July 23, 2006First-trimester use of ACEIs linked to birth injuries

A recent article in the New England Journal of Medicine states that angiotensin-converting enzyme inhibitors (also known as ACE inhibitors or ACEIs) used for the treatment of high blood pressure may cause birth injuries such as cerebral palsy when taken in the first trimester of pregnancy.

Researchers found that women who took ACE inhibitors during their first trimester were twice as likely to deliver a child with a major birth injury, especially in the central nervous system and cardiovascular system.

The Food and Drug Administration responded to these findings by urging pregnant women who are taking ACEIs to consult with their doctors. 

Scientists have known for a long time that ACEIs are not the first choice for treating high blood pressure in most situations—and certainly not during pregnancy. 

The FDA issued a warning in 1992 that use of ACEIs during the second and third trimesters could raise the risk of birth defects. By 1997, the Centers for Disease Control and Prevention extended it to include the first trimester.

Soon came more bad news about ACEIs in the form of the ALLHAT study. It found that ACE inhibitors do not control blood pressure any more effectively than diuretics, but they are linked with higher rates of heart disease and stroke. ACEIs are also considerably more expensive—$532 for a year’s supply as compared with $22 for diuretics.

Be that as it may, the makers of ACEIs have successfully marketed their products. Researchers at the University of Michigan found that most doctors overestimate the benefits of ACEIs and underestimate their risks. Physicians who were most likely to prescribe ACEIs for treating high blood pressure also tended to pass out free drug samples given to them by representatives of pharmaceutical companies. This led the researchers to note the pervasive influence of “big pharma.”

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