Maternal and fetal adverse events of antihypertensives

Question 1

What are the side effects of ACE inhibitor usage in early pregnancy?

Answer 1

In early pregnancy: increased risk of congenital cardiovascular and CNS anomalies

In 2nd trimester: increased risk of renal and skeletal anomalies and fetal death

Question 2

What antihypertensives are safe for pregnancy use?

Answer 2

Methyldopa, labetalol, nifedipine

Question 3

A 30-year-old primigravid woman comes to your office for her first prenatal visit at 12 weeks of gestation. She has mild hypertension that has been treated with pharmacotherapy for the past year. She reports first-trimester exposure to an angiotensin converting enzyme (ACE) inhibitor. Her renal function is normal and she had a negative screen result for diabetes mellitus in the past year. The most appropriate next step to identify fetal abnormalities associated with ACE inhibitor therapy is:

(A) karyotype
(B) nuchal translucency
(C) second-trimester serum screening
(D) targeted ultrasonography

Answer 3

(D) targeted ultrasonography