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

Small for gestational age (weight)

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.
S17123
R71703
Van der Zande - ACE-Is and/or ARBs, 2024 Small for gestational age (birth weight <10th percentile) 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) 1.77 [0.78;4.01] C 7/42   577/5,697 584 42
ref
S13918
R54502
Fisher b - ACE inhibitors (Controls unexposed, disease free), 2018 Small for gestational age (birthweight < 10th percentile for a given gestational age in weeks, sex, race/ethnicity, and parity) during pregnancy (anytime or not specified) retrospective cohort unexposed, disease free excluded Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified Renin angiotensin: ACEIs (Angiotensin-converting enzyme inhibitors) 2.47 [0.52;11.66] C
excluded (control group)
2/10   923/10,050 925 10
ref
S13919
R54503
Fisher b - ACE inhibitors (Controls unexposed, sick), 2018 Small for gestational age (birthweight < 10th percentile for a given gestational age in weeks, sex, race/ethnicity, and parity) during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified Renin angiotensin: ACEIs (Angiotensin-converting enzyme inhibitors) 1.83 [0.38;8.72] C 2/10   101/839 103 10
ref
S14147
R55488
Hoeltzenbein a - ARBs, 2018 Small for gestational age (< 3rd percentile) early pregnancy prospective cohort unexposed, disease free Adjustment: No Indications Antihypertensive: Only chronic hypertension indication Matched Renin angiotensin: ARBs (Angiotensin II receptor blockers) 2.55 [1.11;5.85] C 10/165   14/567 24 165
ref
S13472
R51968
Nakhai-Pour - ACE inhibitors, 2010 Small for gestational age (a birth weight less than the 10th percentile for that gestational age and gender) 2nd and/or 3rd trimester nested case control unexposed (general population or NOS) Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified Renin angiotensin: ACEIs (Angiotensin-converting enzyme inhibitors) 1.64 [0.18;14.69] C 1/5   7,444/56,329 7,445 5
ref
Total 4 studies 2.05 [1.21;3.49] 8,156 222
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 Van der Zande - ACE-Is and/or ARBs, 2024Van der Zande - ACE-Is and/or ARBs, 2024 1.77[0.78; 4.01]5844242%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Fisher b - ACE inhibitors (Controls unexposed, sick), 2018Fisher b - ACE inhibitors, 2018 1 1.83[0.38; 8.72]1031011%ROB confusion: criticalROB selection: criticalROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Hoeltzenbein a - ARBs, 2018Hoeltzenbein a - ARBs, 2018 2.55[1.11; 5.85]2416541%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: lowROB mesure: unclearROB reporting: moderate Nakhai-Pour - ACE inhibitors, 2010Nakhai-Pour - ACE inhibitors, 2010 1.64[0.18; 14.69]7,44556%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Total (4 studies) I2 = 0% 2.05[1.21; 3.49]8,1562220.510.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 2.08[1.21; 3.59]7112170%NAVan der Zande - ACE-Is and/or ARBs, 2024 Fisher b - ACE inhibitors (Controls unexposed, sick), 2018 Hoeltzenbein a - ARBs, 2018 3 case control studiescase control studies 1.64[0.18; 14.69]7,4455 -NANakhai-Pour - ACE inhibitors, 2010 1 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 2.41[1.11; 5.24]7,4691700%NAHoeltzenbein a - ARBs, 2018 Nakhai-Pour - ACE inhibitors, 2010 2 unexposed, sickunexposed, sick 1.79[0.87; 3.68]687520%NAVan der Zande - ACE-Is and/or ARBs, 2024 Fisher b - ACE inhibitors (Controls unexposed, sick), 2018 2 Tags Adjustment   - No  - No 2.05[1.21; 3.49]8,1562220%NAVan der Zande - ACE-Is and/or ARBs, 2024 Fisher b - ACE inhibitors (Controls unexposed, sick), 2018 Hoeltzenbein a - ARBs, 2018 Nakhai-Pour - ACE inhibitors, 2010 4 Indications Antihypertensive   - All hypertensions, any indications ...  - All hypertensions, any indications or not specified 1.76[0.49; 6.29]7,548150%NAFisher b - ACE inhibitors (Controls unexposed, sick), 2018 Nakhai-Pour - ACE inhibitors, 2010 2   - Only cardiac indications other than ...  - Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) 1.77[0.78; 4.01]58442 -NAVan der Zande - ACE-Is and/or ARBs, 2024 1   - Only chronic hypertension indication  - Only chronic hypertension indication 2.55[1.11; 5.85]24165 -NAHoeltzenbein a - ARBs, 2018 1 MatchedMatched 2.55[1.11; 5.85]24165 -NAHoeltzenbein a - ARBs, 2018 1 Renin angiotensin   - ACEIs (Angiotensin-converting enzym ...  - ACEIs (Angiotensin-converting enzyme inhibitors) 1.76[0.49; 6.29]7,548150%NAFisher b - ACE inhibitors (Controls unexposed, sick), 2018 Nakhai-Pour - ACE inhibitors, 2010 2   - ARBs (Angiotensin II receptor blockers)  - ARBs (Angiotensin II receptor blockers) 2.55[1.11; 5.85]24165 -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) 1.77[0.78; 4.01]58442 -NAVan der Zande - ACE-Is and/or ARBs, 2024 1 All studiesAll studies 2.05[1.21; 3.49]8,1562220%NAVan der Zande - ACE-Is and/or ARBs, 2024 Fisher b - ACE inhibitors (Controls unexposed, sick), 2018 Hoeltzenbein a - ARBs, 2018 Nakhai-Pour - ACE inhibitors, 2010 40.510.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-2.63.31.3420.000Van der Zande - ACE-Is and/or ARBs, 2024Fisher b - ACE inhibitors (Controls unexposed, sick), 2018Hoeltzenbein a - ARBs, 2018Nakhai-Pour - ACE inhibitors, 2010

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

not enought points

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 13918

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 2.42[1.21; 4.85]8,3941800%NAFisher b - ACE inhibitors (Controls unexposed, disease free), 2018 Hoeltzenbein a - ARBs, 2018 Nakhai-Pour - ACE inhibitors, 2010 3 unexposed, sick controlsunexposed, sick controls 1.79[0.87; 3.68]687520%NAVan der Zande - ACE-Is and/or ARBs, 2024 Fisher b - ACE inhibitors (Controls unexposed, sick), 2018 20.510.01.0