Increasing exposure to angiotensin-converting enzyme inhibitors in pregnancy

Michael E. Bowen, Wayne A. Ray, Patrick G. Arbogast, Hua Ding, William O. Cooper

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)291.e1-291.e5
JournalAmerican journal of obstetrics and gynecology
Issue number3
StatePublished - Mar 2008


  • angiotensin-converting enzyme inhibitor
  • pregnancy
  • prescription
  • teratogen

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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