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

Elective/induced termination of pregnancy

R analysis
id Study   Lib. in paper Exposition period    Study type 
 Control type 
 
Tags OR 95%CI x1/n1 x0/n0 no cases no exposed ROB Ref.
S14147
R55482		 Hoeltzenbein a - ARBs, 2018 Elective termination of pregnancy early pregnancy prospective cohort unexposed, disease free Adjustment: Yes Indications Antihypertensive: Only chronic hypertension indication Matched Renin angiotensin: ARBs (Angiotensin II receptor blockers) 2.70 [1.30;5.60] 24/189   25/585 49 189
ref
S14149
R55511		 Hoeltzenbein b - ACEi, 2018 Elective termination of pregnancy early pregnancy prospective cohort unexposed, disease free Adjustment: Yes Indications Antihypertensive: Only chronic hypertension indication Matched Renin angiotensin: ACEIs (Angiotensin-converting enzyme inhibitors) 1.18 [0.68;2.02] 30/329   46/654 76 329
ref
S14158
R55560		 Moretti - ACEi/ARBs, 2012 Elective 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) 13.49 [0.75;241.86] C 6/139   0/138 6 139
ref
S14145
R55544		 Diav-Citrin - ACEi/ARB, 2011 Elective termination of pregnancy 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) 3.72 [2.04;6.79] C 31/252   18/495 49 252
ref
S14146
R55477		 Cournot - ACEi, 2006 Voluntary 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) 6.41 [1.41;29.12] C 12/159   2/159 14 159
ref
Total 5 studies 2.80 [1.42;5.52] 194 1,068
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

StudyTE95% CIn casesn exposedweightROBABCDEF Hoeltzenbein a - ARBs, 2018Hoeltzenbein a - ARBs, 2018 2.70[1.30; 5.60]4918925%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: lowROB mesure: unclearROB reporting: moderate Hoeltzenbein b - ACEi, 2018Hoeltzenbein b - ACEi, 2018 1.18[0.68; 2.02]7632929%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Moretti - ACEi/ARBs, 2012Moretti - ACEi/ARBs, 2012 13.49[0.75; 241.86]61395%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Diav-Citrin - ACEi/ARB, 2011Diav-Citrin - ACEi/ARB, 2011 3.72[2.04; 6.79]4925228%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: lowROB mesure: unclearROB reporting: moderate Cournot - ACEi, 2006Cournot - ACEi, 2006 6.41[1.41; 29.12]1415913%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: unclearROB reporting: moderate Total (5 studies) I2 = 66% 2.80[1.42; 5.52]1941,0680.550.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 2.80[1.42; 5.52]1941,06866%NAHoeltzenbein a - ARBs, 2018 Hoeltzenbein b - ACEi, 2018 Moretti - ACEi/ARBs, 2012 Diav-Citrin - ACEi/ARB, 2011 Cournot - ACEi, 2006 5 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 2.80[1.42; 5.52]1941,06866%NAHoeltzenbein a - ARBs, 2018 Hoeltzenbein b - ACEi, 2018 Moretti - ACEi/ARBs, 2012 Diav-Citrin - ACEi/ARB, 2011 Cournot - ACEi, 2006 5 Tags Adjustment   - No  - No 4.18[2.42; 7.25]695500%NAMoretti - ACEi/ARBs, 2012 Diav-Citrin - ACEi/ARB, 2011 Cournot - ACEi, 2006 3   - Yes  - Yes 1.72[0.77; 3.86]12551868%NAHoeltzenbein a - ARBs, 2018 Hoeltzenbein b - ACEi, 2018 2 Indications Antihypertensive   - All hypertensions, any indications ...  - All hypertensions, any indications or not specified 4.18[2.42; 7.25]695500%NAMoretti - ACEi/ARBs, 2012 Diav-Citrin - ACEi/ARB, 2011 Cournot - ACEi, 2006 3   - Only chronic hypertension indication  - Only chronic hypertension indication 1.72[0.77; 3.86]12551868%NAHoeltzenbein a - ARBs, 2018 Hoeltzenbein b - ACEi, 2018 2 MatchedMatched 2.59[1.10; 6.10]14581663%NAHoeltzenbein a - ARBs, 2018 Hoeltzenbein b - ACEi, 2018 Moretti - ACEi/ARBs, 2012 Cournot - ACEi, 2006 4 Renin angiotensin   - ACEIs (Angiotensin-converting enzym ...  - ACEIs (Angiotensin-converting enzyme inhibitors) 2.36[0.46; 12.05]9048876%NAHoeltzenbein b - ACEi, 2018 Cournot - ACEi, 2006 2   - ARBs (Angiotensin II receptor blockers)  - ARBs (Angiotensin II receptor blockers) 2.70[1.30; 5.60]49189 -NAHoeltzenbein a - ARBs, 2018 1   - ARBs and/or ACEIs (Angiotensin II r ...  - ARBs and/or ACEIs (Angiotensin II receptor blockers and/or Angiotensin-converting enzyme inhibitors) 3.92[2.18; 7.07]553910%NAMoretti - ACEi/ARBs, 2012 Diav-Citrin - ACEi/ARB, 2011 2 All studiesAll studies 2.80[1.42; 5.52]1941,06866%NAHoeltzenbein a - ARBs, 2018 Hoeltzenbein b - ACEi, 2018 Moretti - ACEi/ARBs, 2012 Diav-Citrin - ACEi/ARB, 2011 Cournot - ACEi, 2006 50.550.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.54.51.7670.000Hoeltzenbein a - ARBs, 2018Hoeltzenbein b - ACEi, 2018Moretti - ACEi/ARBs, 2012Diav-Citrin - ACEi/ARB, 2011Cournot - ACEi, 2006

Asymetry test p-value = 0.2662 (by Egger's regression)

slope=0.0884 (0.6115); intercept=2.1378 (1.5686); t=1.3629; p=0.2662

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 2.80[1.42; 5.52]1941,06866%NAHoeltzenbein a - ARBs, 2018 Hoeltzenbein b - ACEi, 2018 Moretti - ACEi/ARBs, 2012 Diav-Citrin - ACEi/ARB, 2011 Cournot - ACEi, 2006 50.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Buawangpong (ACEi/ARBs) (Elective termination ...Buawangpong (ACEi/ARBs) (Elective termination of pregnancy) 2.54[1.41; 4.59]73%-Wwhatever (meta-analysis)T11st trimesterstudies TTT6 Buawangpong (ACEi/ARBs) (Elective termination ...Buawangpong (ACEi/ARBs) (Elective termination of pregnancy) 2.54[1.41; 4.59]73%-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT6 metaPregmetaPreg 2.80[1.42; 5.52]66%1,068----Hoeltzenbein a - ARBs, 2018 Hoeltzenbein b - ACEi, 2018 Moretti - ACEi/ARBs, 2012 Diav-Citrin - ACEi/ARB, 2011 Cournot - ACEi, 2006 50.510.01.0