Table 2.
Risk of major birth defects in offspring of 465 754 women who delivered in the Kaiser Permanente Northern California region during 1995–2008 by maternal use of antihypertensive medications during pregnancy
| No (%) of mother-infant pairs | Odds ratio (95% CI) | |||
|---|---|---|---|---|
| Crude | Adjusted* | |||
| Any birth defect | ||||
| Normal controls† | 22 429/416 218 (5.4) | Reference | Reference | — |
| Hypertension controls‡ | 2247/31 274 (7.2) | 1.36 (1.30 to 1.42) | 1.25 (1.19 to 1.31) | Reference |
| Antihypertensive use: | ||||
| Only in 1st trimester: | ||||
| Other antihypertensives§ | 79/1141 (6.9) | 1.31 (1.04 to 1.64) | 1.22 (0.97 to 1.54) | 1.00 (0.79 to 1.27) |
| ACE inhibitors¶ | 34/400 (8.5) | 1.63 (1.15 to 2.32) | 1.20 (0.84 to 1.72) | 0.97 (0.67 to 1.41) |
| Any in 1st trimester** | ||||
| Other antihypertensives§ | 327/4390 (7.5) | 1.41 (1.26 to 1.58) | 1.29 (1.15 to 1.45) | 1.07 (0.94 to 1.21) |
| ACE inhibitors¶ | 58/704 (8.2) | 1.58 (1.21 to 2.06) | 1.15 (0.87 to 1.52) | 0.97 (0.73 to 1.30) |
| Only in 2nd or 3rd trimesters: | ||||
| Other antihypertensives§ | 1334/13 117 (10.2) | 1.99 (1.88 to 2.11) | 1.94 (1.83 to 2.05) | 1.53 (1.43 to 1.65) |
| ACE inhibitors¶ | 7/51 (13.7) | 2.80 (1.26 to 6.21) | 2.34 (1.05 to 5.22) | 1.88 (0.84 to 4.20) |
| Congenital heart defects†† | ||||
| Normal controls† | 6232/400 021 (1.6) | Reference | Reference | — |
| Hypertension controls‡ | 708/29 735 (2.4) | 1.54 (1.43 to 1.67) | 1.41 (1.30 to 1.53) | Reference |
| Antihypertensive use: | ||||
| Only in 1st trimester: | ||||
| Other antihypertensives§ | 28/1090 (2.6) | 1.67 (1.14 to 2.43) | 1.52 (1.04 to 2.21) | 1.12 (0.76 to 1.64) |
| ACE inhibitors¶ | 15/381 (3.9) | 2.59 (1.54 to 4.34) | 1.54 (0.90 to 2.62) | 1.14 (0.65 to 1.98) |
| Any in 1st trimester** | ||||
| Other antihypertensives§ | 123/4186 (2.9) | 1.91 (1.59 to 2.29) | 1.67 (1.39 to 2.01) | 1.24 (1.02 to 1.52) |
| ACE inhibitors¶ | 24/670 (3.6) | 2.35 (1.57 to 3.54) | 1.39 (0.91 to 2.13) | 1.10 (0.70 to 1.71) |
| Only in 2nd or 3rd trimesters: | ||||
| Other antihypertensives§ | 566/12 349 (4.6) | 3.04 (2.78 to 3.32) | 2.90 (2.65 to 3.16) | 2.02 (1.81 to 2.27) |
| ACE inhibitors¶ | 4/48 (8.3) | 5.75 (2.06 to 15.99) | 4.28 (1.53 to 11.97) | 3.04 (1.08 to 8.56) |
| Neural tube defects†† | ||||
| Normal controls† | 2447/396 236 (0.6) | Reference | Reference | — |
| Hypertension controls‡ | 281/29 308 (1.0) | 1.56 (1.38 to 1.76) | 1.43 (1.26 to 1.62) | Reference |
| Antihypertensive use: | ||||
| Only in 1st trimester: | ||||
| Other antihypertensives§ | 9/1071 (0.8) | 1.36 (0.71 to 2.63) | 1.26 (0.65 to 2.44) | 0.90 (0.46 to 1.76) |
| ACE inhibitors¶ | 2/368 (0.5) | 0.88 (0.22 to 3.53) | 0.59 (0.14 to 2.38) | 0.44 (0.11 to 1.84) |
| Any in 1st trimester** | ||||
| Other antihypertensives§ | 41/4104 (1.0) | 1.62 (1.19 to 2.22) | 1.46 (1.07 to 2.00) | 1.07 (0.76 to 1.50) |
| ACE inhibitors¶ | 6/652 (0.9) | 1.50 (0.67 to 3.34) | 1.03 (0.45 to 2.36) | 0.86 (0.37 to 2.03) |
| Only in 2nd or 3rd trimesters: | ||||
| Other antihypertensives§ | 193/11 976 (1.6) | 2.64 (2.27 to 3.06) | 2.51 (2.16 to 2.91) | 1.71 (1.41 to 2.06) |
| ACE inhibitors¶ | 2/46 (4.3) | 7.33 (1.78 to 30.21) | 5.39 (1.30 to 22.40) | 3.79 (0.90 to 15.87) |
*Adjusted for pre-existing diabetes, maternal age, ethnicity, parity, and maternal weight, and with different reference categories (normal controls or hypertension controls).
†No use of antihypertensives during pregnancy and no diagnosis of hypertension.
‡No use of antihypertensives during pregnancy but with a diagnosis of hypertension.
§Use of antihypertensives other than ACE inhibitors during pregnancy.
¶Use of ACE inhibitors during pregnancy.
**Any use of antihypertensives in first trimester regardless of use in other trimesters.
††Excluding cases of other birth defects from the denominator.