Single Best Answer (SBA) · Medical Disorders in Pregnancy
A woman with chronic hypertension on an ACE inhibitor is planning pregnancy. Which single medication change is most appropriate before conception?
Show answer and explanation
Answer: E. Switch the ACE inhibitor to a pregnancy-safe antihypertensive
Reviewing teratogenic drugs before pregnancy
Pre-pregnancy and early-pregnancy care includes reviewing and modifying medications to avoid fetal harm.
| Drug to avoid/switch | Reason |
|---|---|
| ACE inhibitors / ARBs | Fetal renal damage, oligohydramnios, growth effects |
| Atenolol | Fetal growth restriction |
| Warfarin | Teratogenic (warfarin embryopathy); switch to heparin/LMWH |
| Statins | Stopped in pregnancy |
| Sodium valproate | Neural tube and other defects; avoid where possible |
ACE inhibitors and ARBs
- Should be discontinued because of teratogenicity and adverse effects on fetal growth and renal development (oligohydramnios).
- Switch to a pregnancy-safe antihypertensive (labetalol, nifedipine or methyldopa).
Other drugs to review
- Atenolol (growth restriction), statins (stopped), warfarin (switch to heparin/LMWH), and certain anti-epileptics.
The principle is to anticipate pregnancy and replace teratogenic drugs with safer alternatives before conception.
Practise every Obstetrics & Gynaecology topic
This is a free sample. Sign up for the full bank of flashcards and exam-style questions on a spaced-repetition schedule, with 20 free stars a day.