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Teratogenic Drug Withdrawal Pregnancy — ESENeph MCQ

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EasyPregnancy & RenalTeratogenic Drug Withdrawal PregnancyESENeph

A 26-year-old woman at 8 weeks gestation has just discovered she is pregnant. She has CKD G3a from IgA nephropathy and is on Candesartan 16 mg and Atorvastatin 40 mg. What immediate medication changes are required?

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Correct answer: B — Stop both Candesartan (ARB – teratogenic) and Atorvastatin (statin – teratogenic) immediately; switch antihypertensive to Labetalol or Nifedipine

Both ARBs and statins are teratogenic and must be stopped as soon as pregnancy is confirmed. ARBs (and ACEi) cause renal agenesis, oligohydramnios, and fetal death, particularly in the second and third trimesters. Statins are Category X due to potential cholesterol synthesis disruption in fetal development. Antihypertensive should be switched to a pregnancy-safe agent: Labetalol (first-line per NICE NG133) or Nifedipine MR. Ideally, these changes should have been made pre-conception.

Reference: NICE NG133 2019 – Hypertension in Pregnancy; BNF Pregnancy Safety