Angiotensin converting enzyme inhibitors (ACE-Is)
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ACE-Is are only used in pregnancy very rarely when there is no safer option to treat a serious medical condition. Most women taking an ACE-I will be switched to a different drug.
What are they?
ACE-Is are used to treat high blood pressure, heart failure, and kidney disease.
Specific ACE-Is include captopril (Capoten®), enalapril maleate (Innovace®), fosinopril sodium, imidapril hydrochloride (Tanatril®), lisinopril (Zestril®), perindopril erbumine, perindopril arginine (Coversyl®), quinapril, ramipril (Tritace®), trandolapril.
Benefits
What are the benefits of using an ACE-I in pregnancy?
ACE-Is are very rarely used in pregnancy as they can cause problems for your baby if taken after around 20 weeks. If you are taking an ACE-I and planning a pregnancy you should speak to your GP or specialist to discuss switching to a different medicine before trying to conceive.
If you find out that you are pregnant whilst taking an ACE-I, you should contact your doctor as soon as possible so that you can be switched to another medicine.
If you have taken an ACE-I after 20 weeks of pregnancy it is important to let your doctor or midwife know straight away as your baby will need extra monitoring (see below).
Risks
What are the risks of taking an ACE-I in pregnancy?
Taking an ACE-I in early pregnancy is unlikely to harm your baby. An ACE-I should usually be stopped as soon as you find out you are pregnant.
Taking an ACE-I after around 20 weeks of pregnancy can cause a number of problems in your baby, including:
• Reduced levels of amniotic fluid (oligohydramnios)
• Damage to the baby’s kidneys which can lead to long-term kidney problems after birth
• Under-development of the skull bones
• Reduced growth in the womb
• Under-development of the lungs
• Contracted (stiffened) joints
Use of an ACE-I in late pregnancy may increase the chance of stillbirth. Additionally, use of ACE-Is in later pregnancy is linked to babies being born early and with a low birth weight. This may be due to early delivery being induced in women taking an ACE-I in later pregnancy.
Alternatives
What are the alternatives to taking an ACE-I in pregnancy?
There are a number of other medicines that can be used to treat high blood pressure, heart failure, and kidney disease in pregnancy. Your specialist will advise which of these is best.
No treatment
What if I prefer not to take any medicines to treat hypertension, heart failure, or kidney disease?
The medicine(s) that your doctor has advised in place of an ACE-I will be chosen because they are safer for the baby. It is important to take medicines prescribed for hypertension, heart failure, or kidney disease as these conditions can cause serious complications for you and your baby. Your doctor will only prescribe medicines when necessary and will be happy to discuss any of your concerns.
Will my baby need extra monitoring during pregnancy?
All women are offered a scan at around 20 weeks of pregnancy as part of their routine antenatal care. Women who have used an ACE-I in the first trimester will not require any extra monitoring.
If you continue to take an ACE-I after around 20 weeks you will require additional monitoring to assess amniotic fluid levels and your baby’s growth and wellbeing.
Are there any risks to my baby if the father has taken an ACE-I?
We do not expect any increased risk to your baby if the father takes an ACE-I.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet, please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.