The management of hypertension during pregnancy is crucial to reduce the risk of complications for both the mother and the fetus. In Australia, as in many other countries, the choice of antihypertensive medication during pregnancy is based on the safety profile of the drugs for both the mother and the fetus.
Here are the commonly recommended antihypertensive medications for use during pregnancy in Australia:
- Methyldopa: This centrally acting alpha-2 adrenergic agonist has a long history of use in pregnancy and is often considered a first-line treatment for chronic hypertension in pregnant women.
- Labetalol: A combined alpha and beta-blocker, labetalol is commonly used to treat hypertension during pregnancy and is particularly useful when rapid control of blood pressure is needed.
- Nifedipine: This is a calcium channel blocker that is used for the treatment of acute and chronic hypertension in pregnancy.
- Hydralazine: Used less frequently as a first-line agent, hydralazine is primarily used for severe hypertension or in cases of preeclampsia. It’s often administered in a hospital setting due to the potential for rapid changes in blood pressure.
Drugs to Avoid:
- ACE inhibitors (e.g., enalapril, captopril): They can cause fetal renal dysplasia and other anomalies.
- Angiotensin II receptor blockers (ARBs, e.g., losartan, valsartan): Similar to ACE inhibitors, ARBs can adversely affect fetal development.
- Thiazide diuretics: While not strictly contraindicated, they’re generally avoided due to concerns about decreasing plasma volume in pregnancy.
- Direct renin inhibitors (e.g., aliskiren): They are not recommended due to limited data on their safety in pregnancy.
Management of hypertension in pregnancy is multifaceted and not limited to medications. It also includes regular monitoring of blood pressure, assessing fetal well-being, and monitoring for signs of complications like preeclampsia.