Pregnancy and ACE-I

ACE-I are very important agents in the management of hypertension, heart failure and even anti-atherosclerosis. It is very commonly prescribed. Captopril, the short acting ACE-I was the first ACE-I approved by the FDA almost 25 years ago, when I return from UK as a specialist.

We had known for a longtime that ACE-I should be avoided in the second and third trimester of pregnancy. In the 8th June issue of the New England Journal of Medicine, Dr William Cooper and associates, report on their epidermiological findings that the use of ACE-I in the first trimester of pregnancy, is associted with congenital CVS and Neurological birth defects. On reviewing the Vanderbilt University obstetrics database, they studied 29,507 births with 411 pregnancies being exposed to anti-hypertensive therapy, 209 on ACE-I and 202 on other hypertensive drugs.

They found that being on ACE-I in the first trimester, carried a 2.7 times more likely to have a major birth defect. The CVS defects included ASD, VSD and PDA and neurological defects include spina bifida, eye defects and even renal dysplasia. Obviously we need more data to confirm this findings. In the meantime, it would be wise to avoid the use of ACE-I in the first trimester of pregnancy. If you find out that you are pregnant and on an ACE-I, please request your doctor to change you to another anti-hypertensive agent. If you are already on an ACE-I and pregnant, please have a fetal ultrasound done at the 18th week, just to check. I think that this is a reasonable advise.