在基层医疗中，使用 ACEI 或 ARB 类药物的女性妊娠保护和妊娠情况：一项横断面研究。
Pregnancy protection and pregnancies in women prescribed ACE inhibitors or ARBs: a cross-sectional study in primary care.
机构信息
Portsmouth Hospitals NHS Trust, Portsmouth.
Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London.
出版信息
Br J Gen Pract. 2020 Oct 29;70(700):e778-e784. doi: 10.3399/bjgp20X712997. Print 2020 Nov.
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.
背景
血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB）的致畸风险已有充分记录，但在初级保健中越来越频繁地为年轻女性开这些药。
目的
记录在生育年龄的女性中，有多少人在服用 ACE 抑制剂或 ARB 时接受了孕前咨询和/或服用了避孕药，以及在该人群中发生了多少例妊娠、终止和流产。此外，确定上述模式是否因年龄组而异。
设计和设置
在伦敦东部的 141 家全科诊所的患者中进行的横断面研究。
方法
纳入 2018 年 10 月 1 日至 2019 年 1 月 1 日期间服用 ACE 抑制剂或 ARB 的 15-45 岁女性。设计了一个电子搜索策略，从电子临床系统中提取关于孕前和避孕咨询、避孕和妊娠的假名数据；该策略于 2019 年 1 月 1 日应用于选定的队列。数据按 5 年年龄组进行分析。
结果
在 15-45 岁的 302939 名女性中，有 2651 名（0.9%）在 3 个月内开了 ACE 抑制剂或 ARB。其中，2159 名（81.4%）无咨询记录，无避孕处方记录，35 名（1.3%）有孕前咨询记录，230 名（8.7%）有避孕咨询记录。在索引日期（2019 年 1 月 1 日）前的 12 个月内，共记录了 100 例妊娠和 21 例终止/流产。
结论
本研究发现，在服用 ACE 抑制剂或 ARB 的生育年龄女性中，孕前咨询和避孕记录不理想；这可能使妇女及其婴儿在怀孕期间面临接触致畸物的风险。研究结果表明，需要在初级保健中制定更好的安全策略。
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