skip to main content

Pregnancy-safe Antihypertensives — EECC MCQ

Instant feedback + full explanation. One question, done properly.

EasyGeneral CardiologyPregnancy-safe AntihypertensivesEECC

A 55-year-old woman with newly diagnosed hypertension asks which antihypertensive class is safest in pregnancy. She is planning to conceive within the next year. What agents are preferred?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Labetalol, nifedipine (modified-release), and methyldopa are the preferred antihypertensives in pregnancy and pre-conception; ACE inhibitors, ARBs, and direct renin inhibitors are TERATOGENIC and must be stopped before conception

Antihypertensive safety in pregnancy per the 2025 ESC CVD in Pregnancy Guidelines and NICE hypertension in pregnancy guidelines: SAFE (can use throughout pregnancy): (1) labetalol (combined alpha/beta-blocker — most commonly used, first-line); (2) nifedipine MR (dihydropyridine CCB — second-line); (3) methyldopa (central alpha-2 agonist — traditionally first-line, now second/third-line due to side effects). CONTRAINDICATED (teratogenic): (1) ACE inhibitors — cause renal agenesis, oligohydramnios, skull ossification defects, neonatal renal failure (especially in 2nd/3rd trimester, but avoided throughout); (2) ARBs — same teratogenic potential; (3) Direct renin inhibitors (aliskiren). CAUTION: atenolol (fetal growth restriction), thiazides (volume depletion). Women of childbearing potential on ACEi/ARB should be counselled about contraception and the need to switch to pregnancy-safe agents BEFORE conception (ideally while planning pregnancy).

Reference: ESC (2025): CVD in Pregnancy; NICE Hypertension in Pregnancy