A 24-year-old woman with chronic hypertension was conceiving while on oral therapy. Which class of antihypertensive must be stopped before conception because of its association with fetal renal failure, oligohydramnios, calvarial hypoplasia, and limb contractures?
- A Methyldopa
- B Labetalol
- C Enalapril ✓
- D Amlodipine
Correct answer: C. Enalapril
Explanation
ACE inhibitors are fetotoxic in the second and third trimesters: they reduce angiotensin II mediated efferent arteriolar tone in the fetal kidney, causing renal tubular dysgenesis, oligohydramnios, skull hypoplasia, and limb contractures. They should be discontinued before conception and replaced with methyldopa, labetalol, or nifedipine. Labetalol and methyldopa are established safe agents, and amlodipine has no such characteristic fetopathy, so these are the tempting but incorrect choices.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.