Rationale:

• ACE inhibitors and angiotensin-receptor blockers have been associated with fetal malformations.
• No adverse maternal effects are likely to occur with a 9-month hiatus from cholesterol-lowering agents, and because HMG-CoA reductase inhibitors have been implicated as possible teratogens, the risks of their use outweigh the benefits to the mother.
• Daily aspirin therapy may lead to maternal and newborn hemorrhage, increased perinatal mortality, intrauterine growth retardation, and teratogenic effects.

Evidence:

• A review revealed numerous case reports of babies exposed to ACE inhibitors and angiotensin-receptor blockers in utero who had multiple anomalies, including fetal hypocalvaria and renal defects (8).
• In a surveillance study of lovastatin exposures during pregnancy, the overall rate of normal outcomes was 85%, and the following rates of occurence were found: congenital anomalies, 4%; spontaneous abortions, 8%; and fetal deaths or stillbirths, 1% (9).
• In one case-controlled study, 3 of 14 newborns exposed to aspirin within 1 week of delivery had minor hemorrhaging compared with 1 of 17 controls (10). In two retrospective studies, mothers of 1,291 malformed infants were found to have consumed aspirin during pregnancy more frequently than mothers of normal infants (11; 12).

Comments:

• Many diabetic women are on a variety of medications; therefore, pre-conception planning should include a review of all drugs and their potential for teratogenesis.