The adverse effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) for pregnant women and their babies is known, but the recording of pre-pregnancy advice when prescribing these drugs is suboptimal, according to a new study from Queen Mary University of London.
The cross-sectional study was conducted among patients from 141 general practices in East London. Women aged 15-45 years who were issued a prescription for an ACE inhibitor or ARB between 1 October 2018 and 1 January 2019 inclusive were included. An electronic search strategy was designed to extract pseudonymised data concerning preconception and contraception advice, contraception and pregnancies from the electronic clinical system.
Of 302,939 women included, 2651 (0.9%) were prescribed an ACE inhibitor or an ARB in the three-month period. Of these, 2159 (81.4%) had no advice and no contraception prescription recorded, 35 (1.3%) had preconception advice recorded and 230 (8.7%) had contraception advice recorded.
A total of 100 pregnancies and 21 terminations/miscarriages were recorded in the 12 months preceding the index date (1 January 2019).
Presenting the findings in British Journal of General Practice, the authors say the study shows that the recording of pre-pregnancy advice and contraception in women of childbearing age who were prescribed an ACE inhibitor or an ARB is suboptimal, which may be placing women and their babies at risk of exposure to teratogens during pregnancy. They say the findings indicate that there is a need for improved safety strategies based in primary care.