Skip to main content
Canadian Family Physician logoLink to Canadian Family Physician
. 2002 Jun;48:1047–1049.

Taking ACE inhibitors during pregnancy. Is it safe?

Savithiri Ratnapalan 1, Gideon Koren 1
PMCID: PMC2214066  PMID: 12113190

Abstract

QUESTION: A pregnant patient is taking enalapril for primary hypertension. How safe are angiotension-converting enzyme inhibitors (ACEI) during pregnancy? ANSWER: Evidence of whether ACEIs cause problems during the first trimester of pregnancy is reassuring. There is evidence that they cause severe renal and other problems during the second and third trimesters, however. These drugs should be avoided during pregnancy.

Full Text

The Full Text of this article is available as a PDF (124.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barr M., Jr Teratogen update: angiotensin-converting enzyme inhibitors. Teratology. 1994 Dec;50(6):399–409. doi: 10.1002/tera.1420500606. [DOI] [PubMed] [Google Scholar]
  2. Burrows R. F., Burrows E. A. Assessing the teratogenic potential of angiotensin-converting enzyme inhibitors in pregnancy. Aust N Z J Obstet Gynaecol. 1998 Aug;38(3):306–311. doi: 10.1111/j.1479-828x.1998.tb03072.x. [DOI] [PubMed] [Google Scholar]
  3. Chung N. A., Lip G. Y., Beevers M., Beevers D. G. Angiotensin-II-receptor inhibitors in pregnancy. Lancet. 2001 May 19;357(9268):1620–1621. doi: 10.1016/S0140-6736(00)04759-0. [DOI] [PubMed] [Google Scholar]
  4. Cunniff C., Jones K. L., Phillipson J., Benirschke K., Short S., Wujek J. Oligohydramnios sequence and renal tubular malformation associated with maternal enalapril use. Am J Obstet Gynecol. 1990 Jan;162(1):187–189. doi: 10.1016/0002-9378(90)90846-y. [DOI] [PubMed] [Google Scholar]
  5. Easterling T. R., Carr D. B., Davis C., Diederichs C., Brateng D. A., Schmucker B. Low-dose, short-acting, angiotensin-converting enzyme inhibitors as rescue therapy in pregnancy. Obstet Gynecol. 2000 Dec;96(6):956–961. doi: 10.1016/s0029-7844(00)01037-1. [DOI] [PubMed] [Google Scholar]
  6. Hanssens M., Keirse M. J., Vankelecom F., Van Assche F. A. Fetal and neonatal effects of treatment with angiotensin-converting enzyme inhibitors in pregnancy. Obstet Gynecol. 1991 Jul;78(1):128–135. [PubMed] [Google Scholar]
  7. Harewood W. J., Phippard A. F., Duggin G. G., Horvath J. S., Tiller D. J. Fetotoxicity of angiotensin-converting enzyme inhibition in primate pregnancy: a prospective, placebo-controlled study in baboons (Papio hamadryas). Am J Obstet Gynecol. 1994 Sep;171(3):633–642. doi: 10.1016/0002-9378(94)90075-2. [DOI] [PubMed] [Google Scholar]
  8. Kreft-Jais C., Plouin P. F., Tchobroutsky C., Boutroy M. J. Angiotensin-converting enzyme inhibitors during pregnancy: a survey of 22 patients given captopril and nine given enalapril. Br J Obstet Gynaecol. 1988 Apr;95(4):420–422. doi: 10.1111/j.1471-0528.1988.tb06619.x. [DOI] [PubMed] [Google Scholar]
  9. Mastrobattista J. M. Angiotensin converting enzyme inhibitors in pregnancy. Semin Perinatol. 1997 Apr;21(2):124–134. doi: 10.1016/s0146-0005(97)80055-9. [DOI] [PubMed] [Google Scholar]
  10. Pryde P. G., Barr M., Jr Low-dose, short-acting, angiotensin-converting enzyme inhibitors as rescue therapy in pregnancy. Obstet Gynecol. 2001 May;97(5 Pt 1):799–800. doi: 10.1016/s0029-7844(01)01371-0. [DOI] [PubMed] [Google Scholar]
  11. Pryde P. G., Sedman A. B., Nugent C. E., Barr M., Jr Angiotensin-converting enzyme inhibitor fetopathy. J Am Soc Nephrol. 1993 Mar;3(9):1575–1582. doi: 10.1681/ASN.V391575. [DOI] [PubMed] [Google Scholar]
  12. Reisenberger K., Egarter C., Sternberger B., Eckenberger P., Eberle E., Weissenbacher E. R. Placental passage of angiotensin-converting enzyme inhibitors. Am J Obstet Gynecol. 1996 May;174(5):1450–1455. doi: 10.1016/s0002-9378(96)70587-2. [DOI] [PubMed] [Google Scholar]
  13. Rosa F. W., Bosco L. A., Graham C. F., Milstien J. B., Dreis M., Creamer J. Neonatal anuria with maternal angiotensin-converting enzyme inhibition. Obstet Gynecol. 1989 Sep;74(3 Pt 1):371–374. [PubMed] [Google Scholar]
  14. Schubiger G., Flury G., Nussberger J. Enalapril for pregnancy-induced hypertension: acute renal failure in a neonate. Ann Intern Med. 1988 Feb;108(2):215–216. doi: 10.7326/0003-4819-108-2-215. [DOI] [PubMed] [Google Scholar]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

RESOURCES