Consider Both the Unborn Child and the Mother When Treating Hypertension in Pregnancy

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Hypertension in pregnancy is a common cause of maternal and perinatal morbidity and mortality. While the condition is readily treatable with drugs, all antihypertensive agents can cross the placenta and may therefore have adverse effects on the fetus. For these reasons, close monitoring and bed rest are usually considered sufficient in mildly or even moderately hypertensive pregnant women, particularly during the last few weeks of pregnancy. If drug therapy is deemed necessary, the use of oral antihypertensives with established fetal safety profiles (e.g. methyldopa, labetalol, hydralazine, long-acting nifedipine) is generally preferred. ACE inhibitors (and by association angiotensin II receptor antagonists) are contraindicated in the second and third trimesters because they are associated with a characteristic fetopathy; likewise, atenolol is not recommended for use in pregnancy because of concerns about its potential to increase the risk of a 'small for gestational age' infant.

Severe hypertension accounts for much of the maternal risk associated with hypertension in pregnancy, and more aggressive treatment is warranted. Among agents used in this clinical setting are parenteral hydralazine and labetalol.

Decisions about the need to treat hypertension during pregnancy, and the choice of a particular antihypertensive agent, must be based on an individual assessment of the risks and benefits of treatment for the mother and fetus/neonate. Unfortunately, such decisions are often hampered by a lack of data.


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