Increasing exposure to angiotensin-converting enzyme inhibitors in pregnancy

Objective: The objective of the study was to identify angiotensin-converting enzyme (ACE) inhibitor prescription-filling trends in pregnant women. Study Design: This was a retrospective cohort study in women continuously enrolled in Tennessee Medicaid during pregnancy who delivered a live infant or had a fetal death between 1986-2003 (n = 262,179). Results: ACE inhibitor exposures increased more than 4-fold: from 11.2 per 10,000 pregnancies in 1986-1988 to 58.9 per 10,000 pregnancies by 2003 (adjusted risk ratio [RR], 4.49; 95% confidence interval [CI], 2.78-7.25). Exposures in the second and third trimesters nearly tripled (RR, 2.88; 95% CI, 1.45-5.75) and did not decrease following a US Food and Drug Administration black box warning against such use in 1992. Exposures were most common among women 35 years of age or older. Conclusion: Despite evidence of fetal complications associated with ACE inhibitor use during pregnancy, the number of pregnant women with pregnancy-related ACE inhibitor exposures increased steadily between 1986-2003. Better methods are needed to reduce fetal exposure to potentially teratogenic prescribed medications.