Which of the following anti-hypertensive is contraindicated in pregnancy:

Ans. (b) ACE inhibitorsRef KDT 6th ed. 553; Williams 24th ed, /: 1025* ACEs are the drugs which inhibit the conversion of angiotensin-I to angiotensin-II. They can cause severe fetal malformations when given in the second and third trimesters.* These include: Hypocalvaria and renal dysfunction and are also teratogenic and because of this, they are not recommended during pregnancy* Angiotensin-receptor blockers act in a similar manner.But, instead of blocking the production of angiotensin- II, they inhibit binding to its receptor. They are presumed to have the same fetal effects as ACE inhibitors and thus are also contraindicated.Antihypertensive to be avoided during pregnancyAntihypertensive safer during pregnancy* ACE inhibitors (Ex- captopril, enelapril etc.)* Angiotensin antagonist (losartan, telmesartan)* Thiazide diuretics (Ex- hydrochlorthiazide)* Furosemide* Propanolol* Nitroprusside* Hydralazine* Methyldopa* Atenolol* Metoprolol* Labetalol-DOC* Nifedipine* Prazosin and ClonidineDrugs and their respective risk* Diuretics: tend to reduce blood volume; increase risk of placental infarcts, fetal wastage, stillbirth.* ACE inhibitors, ATI antagonists: growth retardation and fetal damage risk.* Propanolol: causes low birth weight, neonatal hypoglycemia and bradycardia.* Nitroprusside: contraindicated in eclampsia.