Which statement best describes pregnancy considerations in heart failure management?

• A. ACE inhibitors/ARBs are teratogenic; alternatives include hydralazine and nitrates; careful monitoring
• B. ACE inhibitors/ARBs are safe in pregnancy
• C. Hydralazine and nitrates are teratogenic
• D. No special considerations

Answer: (A)

In pregnancy, heart failure treatment must protect both mother and fetus, so certain medicines are avoided because of fetal risks. ACE inhibitors and ARBs disrupt fetal kidney development and can cause renal injury, oligohydramnios, and other serious fetal problems, especially after the first trimester. Because of that, they are avoided during pregnancy. Safer alternatives to manage maternal heart failure include hydralazine and nitrates, which lower afterload and preload, respectively, and can be used together to support the mother’s circulation while minimizing fetal risk. This approach requires careful monitoring of the mother’s blood pressure, kidney function, and fetal well-being, with therapy tailored to symptoms and tolerability. The other statements misstate fetal safety or teratogenic risk, so this option best reflects pregnancy considerations in heart failure management.