Renin-angiotensin system (ACEIs and/or ARBs) (versus unexposed) updated on 03-11-2025

Early intrauterine deaths (< 22 weeks) / Spontaneous abortions

id	Study   Auto Van der Zande - ACE-Is and/or ARBs, 2024Hoeltzenbein a - ARBs, 2018Hoeltzenbein b - ACEi, 2018Moretti - ACEi/ARBs, 2012Diav-Citrin - ACEi/ARB, 2011Cournot - ACEi, 2006	Lib. in paper	Exposition period  Auto during pregnancy (anytime or not specified)1st trimester2nd trimester3rd trimester2nd and/or 3rd trimesterthroughout pregnancyearly pregnancydays before deliverylate pregnancypreconception-onlypericonceptionalpreconceptional for kinetic reasonat least 1st trimester3 months (or more) before pregnancy or during pregnancy1st and 2nd trimester3 months or more before pregnancy or1st trimester	Study type  All studies Case control excluded Only case control	Control type    Auto unexposed (general population or NOS)unexposed, sickunexposed, disease freeexposed to other treatment, sicknot specifiedsiblingwhatever (meta-analysis)	Tags	OR 95%CI	x1/n1 x0/n0	no cases	no exposed	ROB	Ref.
S17123 R71686	Van der Zande - ACE-Is and/or ARBs, 2024	Reported miscarriage (NOS)	1st trimester	prospective cohort	unexposed, sick	Adjustment: No Indications Antihypertensive: Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) Renin angiotensin: ARBs and/or ACEIs (Angiotensin II receptor blockers and/or Angiotensin-converting enzyme inhibitors)	2.52 [0.76;8.30] C	3/34   211/5,697	214	34		ref
S14147 R55481	Hoeltzenbein a - ARBs, 2018	Spontaneous abortion	early pregnancy	prospective cohort	unexposed, disease free	Adjustment: Yes Indications Antihypertensive: Only chronic hypertension indication Matched Renin angiotensin: ARBs (Angiotensin II receptor blockers)	0.90 [0.50;1.60]	26/215   57/642	83	215		ref
S14149 R55510	Hoeltzenbein b - ACEi, 2018	Spontaneous abortions	early pregnancy	prospective cohort	unexposed, disease free	Adjustment: Yes Indications Antihypertensive: Only chronic hypertension indication Matched Renin angiotensin: ACEIs (Angiotensin-converting enzyme inhibitors)	1.20 [0.74;1.92]	47/329   54/654	101	329		ref
S14158 R55559	Moretti - ACEi/ARBs, 2012	Spontaneous abortion	1st trimester	prospective cohort	unexposed, disease free	Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified Matched Renin angiotensin: ARBs and/or ACEIs (Angiotensin II receptor blockers and/or Angiotensin-converting enzyme inhibitors)	1.67 [0.85;3.29] C	25/139   16/138	41	139		ref
S14145 R55543	Diav-Citrin - ACEi/ARB, 2011	Miscarriage	early pregnancy	prospective cohort	unexposed (general population or NOS)	Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified Renin angiotensin: ARBs and/or ACEIs (Angiotensin II receptor blockers and/or Angiotensin-converting enzyme inhibitors)	1.95 [1.14;3.31] C	29/252   31/495	60	252		ref
S14146 R55476	Cournot - ACEi, 2006	Spontaneous abortions	1st trimester	prospective cohort	unexposed (general population or NOS)	Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified Matched Renin angiotensin: ACEIs (Angiotensin-converting enzyme inhibitors)	1.46 [0.54;3.93] C	10/159   7/159	17	159		ref
					Total	6 studies	1.41 [1.07;1.84]		516	1,128
x1: number of endpoints among exposed, n1: number of exposed; x0: number of endpoints among non exposed, n0: number of non exposed; C: calculated odds ratio from numbers of events and effectives

Forest plot

Sensitivity analysis

Publication bias and p-hacking diagnosis

Sub-groups analysis using all included studies

excluded

Umbrella review (other published meta-analyses)