20.500.12556/DiRROS-24750 ACE inhibitor and angiotensin receptor blocker use during pregnancy data from the ESC registry of pregnancy and cardiac disease (ROPAC) Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are not recommended during the second and third trimester because of the significant risk of congenital anomalies associated with their use. However, data are scarce, especially regarding their use in the first trimester and about the impact of stopping just before pregnancy. Our study illustrates the profile of the women who used ACE-Is or ARBs during pregnancy and evaluates the impact on perinatal outcomes. The Registry of Pregnancy and Cardiac Disease is a prospective, global registry of pregnancies in women with structural heart disease. Outcomes were compared between women who used ACE-Is or ARBs and those who did not. Multivariable regression analysis was performed to assess the effect of ACE-I or ARB use on the occurrence of congenital anomalies. ACE-Is (n = 35) and/or ARBs (n = 8) were used in 42 (0.7%) of the 5,739 Registry of Pregnancy and Cardiac Disease pregnancies. Women who used ACE-Is or ARBs more often came from a low-or-middle-income country (57% vs 40%, p = 0.021), had chronic hypertension (31% vs 6%, p <0.001), or a left ventricular ejection fraction <40% (33% vs 4%, p <0.001). In the multivariable analysis, ACE-I use during the first trimester was associated with an increased risk of congenital anomaly (odds ratio 3.2, 95% confidence interval 1.0 to 9.6). Therefore, ACE-Is should be avoided during pregnancy, also in the first trimester, because of a higher risk of congenital anomalies. However, there is no need to stop long before pregnancy. Preconception counseling is crucial to discuss the potential risks of these medications, to evaluate the clinical condition and, if possible, to change or stop the medication. ACE inhibitor angiotensin receptor blocker preconception pregnancy true false true Angleški jezik Ni določen Neznano 2025-12-16 13:56:18 2025-12-16 13:56:18 2025-12-17 03:58:07 0000-00-00 00:00:00 2024 0 0 Nasl. z nasl. zaslona; Opis vira z dne 19. 11. 2025; str. 27-36 Vol. 230 2024 0000-00-00 Zaloznikova Objavljeno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 616.1 1879-1913 10.1016/j.amjcard.2024.08.004 257731075 RAZ_Van_der_Zande_Johanna_A._2024.pdf RAZ_Van_der_Zande_Johanna_A._2024.pdf 1 94F81EF168481F7235CC6680ECFB3EC3 307a0e17bdbd3f02eccc66ba57e21b729e369a289edfc4a8b79f7a516dade74e cab7aa04-da7e-11f0-94a7-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=36990 https://www.ajconline.org/article/S0002-9149(24)00579-4 0 d74f5cf5-da7e-11f0-94a7-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=36991 Univerzitetni klinični center Ljubljana 0 0 0