medications, to evaluate the clinical condition and, if possible, change or stop the medication.
Keywords
ACE inhibitor – Angiotensin receptor blocker – Preconception – Pregnancy
Pubmed
Create date
19/08/2024 8:47
Last modification date
20/08/2024 7:24
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