Motherrisk Update: Taking ACE inhibitors during pregnancy. Is it safe?

Question. A pregnant patient is taking enalapril for primary hypertension. How safe are angiotensin-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.