A 26-year-old woman on enalapril for chronic hypertension confirms pregnancy at 8 weeks gestation. Today her blood pressure is 138/86 mmHg and she feels well. What is the appropriate management of her antihypertensive therapy?

• A Continue enalapril with monthly serum creatinine monitoring
• B Stop enalapril and start labetalol ✓
• C Add furosemide to the existing regimen
• D Switch to atenolol

Explanation

ACE inhibitors are fetotoxic throughout pregnancy, particularly in the second and third trimesters, where they cause fetal renal dysgenesis, oligohydramnios, skull hypoplasia and neonatal renal failure, so they must be stopped as soon as pregnancy is confirmed. Labetalol is a first-line oral agent in pregnancy alongside methyldopa and nifedipine. Atenolol is avoided because it impairs fetal growth, and loop diuretics are reserved for cardiac or renal indications rather than routine hypertension.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.