Which drug class is associated with neonatal renal failure when used during pregnancy?

• A. ACE inhibitors
• B. Beta-blockers
• C. Heparin
• D. Warfarin

Answer: (A)

ACE inhibitors disrupt the fetal renin-angiotensin system, reducing fetal renal perfusion and glomerular filtration. This can lead to fetal and neonatal renal dysfunction, including neonatal renal failure, especially with exposure in the latter stages of pregnancy. That is why this drug class is associated with neonatal renal impairment when used during pregnancy. Other options pose different fetal risks (beta-blockers can cause neonatal bradycardia and hypoglycemia; heparin is generally safe for the fetus; warfarin is teratogenic, particularly in the first trimester, but not primarily linked to neonatal renal failure).