What are the potential effects of ACE inhibitors when taken during pregnancy?

The potential effects of ACE inhibitors when taken during pregnancy are well documented, with a notable focus on renal anomalies, Potter sequence, and intrauterine growth restriction (IUGR). ACE inhibitors are known to affect fetal renal function, especially during the second and third trimesters when the developing fetus relies on amniotic fluid for crucial physical development. Inhibition of the angiotensin-converting enzyme can lead to reduced renal blood flow and subsequent oligohydramnios (low amniotic fluid levels), which is associated with the Potter sequence—a condition characterized by specific physical abnormalities due to the lack of amniotic fluid, such as limb deformations and facial deformities.

Additionally, these drugs can directly influence fetal growth by compromising the nutrient and oxygen supply to the fetus, leading to IUGR. Because of these risks, ACE inhibitors are generally contraindicated during pregnancy, particularly in the later stages. The other options may have associations with different teratogens or genetic conditions, but the combination of renal anomalies, Potter sequence, and IUGR is specifically linked to ACE inhibitor exposure during pregnancy. This knowledge emphasizes the importance of careful medication management in pregnant patients to avoid these serious complications.