Increasing exposure to angiotensin-converting enzyme inhibitors in pregnancy
Increasing exposure to angiotensin-converting enzyme inhibitors in pregnancy
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DOI：
10.1016/j.ajog.2007.09.009
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发表时间：
2008-03-01
影响因子：
9.8
通讯作者：
Cooper, William O.
中科院分区：
文献类型：
--
作者：
Bowen, Michael E.;Ray, Wayne A.;Cooper, William O.
目的：这项研究的目的是确定血管紧张素转换酶（ACE）抑制剂处方填充的趋势，在孕妇研究设计：这是一项回顾性队列研究，在妇女连续登记在田纳西州医疗补助计划在怀孕期间谁提供了一个活的婴儿或胎儿死亡之间1986年至2003年结果：ACE抑制剂暴露增加了4倍多：从1986-1988年的11.2/10000例妊娠增加到2003年的58.9/10000例妊娠（校正风险比[RR]，4.49; 95%置信区间[Cl]，2.78-7.25）。妊娠中期和妊娠晚期的暴露量几乎增加了两倍（RR，2.88; 95% CI，1.45-5.75），并且在1992年美国食品和药物管理局针对此类使用发出黑盒警告后没有减少。暴露是最常见的妇女35岁或older.CONCLUSION：尽管有证据表明，胎儿并发症与ACE抑制剂使用在怀孕期间，怀孕相关的ACE抑制剂暴露的孕妇人数稳步增加，1986-2003年之间。需要更好的方法来减少胎儿暴露于潜在的致畸处方药。
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 [Cl], 2.78-7.25). Exposures in the second and third trimesters nearly tripled ( RR, 2.88; 95% Cl, 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.