A 31-year-old woman with chronic essential hypertension was taking lisinopril before conception and has continued it inadvertently into the second trimester. Which fetal complication is most characteristically associated with this exposure?

• A Neural tube defects
• B Fetal goitre
• C Ebstein anomaly
• D Fetal renal failure with oligohydramnios and skull hypoplasia ✓

Explanation

ACE inhibitors are contraindicated in pregnancy, particularly after the first trimester. They reduce fetal angiotensin II production, causing fetal renal tubular dysgenesis, renal failure, oligohydramnios, limb contractures, skull hypoplasia, and pulmonary hypoplasia, collectively described as ACE inhibitor fetopathy. Neural tube defects are linked to antiepileptic drugs such as valproate and carbamazepine, Ebstein anomaly to lithium, and fetal goitre to antithyroid drugs like carbimazole. Women planning conception should be switched to labetalol, methyldopa, or nifedipine.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.