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

Preterm (< 37 weeks)

id	Study   Auto Vaclavik - ACEs/ARBs, 2024Van der Zande - ACE-Is and/or ARBs, 2024Chintamaneni - ACE inhibitors, 2018Hoeltzenbein a - ARBs, 2018Hoeltzenbein b - ACEi, 2018Colvin - ACEi, 2014Moretti - ACEi/ARBs, 2012Diav-Citrin - ACEi/ARB, 2011	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.
S17160 R71969	Vaclavik - ACEs/ARBs, 2024	Preterm delivery	during pregnancy (anytime or not specified)	population based cohort retrospective	unexposed, disease free	Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified	1.35 [0.91;2.01]	-/27   -/71,860	-	27		ref
S17123 R71697	Van der Zande - ACE-Is and/or ARBs, 2024	Preterm birth	during pregnancy (anytime or not specified)	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)	2.72 [1.42;5.18] C	14/42   886/5,697	900	42		ref
S14118 R55459	Chintamaneni - ACE inhibitors, 2018	Preterm births (<37 weeks)	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	unexposed (general population or NOS)	Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified Renin angiotensin: ACEIs (Angiotensin-converting enzyme inhibitors)	3.63 [2.89;4.58] C	95/404   29,549/378,834	29,644	404		ref
S14147 R55487	Hoeltzenbein a - ARBs, 2018	Preterm neonates (< 37 completed gestational weeks)	early pregnancy	prospective cohort	unexposed, disease free	Adjustment: Yes Indications Antihypertensive: Only chronic hypertension indication Matched Renin angiotensin: ARBs (Angiotensin II receptor blockers)	2.96 [1.70;5.10]	40/166   68/569	108	166		ref
S14149 R55514	Hoeltzenbein b - ACEi, 2018	Preterm birth (< 37 completed gestational weeks)	early pregnancy	prospective cohort	unexposed, disease free	Adjustment: Yes Indications Antihypertensive: Only chronic hypertension indication Matched Renin angiotensin: ACEIs (Angiotensin-converting enzyme inhibitors)	2.40 [1.50;3.86]	56/253   65/564	121	253		ref
S14211 R55715	Colvin - ACEi, 2014	Preterm birth	1st trimester	retrospective cohort (claims database)	unexposed (general population or NOS)	Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified Renin angiotensin: ACEIs (Angiotensin-converting enzyme inhibitors)	2.79 [1.38;5.63]	25/83   7,754/95,926	7,779	83		ref
S14158 R55563	Moretti - ACEi/ARBs, 2012	Preterm delivery	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)	13.00 [3.82;44.30] C	27/108   3/120	30	108		ref
S14145 R55549	Diav-Citrin - ACEi/ARB, 2011	Preterm delivery, ≤36 weeks	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)	3.10 [1.89;5.09] C	39/184   35/439	74	184		ref
					Total	8 studies	2.83 [2.04;3.94]		38,656	1,267
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)