This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Management and Long-Term Consequences, Subject name: Gynaecology & Obstetrics
Which of the following can he used in pregnancy? 
Select and explain. 
A. ACE inhibitors, B. Aldosterone, C. AT receptor antagonist, D. Propylthiouracil
D: Propylthiouracil
Answer: D: Propylthiouracil 
Explanation: Ans. d. Propylthiouracil Propylthiouracil is the drug of choice for hyperthyroidism during pregnancy."ACE inhibitors inhibit the conversion of angiotensin-I to the potent vasoconstrictor angiotensin-II. They can cause severe fetal malformations that include hypocalvaria when given in the second and third trimesters. Because of this, they are not recommended during pregnancy. Angiotensin-receptor blockers act in a similar manner, but instead of blocking the production of angiotensin-II, they inhibit binding to its receptor. They are presumed to have the same fetal effects as ACE inhibitors and are also contraindicated. "- Goodman and Gilman 12/e p736Antihypertensives to be avoided in Pregnancy (Mnemonic: SAAND)* Sodium nitroprusside* ACE inhibitors0* ARBs* Non-selective beta blockers* Diuretics Drugs in PregnancyAntithyroid drugsAntihypertensive Drugs* Propylthiouracil and methimezole are both antithyroid drug that cross the placenta and can lead to fetal goiter.* Methimazole has been associated with "cutis aplasia'-, scalp defects, cloanat atresia esophageal atresia and increased maternal side effects.* Because both medications are equally effective the drug of choice for hyperthyroidism in pregnancy is propylthiouracil.* ACE inhibitor e.g. Enalaprif captopril can cause fetal renal tubular dysplasia in the second and third trimesters leading to oligohydramnios, fetal limb contractures, craniofacial deformities and hypoplastic lung development.* Angiotensin II receptor antagonist have been shown to have second and third trimester finding consistent with ACE inhibitors and are not recommended in pregnancy.