title: Pregnancy outcome after in utero exposure to angiotensin converting enzyme inhibitors or angiotensin receptor blockers.
abstract: OBJECTIVE
  To examine first trimester safety of angiotensin-converting-enzyme-inhibitors (ACEIs) or angiotensin-receptor-blockers (ARBs).
  
  
  METHODS
  Prospective observational cohort regarding pregnancy ACEI/ARBs-exposure including contacts to two Teratology Information Services in Israel (1994-2007) and Italy (1990-2008), with two comparison groups: (1) exposed to other antihypertensives (OAH) (2) after non-teratogenic exposure (NTE) in similar time frames.
  
  
  RESULTS
  252 ACEI/ARBs-exposed, 256 OAH-exposed and 495 NTE-exposed pregnancies were followed-up. The rate of major congenital anomalies was comparable between the groups (8/190, 4.2%, ACEI/ARB; 9/212, 4.2%, OAH; 18/471, 3.8% NTE; p = 0.954) among first trimester exposed pregnancies. The median gestational age at delivery was two weeks earlier, rate of preterm deliveries more than 2-fold higher, and median birth weight more than 200 g lower in the ACEI/ARB and OAH groups compared to the NTE group.
  
  
  CONCLUSIONS
  The present study suggests that ACEI/ARBs are not major teratogens when used in the first trimester, and can reassure women with similar exposures.
authors.affiliation: The Israeli Teratology Information Service, Jerusalem, Israel Ministry of Health, Jerusalem, Israel.
authors.forename: Orna
authors.initials: O
authors.lastname: Diav-Citrin
authors.forename: Svetlana
authors.initials: S
authors.lastname: Shechtman
authors.forename: Yehudit
authors.initials: Y
authors.lastname: Halberstadt
authors.forename: Victoriya
authors.initials: V
authors.lastname: Finkel-Pekarsky
authors.forename: Rebecka
authors.initials: R
authors.lastname: Wajnberg
authors.forename: Judy
authors.initials: J
authors.lastname: Arnon
authors.forename: Elena
authors.initials: E
authors.lastname: Di Gianantonio
authors.forename: Maurizio
authors.initials: M
authors.lastname: Clementi
authors.forename: Asher
authors.initials: A
authors.lastname: Ornoy
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology; D000328:Adult; D000704:Analysis of Variance; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001724:Birth Weight / Q000187:drug effects; D016009:Chi-Square Distribution; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D018811:Maternal Exposure; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced* / Q000453:epidemiology; D011261:Pregnancy Trimester, First; D047928:Premature Birth / Q000139:chemically induced; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents