Taking ACE inhibitors during early pregnancy

We have some significant reservations regarding Cooper and colleagues’ findings. 1 We believe that ascertainment bias and unrealized confounding are likely to have had an impact on these results. Clinicians and women thinking about getting pregnant should be discouraged from heeding the authors’ advice to refrain from using ACE inhibitors during the first trimester of pregnancy. Although the authors did not include women who were medicated or hospitalized for diabetes mellitus (DM), they were unable to do so for those who were undiagnosed or under diet control, who together account for more than half of all young women with DM. 2, 3 Additionally, Cooper and associates neglected to account for pre-pregnancy body mass, which is a significant predictor of the risk of type 2 diabetes and hypertension as well as a possible risk factor for fetal congenital abnormalities. 4, 5 These significant and significant unmeasured confounding factors may be directly related to the specific use of an ACE inhibitor (versus another antihypertensive medication, 6, 7). This idea would be supported by the fact that the majority of birth defects in the group exposed to ACE inhibitors were cardiac, for which maternal DM is a known risk factor8,

These results might deter young, non-pregnant women from using ACE inhibitors to achieve adequate blood pressure control even though there is level I evidence that they protect against cardiovascular and renal disease. Other studies that have been published have not discovered a link between ACE inhibitor use during the first trimester and fetal abnormalities. 13 We think that ACE inhibitors should not be portrayed as teratogenic when taken during the first trimester of pregnancy until it is proven otherwise. Before entering the second trimester of pregnancy, patients should switch to a different medication (such as labeta-alol or alpha-methyldopa). 13.

RESPONSE A recent study effectively quantifies the increased risk of malformations among women receiving treatment for hypertension following exposure to ECA inhibitors during the first three months. We believe that this study has significant limitations that prevent us from drawing conclusions at this time.

Finally, because about half of all pregnancies affected by major fetal anomalies are terminated, using birth certificate data alone to capture fetal anomalies, as was the case in their study, introduces ascertainment bias. 10–12 Any actual link between the use of ACE inhibitors and numerous significant anomalies would be obscured by the absence of a sizable number of terminated pregnancies.

Because of the increased risk of fetal renal damage, it is widely accepted that angiotensin-converting enzyme (ACE) inhibitors should not be used during the second and third trimesters of pregnancy. However, there is no evidence connecting first-trimester use to bad fetal outcomes.

Low levels of amniotic fluid (the fluid that surrounds the baby), which is caused by the use of lisinopril or any ACE inhibitor, may occur during the second or third trimester of pregnancy. Low levels of amniotic fluid can affect the developing baby’s health. Poor lung and skull development, growth restriction, and facial deformities are possible issues. A newborn baby’s low blood pressure and kidney failure can also be brought on by ACE inhibitors. After treatment, the infant has occasionally survived the complications. In other cases, the baby has died from these complications.

A medication called lisinopril is an ACE inhibitor, short for angiotensin-converting enzyme. Ace inhibitors result in blood vessel relaxation and a reduction in blood volume, which lowers blood pressure. Lisinopril is used to treat high blood pressure, safeguard the kidneys in diabetics, and lessen the chance of passing away from a heart attack. Some brand names for lisinopril are Prinivil®, Qbrelis®, and Zestril®. Another option for taking lisinopril is in combination with the diuretic hydrochlorothiazide (Zestoretic®). Please refer to the MotherToBaby fact sheet ACE Inhibitors for more information on ACE inhibitors. org/fact-sheets/ace-inhibitors-pregnancy/.

OTIS/MotherToBaby encourages inclusive and person-centered language. Although mothers are still mentioned in our name, we are updating our resources to use more inclusive language. When the terms “mother” or “maternal” are used, they refer to a pregnant person. When the terms “father” or “paternal” are used, it refers to a sperm donor.

When taken during the second and third trimesters of pregnancy, lisinopril can harm the unborn child. Because of this, it is advised that women who are pregnant stop taking lisinopril as soon as a pregnancy is discovered. However, you should not stop taking lisinopril without first speaking with your healthcare provider. Your doctor may need to recommend a different medication if you are currently taking lisinopril for high blood pressure in order to manage it during pregnancy. Stopping an ACE inhibitor abruptly without immediately beginning another medication for high blood pressure can result in a risky blood pressure spike that could have negative effects on the pregnancy.

There are no studies examining potential dangers to an unborn child if the baby’s father or sperm donor takes lisinopril. In general, fathers’ or sperm donors’ exposures are unlikely to raise pregnancy risks. Please visit MotherToBaby’s fact sheet Paternal Exposures and Pregnancy at https://mothertobaby.com for more details. org/fact-sheets/paternal-exposures-pregnancy/pdf/.

Mother To Baby | Fact Sheets [Internet].

Published online: October 1, 2020.

This fact sheet addresses the use of lisonpril during breastfeeding and pregnancy. This information shouldn’t replace seeking medical attention or seeking your healthcare provider’s advice.

What is lisinopril?

I take lisinopril. Can it make it harder for me to get pregnant?.

I just found out I am pregnant. Should I stop taking lisinopril? .

Does taking lisinopril increase the chance for miscarriage?

Does taking lisinopril increase the chance of birth defects?

Could taking lisinopril cause other pregnancy complications?

Can I breastfeed my baby if I am taking lisinopril?

I take lisinopril. Can it increase the likelihood of birth defects or make it harder for me to get my partner pregnant?

“OTIS/MotherToBaby encourages inclusive and person-centered language. Although mothers are still mentioned in our name, we are updating our resources to use more inclusive language. When the terms “mother” or “maternal” are used, they refer to a pregnant person. When the terms “father” or “paternal” are used, it refers to a sperm donor.

This work is available under the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported license (CC BY-NC-ND 3.0)

Lisinopril | What All Patients Need to Know | How to take it correctly, Side effects and more

Leave a Comment