American Board of Internal Medicine (ABIM) Certification Practice Exam

Which medications are considered teratogenic for women planning pregnancy?

1. SSRI antidepressants

2. Statins and ACE inhibitors

3. Calcium channel blockers

4. Beta-blockers

The correct answer is: Statins and ACE inhibitors

Statins and ACE inhibitors are classified as teratogenic medications due to their potential to cause fetal harm when taken during pregnancy. Statins, which are used to lower cholesterol levels, can interfere with fetal development, particularly in the first trimester when organogenesis is occurring. They have been associated with a range of congenital malformations, particularly in the central nervous system and musculoskeletal system. ACE inhibitors, commonly prescribed for hypertension and heart failure, can also adversely affect fetal development if taken during pregnancy, especially in the second and third trimesters. They have been linked to renal dysfunction, oligohydramnios (low amniotic fluid), and even fetal death when exposed in utero. In contrast, while SSRIs have some considerations regarding pregnancy, their teratogenic risk is not as well-defined or universally accepted as that of statins and ACE inhibitors. Calcium channel blockers and beta-blockers are generally considered safer options during pregnancy, though they may carry risks depending on the specific drug and timing of exposure. Therefore, statins and ACE inhibitors are the primary medications recognized for their teratogenic potential, making the correct answer clear.