Which medications are contraindicated for the treatment of hypertensive disorders during pregnancy?

Updated: Jun 12, 2018
  • Author: Michael P Carson, MD; Chief Editor: Edward H Springel, MD, FACOG  more...
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ACE inhibitors should be avoided during pregnancy, as they are associated with fetal renal dysgenesis or death when used in the second and third trimesters, as well as with increased risk of cardiovascular and central nervous system malformations when used in the first trimester. [24] In a retrospective cohort study, Li et al found that during the first trimester, the risk of malformations with the use of ACE inhibitors is similar to the use of other antihypertensives but that the apparent increased risk of malformations is due more to the mother’s underlying hypertension rather than the medications. [25]

Angiotensin II receptor antagonists/blockers are not used during pregnancy, because they have a mechanism of action that is similar to that of ACE inhibitors. Diuretics do not cause fetal malformations but are generally avoided in pregnancy, as they prevent the physiologic volume expansion seen in normal pregnancy. They may be used in states of volume-dependent hypertension, such as renal or cardiac disease.

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