Is It Safe to Use an Antihypertensive in Pregnancy?

A. Gamm

Some women may worry about needing to take an antihypertensive in pregnancy either due to chronic hypertension, pre-eclampsia or other pregnancy-related blood pressure issues. Most women who suffer from chronic hypertension may not require medication while pregnant, unless their blood pressure reaches a certain level. Other women who develop hypertension due to pre-eclampsia or any other reason may usually take most antihypertensive medications in pregnancy with little to no risk. As of 2012, only two antihypertensive medications are not recommended for pregnant women. Generally, it is recommended to discuss the risks and benefits of antihypertensive use in pregnancy with a healthcare professional.

Antihypertensive medications may be prescribed to women with pre-eclampsia.
Antihypertensive medications may be prescribed to women with pre-eclampsia.

Typically, women with chronic hypertension may stop taking an antihypertensive in pregnancy and instead be monitored. As blood pressure normally drops in early pregnancy, this is the most recommended option. Research also indicates that chronic hypertension does not make a woman more prone to developing pre-eclampsia than other women. If hypertension worsens or if developing pre-eclampsia is suspected, then standard antihypertensive medications may be used with little to no risk to the baby or mother as long as the mother is otherwise in good health. It is still recommended to try to refrain from antihypertensive medications in the first trimester.

Doctors weigh the risks and the rewards when prescribing an antihypertensive during pregnancy, but most are relatively safe.
Doctors weigh the risks and the rewards when prescribing an antihypertensive during pregnancy, but most are relatively safe.

According to the various US Food and Drug Administration (FDA) classifications of antihypertensive medications, most are believed to be safe for use in pregnancy if the healthcare professional believes the benefits outweigh any possible risks and the mother is healthy. Certain medications are indeed believed to be safer than others, according to research. Magnesium sulfate, nifedpine and methyldopa are usually the most recommended antihypertensive in pregnancy, especially for women who have pre-clampsia and are also prone to seizures. Nearly all other antihypertensive medications may also be suitable, with the exception of angiotensin-converting enzyme (ACE) and angiotensin II receptor blockers (ARB).

High blood pressure during pregnancy may cause stillbirth.
High blood pressure during pregnancy may cause stillbirth.

As of 2012, there are two antihypertensive medications that are not recommended during pregnancy. ACE may pose a serious and potentially fatal risk to the fetus in the second and third trimesters. It is believed that it may cause death or fatal kidney problems. Malformations of the central nervous or cardiovascular system may also occur with its use in the first trimester. Research indicates that using the ARB antihypertensive in pregnancy may pose similar threats to the fetus.

A pregnant woman should always consult her gynecologist when she has concerns about antihypertensives or any other medication.
A pregnant woman should always consult her gynecologist when she has concerns about antihypertensives or any other medication.

Although most women may use an antihypertensive in pregnancy without any problems, it is recommended to seek medical advice before deciding to take any treatments for hypertension. It is possible that certain antihypertensives may be more suitable than others depending on each particular case. A healthcare professional may be able to more accurately determine what course of treatment is the most beneficial.

Women have health concerns during pregnancy.
Women have health concerns during pregnancy.

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