Pregnancy protection and pregnancies in women prescribed ACE inhibitors or ARBs: a cross-sectional study in primary care
Pregnancy protection and pregnancies in women prescribed ACE inhibitors or ARBs: a cross-sectional study in primary care
BACKGROUND: The teratogenic risks of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are well documented, but prescribing these in younger women in primary care is becoming increasingly frequent.
AIM: To record how frequently women of childbearing age, who are prescribed an ACE inhibitor or ARB, receive preconception advice and/or are prescribed contraception, and how many pregnancies, terminations, and miscarriages occur in this population. Additionally, to ascertain whether patterns in the above differ across age groups.
DESIGN AND SETTING: Cross-sectional study conducted among patients from 141 general practices in East London.
METHOD: 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; this was applied to the selected cohort on 1 January 2019. Data were analysed in 5-year age groups.
RESULTS: Of 302 939 women aged 15-45 years, 2651 (0.9%) were prescribed an ACE inhibitor or an ARB in a 3-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).
CONCLUSION: This study found that the recording of pre-pregnancy advice and contraception in women of childbearing age who were prescribed an ACE inhibitor or an ARB was suboptimal; this may place women and their babies at risk of exposure to teratogens during pregnancy. The findings indicate that there is a need for improved safety strategies based in primary care.
Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors/adverse effects, Cross-Sectional Studies, Female, Humans, London, Pregnancy, Primary Health Care
e778-e784
Lovegrove, Elizabeth
d7b61630-099a-4faf-94a8-10506cc9887c
Robson, John
3aae61e5-2c15-49db-b25a-86a844287aa0
McGettigan, Patricia
c9e23813-4615-4cd0-a015-7adef72c3e13
November 2020
Lovegrove, Elizabeth
d7b61630-099a-4faf-94a8-10506cc9887c
Robson, John
3aae61e5-2c15-49db-b25a-86a844287aa0
McGettigan, Patricia
c9e23813-4615-4cd0-a015-7adef72c3e13
Lovegrove, Elizabeth, Robson, John and McGettigan, Patricia
(2020)
Pregnancy protection and pregnancies in women prescribed ACE inhibitors or ARBs: a cross-sectional study in primary care.
The British journal of general practice : the journal of the Royal College of General Practitioners, 70 (700), .
(doi:10.3399/bjgp20X712997).
Abstract
BACKGROUND: The teratogenic risks of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are well documented, but prescribing these in younger women in primary care is becoming increasingly frequent.
AIM: To record how frequently women of childbearing age, who are prescribed an ACE inhibitor or ARB, receive preconception advice and/or are prescribed contraception, and how many pregnancies, terminations, and miscarriages occur in this population. Additionally, to ascertain whether patterns in the above differ across age groups.
DESIGN AND SETTING: Cross-sectional study conducted among patients from 141 general practices in East London.
METHOD: 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; this was applied to the selected cohort on 1 January 2019. Data were analysed in 5-year age groups.
RESULTS: Of 302 939 women aged 15-45 years, 2651 (0.9%) were prescribed an ACE inhibitor or an ARB in a 3-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).
CONCLUSION: This study found that the recording of pre-pregnancy advice and contraception in women of childbearing age who were prescribed an ACE inhibitor or an ARB was suboptimal; this may place women and their babies at risk of exposure to teratogens during pregnancy. The findings indicate that there is a need for improved safety strategies based in primary care.
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Published date: November 2020
Additional Information:
© British Journal of General Practice 2020.
Keywords:
Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors/adverse effects, Cross-Sectional Studies, Female, Humans, London, Pregnancy, Primary Health Care
Identifiers
Local EPrints ID: 505899
URI: http://eprints.soton.ac.uk/id/eprint/505899
ISSN: 0960-1643
PURE UUID: 69ec4ed7-756f-4ba6-a55d-1f00929e7a79
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Date deposited: 22 Oct 2025 16:57
Last modified: 23 Oct 2025 02:15
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Author:
John Robson
Author:
Patricia McGettigan
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