Which statement best reflects ACE inhibitor use during pregnancy?

• A. They are safe to use in pregnancy
• B. They are safe in all trimesters
• C. They do not require kidney monitoring
• D. They are contraindicated in pregnancy

Answer: (D)

ACE inhibitors are avoided in pregnancy because they can cause serious fetal harm, particularly to the kidneys. They disrupt the developing fetus’s renin-angiotensin system, which is essential for normal kidney formation and function. This interference can lead to fetal renal dysplasia and oligohydramnios, which in turn can cause limb and skull abnormalities, pulmonary hypoplasia, growth restriction, and even fetal or neonatal death. Because of these risks, ACE inhibitors are contraindicated during pregnancy and should be stopped if pregnancy occurs. Safer antihypertensives during pregnancy include options like labetalol, methyldopa, or nifedipine. Monitoring the mother’s kidney function does not make ACE inhibitors safe for the fetus.