Workshop Group 1 Question 3 by Kingston https://padlet.com/kingrajiah/ycleimxjlfq1 Pregnancy and Breast feeding en-us 2015-09-07 08:47:58 UTC 2025-10-02 12:51:46 UTC hello@padlet.com A 35-year old female with hypertension is currently well controlled on hydrochlorothiazide. She has discovered that she is one month pregnant. She wants to know whether the drug is safe for her and her baby. kingrajiah https://padlet.com/kingrajiah/ycleimxjlfq1/wish/68830979

]]> 2015-09-07 09:03:26 UTC https://padlet.com/kingrajiah/ycleimxjlfq1/wish/68830979 Will it be safe if she stopped taking medication https://padlet.com/kingrajiah/ycleimxjlfq1/wish/68897194

]]> 2015-09-08 00:39:54 UTC https://padlet.com/kingrajiah/ycleimxjlfq1/wish/68897194 Is hydrochloride safe in pregnancy? https://padlet.com/kingrajiah/ycleimxjlfq1/wish/68897951

]]> 2015-09-08 00:50:32 UTC https://padlet.com/kingrajiah/ycleimxjlfq1/wish/68897951 What can be used instead https://padlet.com/kingrajiah/ycleimxjlfq1/wish/68898260

]]> 2015-09-08 00:54:51 UTC https://padlet.com/kingrajiah/ycleimxjlfq1/wish/68898260 Can she choose not to take amy hypertensive agent during pregnancy? https://padlet.com/kingrajiah/ycleimxjlfq1/wish/68898466

]]> 2015-09-08 00:57:35 UTC https://padlet.com/kingrajiah/ycleimxjlfq1/wish/68898466 Can she breastfeed whilst on antihypertensive drugs? Which might be suitable? https://padlet.com/kingrajiah/ycleimxjlfq1/wish/68898560

]]> 2015-09-08 00:58:29 UTC https://padlet.com/kingrajiah/ycleimxjlfq1/wish/68898560 a.       Will it be safer if she stopped taking medication? https://padlet.com/kingrajiah/ycleimxjlfq1/wish/121976826 No, If the patient stops medication without any alternatives.]]> 2016-09-07 00:50:34 UTC https://padlet.com/kingrajiah/ycleimxjlfq1/wish/121976826 b.       Is hydrochlorothiazide safe in pregnancy? https://padlet.com/kingrajiah/ycleimxjlfq1/wish/121977137 No, Thiazides should not be used to treat hypertension during pregnancy. It may cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbances, and hypoglycaemia; placental perfusion may also be reduced. Stimulation of labour, uterine inertia, and meconium staining have also been reported. 

Source: BNF 69 pg 87

]]> 2016-09-07 00:53:11 UTC https://padlet.com/kingrajiah/ycleimxjlfq1/wish/121977137 c.       What can be used instead? https://padlet.com/kingrajiah/ycleimxjlfq1/wish/121977334 Women with chronic hypertension may require a change in the type of anti- hypertensive agent used pre-pregnancy. The drugs of choice in pregnancy are still methyldopa and labetalol.

Methyldopa - Oral 250 mg tds, doubling every 48 hours (up to 1 gm tds) until BP well controlled. Oldest anti-hypertensive agent used in pregnancy, with best safety profile
Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1sttrimester (and there is no evidence of a risk in later trimesters).

Labetalol - Oral 100 mg bd, doubling every 48 hours (up to 400mg bd) until BP well controlled.
Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Nifedipine - Oral 10 mg tds, up to 20 mg tds, usually as second line antihypertensive, when BP poorly controlled despite maximum doses of methyldopa ± labetalol. 

Source: Management of Hypertension 4th ed Malaysian CPG]]> 2016-09-07 00:54:53 UTC https://padlet.com/kingrajiah/ycleimxjlfq1/wish/121977334 Can she breastfeed whilst on antihypertensive drugs? Which might be suitable?  https://padlet.com/kingrajiah/ycleimxjlfq1/wish/121977960 Methyldopa – amount too small to be harmful

Labetalol – With systemic use in the mother, infants should be monitored as there is a risk of possible toxicity due to beta-blockade. However, the amount of most beta-blockers present in milk is too small to affect infants.
Infants should be monitored as there is a risk of possible toxicity due to alpha-blockade (in addition to beta-blockade) 

Source: BNF 69 pg 105,106
]]> 2016-09-07 01:00:19 UTC https://padlet.com/kingrajiah/ycleimxjlfq1/wish/121977960 d.       Can she choose not to take any antihypertensive agent during pregnancy? https://padlet.com/kingrajiah/ycleimxjlfq1/wish/121977962 No, hypertension during pregnancy is the leading cause of maternal death and substantial maternal morbidity. 

High blood pressure during pregnancy can place extra stress on your heart and kidneys and can increase your risk of heart disease, kidney disease, and stroke. Other possible complications include the following:

  • Fetal growth restriction—High blood pressure can decrease the flow of nutrients to the baby through the placenta. The baby may have growth problems as a result.
  • Preeclampsia—This condition is more likely to occur in women with chronic high blood pressure than in women with normal blood pressure.
  • Preterm delivery—If the placenta is not providing enough nutrients and oxygen to your baby, it may be decided that early delivery is better for your baby than allowing the pregnancy to continue.
  • Placental abruption—This condition, in which the placenta prematurely detaches from the wall of the uterus, is a medical emergency that requires immediate treatment.
  • Cesarean delivery—Women with hypertension are more likely to have a cesarean delivery than women with normal blood pressure. A cesarean delivery carries risks of infection, injury to internal organs, and bleeding.

Source: The American Congress of Obstetrician and Gynecologist
 http://www.acog.org/Patients/FAQs/Preeclampsia-and-High-Blood-Pressure-During-Pregnancy
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