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Antihypertensive drugs and the risk of congenital anomalies
Catherine Vasilakis-Scaramozza1, Ann Aschengrau, Howard J Cabral
1Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
Study Objective:
To estimate the prevalence of congenital anomalies among the offspring of women exposed and unexposed to antihypertensive drugs during early pregnancy.
Design:
Matched cohort study.
Database:
The United Kingdom's General Practice Research Database.
Subjects:
Women exposed to antihypertensive drugs during early pregnancy and a sample of matched unexposed pregnant women.
Measurements And Main Results:
The prevalence of any anomaly among unexposed and exposed women was 23.5 (95% confidence interval [CI] 14.4-38.3) and 20.9 (95% CI 10.0-43.8) per 1000 pregnancies, respectively (relative risk [RR] 0.9, 95% CI 0.4-2.2). The relative risk of limb anomalies among women exposed to β-blockers was 6.4 (95% CI 0.6-70.1). Exposure to angiotensin-converting enzyme (ACE) inhibitors, β-blockers, and calcium channel blockers increased the risk of genital anomalies (RR 3.8, 95% CI 0.9-16.0; RR 2.8, 95% CI 0.7-11.9; RR 1.3, 95% CI 0.1-12.4, respectively).
Conclusion:
ACE inhibitors prescribed in the first trimester of pregnancy appeared to increase the risk of congenital anomalies among the offspring of exposed women (RR 2.5, 95% CI 0.5-13.5). These drugs should be avoided in women planning to become pregnant. A marginally increased risk was also found with exposure to β-blockers (RR 1.4, 95% CI 0.6-3.3). These findings are based on small numbers and are not statistically significant.
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