Can I take an angiotensin-converting enzyme (ACE) inhibitor while pregnant?

Angiotensin-converting enzyme (ACE) inhibitors are FDA Pregnancy Category D agents.^1-10 Women should stop taking an ACE inhibitor as soon as possible after pregnancy is detected. ACE inhibitors that affect the renin-angiotensin system can cause injury and death to the developing fetus.

The American College of Obstetricians and Gynecologists strongly recommends that women of reproductive age with chronic hypertension not use ACE inhibitors, angiotensin receptor blockers (ARBs), renin inhibitors, or mineralocorticoid receptor antagonists, unless there is a compelling reason to do so, such as proteinuric renal disease.¹¹

The 2017 American College of Cardiology and American Heart Association hypertension guidelines state that hypertensive women who become pregnant should not be treated with ACE inhibitors, ARBs, or direct renin inhibitors [Strong-HARM Recommendation (Level C-LD)].¹² The guideline also recommends that women who are planning to become pregnant or become pregnant should be switched from antihypertensives they are currently taking to either methyldopa, nifedipine, or labetalol during pregnancy [Strong Recommendation (Level C-LD)].

^References

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6. Aceon [package insert]. North Chicago, IL: Abbot Laboratories; 2011.
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8. Fosinopril sodium [package insert]. Miami, FL: Ciplo USA Inc; 2015.
9. Trandolapril [package insert]. Laurelton, NY: Epic Pharma, LLC; 2017.
10. Prinivil [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp.; 2016.
11. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122 (5): 1122-1131.
12. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017.