Drugs in pregnancy: ACE inhibitor fetopathy: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Drugs in pregnancy: ACE inhibitor fetopathy

Sample item

A woman who conceived while taking enalapril for hypertension continued it into the third trimester. Ultrasound at 32 weeks would most likely show which finding?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Oligohydramnios from reduced fetal renal function

ACE inhibitors and angiotensin receptor blockers reduce fetal glomerular perfusion in the second and third trimesters, causing renal failure, oligohydramnios, pulmonary hypoplasia, skull hypoplasia and neonatal hypotension. They are contraindicated in pregnancy, and labetalol, nifedipine or methyldopa are used instead.

Option by option

  • A. Open neural tube defect

    Neural tube defects are associated with valproate and carbamazepine.

  • B. Oligohydramnios from reduced fetal renal function (correct)

    Correct. Fetal renal hypoperfusion lowers urine output and amniotic fluid volume.

  • C. Fetal goitre

    Fetal goitre is associated with antithyroid drug excess or iodide exposure.

  • D. Polyhydramnios from fetal polyuria

    Fetal oliguria rather than polyuria is expected.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is B, Oligohydramnios from reduced fetal renal function. ACE inhibitors and angiotensin receptor blockers reduce fetal glomerular perfusion in the second and third trimesters, causing renal failure, oligohydramnios, pulmonary hypoplasia, skull hypoplasia and neonatal hypotension.

Why is "Open neural tube defect" not the answer?

Neural tube defects are associated with valproate and carbamazepine.

Why is "Fetal goitre" not the answer?

Fetal goitre is associated with antithyroid drug excess or iodide exposure.

Why is "Polyhydramnios from fetal polyuria" not the answer?

Fetal oliguria rather than polyuria is expected.

What concept does this question test?

It tests Drugs in pregnancy: ACE inhibitor fetopathy in Pharmacology. They are contraindicated in pregnancy, and labetalol, nifedipine or methyldopa are used instead.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Drugs in pregnancy: ACE inhibitor fetopathy?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.