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Many pregnant women continue to be prescribed a class of antihypertensive medications dangerous to the fetus

Use of antihypertensive angiotensin-converting enzyme (ACE) inhibitors is contraindicated during the second and third trimesters of pregnancy due to dangers to the fetus. These dangers range from excessively low blood pressure and scant amniotic fluid to kidney problems and death. Yet the number of pregnant women prescribed these medications grew steadily between 1986 and 2003, according to a new study. Clearly, better methods are needed to reduce fetal exposure to prescribed medications with potential for fetal harm, concludes Wayne A. Ray, Ph.D., of the Vanderbilt University Medical Center CERT (Center for Education and Research on Therapeutics), which is supported by the Agency for Healthcare Research and Quality (HS10384).

Dr. Ray and fellow researchers retrospectively studied 262,179 women enrolled in the Tennessee Medicaid program during their pregnancy who delivered a live infant or suffered a fetal death between 1986 and 2003. During this period, use of ACE inhibitors increased 4.5-fold from 11.2 to 58.9 per 10,000 pregnancies. Women's exposure to these drugs in the second and third trimesters nearly tripled and did not decrease following a U.S. Food and Drug Administration black box warning against such use in 1992. Use of these drugs was most common among pregnant women 35 years and older. A recent study found dangers of first-trimester use of ACE inhibitors as well, further underscoring concerns about these medications for pregnant women.

The authors recommend educating physicians and patients about the dangers of ACE inhibitors to the fetus and counseling women about their risks and benefits when initially prescribing them.

More details are in "Increasing exposure to angiotensin-converting enzyme inhibitors in pregnancy," by Michael E. Bowen, M.D., M.P.H., Dr. Ray, Patrick G. Arbogast, Ph.D., and others, in the March 2008 American Journal of Obstetrics & Gynecology 198, pp. 291.e1-291.e5.

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