A female patient on ACE inhibitors becomes pregnant. What is the recommended counseling?

• A. Continue the medication and monitor fetal development.
• B. Stop taking the medication and contact her provider immediately.
• C. Switch to an ARB immediately.
• D. Take higher doses to ensure blood pressure control.

Answer: (B)

Exposure to ACE inhibitors during pregnancy can cause significant fetal harm, especially to kidney development and amniotic fluid. When pregnancy occurs, the safest and most important step is to discontinue the ACE inhibitor immediately and contact the provider to adjust therapy. The clinician will switch to a pregnancy-safe antihypertensive (such as labetalol, nifedipine, or methyldopa) and closely monitor both blood pressure and fetal well-being. Switching to an ARB wouldn’t lower risk, as ARBs carry similar teratogenic effects, and continuing or increasing the ACE inhibitor would increase fetal risk. The key is stopping the drug now and getting guidance for a safe alternative regimen.