Hypertension In Pregnancy Treatment Options
You may remember the case of Maria Reed of Clearwater, FL who got pregnancy induced hypertension. It was diagnosed in the 2nd trimester. And it was complicated by fetal growth restriction.
Her physician had some important choices to make. Fortunately Dr. Wade was able to use the best treatment and things turned out alright for mom and baby.
The treatments that Dr. Wade had to choose from included medication, hospitalization and early delivery of the baby through pitosin or C-section.
Several types of treatment are still considered even though there is no proof that they work. Those include restricting activity and dietary changes. Supplemental calcium, salt restriction, supplemental magnesium, and fish oil therapy have been tried without evidence of helping. There is some evidence that low dose aspirin does help.
Medications used for hypertension in pregnancy include Alpha-adrenergic inhibitors such as Methyldopa (Aldomet), Centrally acting alpha-adrenergic agonists such as Clonidine (Catapres), Vasodilators like Nitroprusside (Nitropress) and Hydralazine (Apresoline), Beta-adrenergic receptor blockers such as Labetalol (Normodyne, Trandate), Pindolol (Visken), Oxprenolol (Apsolox, Trasicor, Captol), Metoprolol (Lopressor, Toprol XL) and Atenolol (Tenormin), Diuretics such as Hydrochlorothiazide (Esidrix, HydroDIURIL) and Furosemide (Lasix) and Anticonvulsants like (Phenytoin (Dilantin) and Magnesium sulfate.
The Alpha-adrenergic inhibitors are probably the safest during pregnancy and are usually the first medication most doctors would use. If there is an allergy to the medicine or liver problems it is not as safe. But, there has not been any studies that show any harm to the baby.
Beta-adrenergic receptor blockers include some medications that are very safe and some not quite as safe. The safe ones can also be the first choice for treatment.
Calcium channel blockers may not be as safe. They have been labled ‘C’ because their safety for use in pregnancy has not been proven.
Centrally acting alpha-adrenergic agonists are usually saved for use in those that can’t take the more frequently used medications. Like the calcium channel blockers, it has not been proven safe in pregnancy. (However, that does not mean they should not be used - but you should discuss it with your doctor.)
Diuretics also have a ‘C’ rating so their use is limited to cases where your doctor has determined that other safer drugs cannot be used and your high blood pressure is dangerous to you or your baby.
Vasodilators have to be given intravenously so are restricted to in hospital use. Therefore, you have to have pretty bad hypertension problems to have these used.
The seizure medications include the only medication in the group with an ‘A’ rating meaning that it is absolutely safe in pregnancy. That is magnesium sulfate. This is used in women who have severe pregnancy induced hypertension (eclampsia or preeclampsia) to prevent any dangerous seizures.
Naturally, any of these medicines need to be used under your physician’s care and frequent follow-up will be required.
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