Pregnancy with prolonged fetal exposure to an angiotensin-converting enzyme inhibitor

Maternal exposure to angiotensin-converting enzyme (ACE) inhibitors has consistently been associated with significant fetal toxicity. We report the case of a 24-year-old woman, gravida 3, para 1-0-1-1 who presented at 24 2/7 weeks' gestation with initial abnormal fetal sonographic findings, including severe oligohydramnios, misshapen cranium, pericardial effusion, small bladder, and echogenic bowel, all after prolonged exposure to multiple medications including an ACE inhibitor. Eighteen days after discontinuation of the ACE inhibitor, repeat fetal sonography revealed normal amniotic fluid and normal cranial and fetal anatomy. The patient gave birth to a normal infant at 36 weeks' gestation. Poor neonatal outcome with prolonged antenatal exposure to ACE inhibitors is not inevitable. Early follow up sonographic evaluation in patients with prolonged exposure to ACE inhibitors may allow physicians to more accurately counsel patients on pregnancy outcome.