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Aetiology
Fetal exposure to ACE inhibitors increased risk of major congenital malformations

https://doi.org/10.1136/ebm.12.1.26

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    Cooper WO, Hernandez-Diaz S, Arbogast PG, et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med 2006;354:2443–51.
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 Q Is fetal exposure to angiotensin converting enzyme (ACE) inhibitors during the first trimester of pregnancy associated with increased risk of congenital malformations?

    Clinical impact ratings GP/FP/Primary care ★★★★★★☆ Cardiology ★★★★★★☆ Obstetrics ★★★★★★☆ Paediatrics ★★★★★☆☆ Paediatric neonatology ★★★★★★★ Paediatric hospital medicine ★★★★★★☆

    METHODS

    Embedded ImageDesign:

    database linked cohort study.

    Embedded ImageSetting:

    Tennessee, USA.

    Embedded ImagePatients:

    29 507 infants born between 1985 and 2000 whose mothers were enrolled in Medicaid. 209 infants had been exposed to ACE inhibitors in the first trimester only, 202 infants had been exposed to other antihypertensive drugs in the first trimester only, and 29 096 had had no such exposure. Exclusion criteria: evidence of maternal diabetes before or during pregnancy, maternal prescription for angiotensin receptor antagonists, fetal exposure to ACE inhibitors or other antihypertensive drugs beyond the first trimester, or fetal exposure to …

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    Footnotes

    • For correspondence: Dr W O Cooper, Vanderbilt University School of Medicine, Nashville, TN, USA. william.cooper{at}vanderbilt.edu

    • Sources of funding: Food and Drug Administration; Agency for Healthcare Research and Quality; Centers for Education and Research on Therapeutics.