Antihypertensives in pregnancy

[Guest guest]

Hello All,

Hypertensive disorders are the most common medical disorders during pregnancy. These disorders are a major cause of maternal and perinatal mortality and morbidity. There are many antihypertensive drugs reported to be safe during pregnancy. Undoubtedly methyldopa is the agent most widely used during pregnancy for the treatment of HT and its many years of use attest to its use.

Hydrallazine can be used to treat HT in the later half of pregnancy without apparent adverse fetal effects. Clonidine is another such agent.

Beta blockers: There are conflicting reports about a possible association between beta blockers and fetal growth restriction and neonanatal hypoglycemia. Beta blockers have not been linked to structural fetal anomalies.

Calcium channel blockers: The FDA has classified calcium channel blockers as pregnancy Category C medications, meaning they may not be safe for use during pregnancy. In animal studies of calcium channel blockers and pregnancy, the drugs were shown to cause certain problems. However, animals do not always respond to medicines in the same way that humans do, and a healthcare professional can still prescribe the drug if the benefits outweigh the risks.

Diuretics: Diuretics have been used for treatment of hypertension during pregnancy. Theoretically, diuretics can be associated with potential harmful effects owing to the reduction of plasma volume, cardiac output, and uteroplacental perfusion. Many studies--including a meta-analysis of almost 7000 neonates exposed to diuretics during pregnancy--did not find an increased risk of adverse effects, such as birth defects, fetal growth restriction, thrombocytopenia, or diabetes, among neonates exposed to diuretics in

utero.( Can Fam Physician 2009 Jan;55(1):44-5.)

In women taking diuretics from early pregnancy onward, plasma volume does not expand as much as in normal pregnancy. Because of this several investigators recommend that diuretics should not be used during pregnancy.

I would like to invite our clinician members to comment .

Dr. Smita

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[Guest guest]

Dear Dr. Desai Sir,

Thanks for your comments..I agree that use of antihypertensive drugs in pregnancy itself would require an in-depth discussion which should be supported by clinical experience.

Many times it does happen that what we read in books and what is actually practiced differ widely. And that is why I feel such discussions require valuable contributions from clinicians. Thank you for providing the same.

Regards,

Dr. Smita

From: smita sontakke <smitaavanti@ .co. in>Subject: Antihypertensives in pregnancynetrumgroups (DOT) comDate: Monday, 7 September, 2009, 9:21 PM

Hello All, Hypertensive disorders are the most common medical disorders during pregnancy. These disorders are a major cause of maternal and perinatal mortality and morbidity. There are many antihypertensive drugs reported to be safe during pregnancy. Undoubtedly methyldopa is the agent most widely used during pregnancy for the treatment of HT and its many years of use attest to its use. Hydrallazine can be used to treat HT in the later half of pregnancy without apparent adverse fetal effects. Clonidine is another such agent. Beta blockers: There are conflicting reports about a possible association between beta blockers and fetal growth restriction and neonanatal hypoglycemia. Beta blockers have not been linked to structural fetal anomalies. Calcium channel blockers: The FDA has classified calcium channel blockers as pregnancy Category C medications, meaning they may not be safe for use during pregnancy. In animal studies of calcium channel blockers and pregnancy, the drugs were shown to cause certain problems. However, animals do not always respond to medicines in the same way that humans do, and a healthcare professional can still prescribe the drug if the benefits outweigh the risks.

Diuretics: Diuretics have been used for treatment of hypertension during pregnancy. Theoretically, diuretics can be associated with potential harmful effects owing to the reduction of plasma volume, cardiac output, and uteroplacental perfusion. Many studies--including a meta-analysis of almost 7000 neonates exposed to diuretics during pregnancy--did not find an increased risk of adverse effects, such as birth defects, fetal growth restriction, thrombocytopenia, or diabetes, among neonates exposed to diuretics in utero.( Can Fam Physician 2009 Jan;55(1):44- 5.)

In women taking diuretics from early pregnancy onward, plasma volume does not expand as much as in normal pregnancy. Because of this several investigators recommend that diuretics should not be used during pregnancy.

I would like to invite our clinician members to comment .

Dr. Smita

See the Web's breaking stories, chosen by people like you. Check out Buzz.

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