Angiotensin converting enzyme (ACE) inhibitors can adversely effect both the fetus and newborn primarily because of its effects on the fetal kidney.


Example of ACE inhibitors: captopril, enalapril, lisinopril, quinapril, fosinopril


Timing of adverse effects: when taken during the second and third trimester (not the first)


Organs affected:

(1) renal

(2) pulmonary

(3) osseous (calvarium)


Renal effects:

(1) renal tubular dysplasia

(2) renal failure with oliguria or anuria


Respiratory effects: pulmonary hypoplasia


Osseous changes:

(1) decreased skull ossification

(2) hypocalvaria or acalvaria


Additional physiologic effects on the fetus:

(1) vasodilation and hypotension

(2) oligohydramnios

(3) limb deformities


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