Prenatal exposure to ACE inhibitors or ARBs has been linked to which neonatal complication?

• A. Hypoglycemia
• B. Necrotizing enterocolitis (NEC)
• C. Neonatal jaundice
• D. Renal failure

Answer: (D)

Exposure to ACE inhibitors or ARBs in pregnancy disrupts the fetal renin-angiotensin system, which is important for kidney development and maintaining fetal kidney blood flow. Angiotensin II helps sustain fetal urine production; blocking it reduces urine output, leading to oligohydramnios (low amniotic fluid). Severe oligohydramnios can contribute to impaired renal function after birth, so the neonate is at risk for renal failure with low urine output and electrolyte disturbances. That connection makes renal failure the most likely neonatal complication from prenatal ACE inhibitor or ARB exposure. The other options are not typical direct outcomes of this exposure.