VAIL, COLO. -- Methyldopa is an old and frequently overlooked agent that, in the setting of hypertension in pregnancy, is suddenly transformed into first-line therapy, Dr. Jill Davies said at a conference on obstetrics and gynecology sponsored by the University of Colorado.
"Aldomet [methyldopa] is a category B medication. It has the longest safety record for treatment of hypertension in pregnancy. So even though outside of pregnancy it's not even close to being considered a first-line agent, we still consider it first-line therapy in pregnancy because of its safety record," said Dr. Davies of the university.
The most problematic class of antihypertensive agents in pregnancy are the angiotensin-converting enzyme inhibitors. They are particularly teratogenic and have been linked to congenital skull defects, oligohydramnios, nephrotoxicity, intrauterine growth retardation, hypoplastic lungs, and increased perinatal mortality.
[beta]-blockers, while not teratogenic, have been associated with ill effects on the fetus, most commonly intrauterine growth retardation. Of course, hypertensive patients are already predisposed to fetal growth restriction due to their underlying blood pressure disorder. However, [beta]-blockers have also been linked to growth retardation when prescribed as antiarrhythmic agents in normotensive pregnant women.
"This makes sense because [beta]-blockers lower the blood pressure systemically, which lowers uterine perfusion pressure, Dr. Davies noted.
COPYRIGHT 2001 International Medical News Group
COPYRIGHT 2001 Gale Group