ACE inhibitors in early pregnancy

This question came up in the study session tonight.
Bottom line:
ACE inhibs ok for first trimester but not after.

ACE Inhibitors in Early Pregnancy
Medsafe Editorial Team

Oligohydramnios, renal failure, bony malformations and prolonged hypotension have been associated with the use of ACE inhibitors in the second and third trimesters of pregnancy.

However, recent case series suggest that teratogenicity or toxicity may not be a problem if a woman becomes pregnant while taking an ACE inhibitor.

Among a total of 93 completed pregnancies (including one twin) exposed to an ACE inhibitor during the first trimester, only one case of congenital anomaly was identified (congestive cardiomyopathy), and no cases of neonatal renal dysfunction occurred. Preterm birth, low birthweight and intrauterine growth retardation were common; possible causes were medication, more serious maternal illness and twin pregnancy. Two babies died in the perinatal period.
ACE inhibitors need not be contraindicated in women of childbearing potential, but women intending to become pregnant should switch from an ACE inhibitor in anticipation. A contraindication applies after the first trimester.