1, 2 ACEIs/ARBs modulate the RAAS by either inhibiting an enzyme responsible for the conversion of angiotensin I to angiotensin II or by antagonizing the effects of angiotensin II at its receptors. Women of reproductive age should be aware of the potential teratogenic risks of these drugs if they become pregnant.Īngiotensin‐converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), an alternative for ACEI‐intolerant patients, are commonly used for the treatment of cardiovascular disease whereby the renin‐angiotensin‐aldosterone system (RAAS) is involved in its pathophysiology. In conclusion, prenatal exposure to ACEIs/ARBs in the first trimester of pregnancy was found to be associated with an increased risk of adverse pregnancy outcomes.

Cardiovascular malformations, miscarriage, and stillbirth also provided a significant relation with ACEI/ARB exposure. Meta‐analysis revealed a significant association between overall congenital malformations and first trimester‐only exposure to ACEIs/ARBs (OR = 1.94, 95% CI = 1.71‐2.21, P < .0001). Of 19 included articles involving a total of 4 163 753 pregnant women, 13 studies reported an increased risk of, at least, one adverse pregnancy outcome in pregnant women who were exposed to ACEIs/ARBs. The main outcomes included overall and specific congenital malformations, low birth weight, miscarriage, elective termination of pregnancy, stillbirth, and preterm delivery. Pooled‐effect estimates of each outcome were calculated by the random‐effects meta‐analysis. Odds ratios were used as a summary effect measure.

Included studies were limited to original investigations assessing the association between prenatal exposure to ACEIs/ARBs and adverse pregnancy outcomes. A systematic search was performed on four databases, that is, PubMed, Scopus, Web of Science, and Cochrane Library, to identify relevant articles published up to December 31, 2019. This study aimed to determine the effects of prenatal exposure to angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), particularly when exposure is limited to the first trimester of pregnancy, on adverse maternal and neonatal outcomes.

Specific side effect of ace inhibitors