Animal studies have revealed evidence of fetotoxicity. In humans, use of drugs that act on RAS during the second and third trimesters can cause the following: reduced fetal renal function leading to anuria and renal failure, oligohydramnios, fetal lung hypoplasia and skeletal deformations including skull hypoplasia, hypotension, and death. There are no controlled data in human pregnancy.

AU TGA pregnancy category D: Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details.

US FDA pregnancy category D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

US FDA pregnancy category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.

Use during pregnancy is considered contraindicated. (AU, UK)
This drug is only recommended for use during pregnancy when there are no alternatives and the benefit outweighs the risk. (US)

AU TGA pregnancy category: D
US FDA pregnancy category:
-Oral tablets: D
-Injection solution: D (for use during the second and third trimesters) and C (during the first trimester)
-Oral solution: Not Assigned

Risk Summary: Use of drugs that act on the renin angiotensin system (RAS) during the second and third trimesters increases fetal and neonatal morbidity and death.

Comments:
-Adequate methods of contraception should be encouraged.
-If pregnancy is detected, discontinue this drug as soon as possible.
-If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential harm to the fetus.

See references

-A decision should be made to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother. (AU, US)
-According to the manufacturer, use during lactation is not recommended when the infant is preterm or in the first few weeks after delivery. Use of by mothers of older infants can be considered if the treatment is necessary for the mother and the infant is monitored for any adverse effects. (UK)

Excreted into human milk: Yes

See references