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ACE inhibitor fetal renal effect — MRCPCH TAS MCQ

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HardPharmacologyACE inhibitor fetal renal effectMRCPCH TAS

A newborn has oliguria, pulmonary hypoplasia and a history of severe oligohydramnios. The mother was treated for hypertension throughout pregnancy with a renin-angiotensin system drug. Which drug is most likely responsible?

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

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Correct answer: A — Enalapril

ACE inhibitors can impair fetal renal perfusion and cause oligohydramnios, renal dysfunction and pulmonary hypoplasia. Labetalol and nifedipine are commonly used for hypertension in pregnancy and do not produce this characteristic fetal renal toxicity. The pearl is that fetal urine production is a major contributor to amniotic fluid later in pregnancy.

Reference: BNFc; Nelson Textbook of Pediatrics; RCPCH Theory examination syllabi