Pregnancy protection and pregnancies in women prescribed ACE inhibitors or ARBs: a cross-sectional study in primary care

Elizabeth Lovegrove; John Robson; Patricia McGettigan

doi:10.3399/bjgp20X712997

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Figure 1.
Percentage of each age group for whom preconception or contraception advice was recorded during the 12 months preceding the index date.
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Figure 2.
Percentage of each age group for whom a LARC or an oral/transdermal contraceptive was recorded in the relevant time frames. LARC = long-acting reversible contraception.
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Figure 3.
Percentage of each age group for whom no preconception advice, contraception advice, or contraception was recorded in the relevant time frames.
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Figure 4.
Percentage of each age group, for whom either a pregnancy or a termination/miscarriage was recorded in the 12 months preceding the index date.

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Exposure to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers during pregnancy is associated with teratogenic risk to the fetus. This study shows that the recording of pre-pregnancy advice and contraception in women of childbearing age, who are prescribed such medicines, is suboptimal and a number of pregnancies occur in this population. As this may place women and their babies at risk of exposure to teratogens, there is a need for significant improvements in the care of these patients.

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Table 1.

Age and ethnicity of the study population (N = 2651)

Characteristic	n (%)
Age group^a
15–19 years	19 (0.7)
20–24 years	34 (1.3)
25–29 years	93 (3.5)
30–34 years	238 (9.0)
35–39 years	626 (23.6)
40–45 years	1641 (61.9)

Ethnicity^b
Asian/Asian British	1641 (61.9)
White/other white	342 (12.9)
Black African/black Caribbean/black British	334 (12.6)

↵a Range: 15–45 years; mean age: 39.6 years.
↵b Small numbers of women listed under various ethnicities, or women with no recorded ethnicity, made up the remaining 12.6% (n = 334) of the study population’s listed ethnicities.

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Table 2.

Recorded preconception advice, contraception advice, pregnancies, and terminations/miscarriages

Population	Time frame	Recorded pregnancies, n (%)	Recorded terminations/miscarriages, n (%)
All women (n = 2651)	12 months preceding the index date	100 (3.8)	21 (0.8)
All women (n = 2651)	Following most-recent ACE inhibitor/ARB prescription	13 (0.5)	4 (0.2)
Women with no recorded advice or contraception (n = 2159)	12 months preceding the index date	63 (2.9)	16 (0.7)
Women with no recorded advice or contraception (n = 2159)	Following most recent ACE inhibitor/ARB prescription	11 (0.5)	3 (0.1)

ACE = angiotensin-converting enzyme. ARB = angiotensin receptor blocker.

Supplementary Data

SUPPLEMENTARY DATA

Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.