Abstract
Background: The direct effects of angiotensin converting enzyme inhibitor (ACEI) medications on the fetus are difficult to determine since these medicines are usually administered to women presenting with high-risk pregnancies. The aim of this study was to provide an overview of the dispensing patterns, demographic characteristics and pregnancy outcomes of women dispensed an ACEI during pregnancy. Methods: Exposed pregnancies were all births in Western Australia, 2002-2005 where the mother was dispensed an ACEI under the Australian Pharmaceutical Benefits Scheme, compared with all other births during the same period. Result: From 2002 to 2005, there were 96,698 births in Western Australia. At least one form of ACEI was dispensed to 95 pregnant women (0.1%) and a further 677 pregnant women (0.7%) were dispensed an antihypertensive medication that was not an ACEI. Women dispensed an ACEI in the first trimester were more likely to be obese (aOR 33.4; 95% CI: 19.5-57.2), to have gestational diabetes (aOR 2.6; 1.3-5.4), to have a preterm delivery (aOR 2.8; 1.4-5.6), and to have smoked during their pregnancy (aOR 1.9; 1.2-3.0). The children of women dispensed an ACEI were more likely to have a major birth defect (aOR 2.6; 1.3-5.2). The risk of a major uro-genital birth defect (aOR 4.8; 2.0-11.7) was increased. Conclusion: Although ACEIs are contraindicated, pregnant women continue to be dispensed these medications. This study provides a profile of these women and their pregnancy outcomes. A clear change in the pattern of dispensing ACEIs later in pregnancy was apparent for these women. A greater number of women were dispensed ACEIs during trimester 1, followed by a marked reduction in dispenses in trimester 2 and trimester 3. Although the number of children affected is small, our data suggests that an increased risk of uro-genital defects may arise with maternal ACEI use in the first trimester.
Highlights
Hypertension is a common complication in pregnancy, with gestational hypertension occurring in approximately 10% of pregnancies and preeclampsia in 2-8% of pregnancies [1,2,3,4]
De-identified data were provided from the WA Data Linkage System (WADLS), linking the records of women with each pregnancy event to any related records in the Midwives’ Notification System (MNS), the Western Australian Register of Developmental Anomalies (WARDA) and the Registry of Births and Deaths
We investigated the risk of a primary postpartum haemorrhage of ≥ 500 ml after adjusting for Caesarean delivery, preeclampsia, plurality, and co-morbidities recorded on the birth admission and found there was still an increased risk, not statistically significant (1.6; 0.9-2.7)
Summary
Hypertension is a common complication in pregnancy, with gestational hypertension occurring in approximately 10% of pregnancies and preeclampsia in 2-8% of pregnancies [1,2,3,4]. Hypertension in pregnancy is defined by the Society of Obstetric Medicine of Australia and New Zealand as systolic blood pressure greater than or equal to 140 mmHg and/or diastolic blood pressure greater than or equal to 90 mmHg. The Society’s guidelines for selecting oral antihypertensive (AH) agents in the management of hypertension are included in the clinical guidelines of the primary tertiary hospital in Western Australia (WA) with treatment generally considered when blood pressure exceeds 150 mmHg systolic or 95 mmHg diastolic on several occasions. Second line agents are hydralazine, nifedipine and prazosin [5]. The direct effects of angiotensin converting enzyme inhibitor (ACEI) medications on the fetus are difficult to determine since these medicines are usually administered to women presenting with high-risk pregnancies. The aim of this study was to provide an overview of the dispensing patterns, demographic characteristics and pregnancy outcomes of women dispensed an ACEI during pregnancy
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