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A meta-analysis, limited by small study size (n=786), demonstrated a significant risk ratio (relative risk [RR] 1.78, 95% confidence interval [CI] 1.072.94) of increased anomalies in infants exposed to first-trimester ACE inhibitors and ARBs compared to the general population (67)
IGF can alter and enhance the sensitivity of theca or granulosa cells to stimulation of gonadotropin, and thus regulate the secretion of sex steroid, and liberation into follicles, finally leading to cell growth enhancement s paracrine/autocrine steroidization factors
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