by expert on call (297 Posts), Mon Jan 26, 2004 11:37 am
This answer has two parts: There are currently different practices among obstetricians, fetal-maternal medicine subspecialists as well as internists who help manage hypertension complicating pregnancy. The preferred drug in the most recent report of the National High Blood Pressure Educational ProgramÃ¢â‚¬â„¢s Working Group is still Methyl-Dopa (Aldomet), based on its many many years of safe use during pregnancy and 7.5 year follow-up data on infants of mothers treated with the drug. There is however, many who utilize alternative drugs, especially Labetalol, claiming suggestive evidence of better fetal out comes when compared to aldomet (the evidence being several systematic reviews of the literature). Concerning atenolol, specifically, there are claims that this class of drugs, especially when used so early in gestation may adversely affect the growth of the fetus. But there are also those who believe the drug may prevent superimposed preeclampsia (a complication that occurs more often in women with essential hypertension). Having said all this, I would side with the use Aldomet here, based mainly on the follow-up data, and the belief that given the different practices, all with the standard of appropriate care, it is best for your physician to use the regimen he or she is most familiar with.
Also, blood pressure normally decreases in early pregnancy, and the decreases in women with essential hypertension can be greater than those observed in normal pregnant women. When these decreases occur spontaneously they often portend a very favorable pregnancy, and if the decrease does not occur the caregiver may be alerted to watch the patients progress even more closely. Thus, there are many who observing a pressure of 125/ 78 mm Hg, might just stop the atenalol and watch, since spontaneous decreases in pressure may continue past the 16th week of pregnancy.
The current status of aspirin or vitamin C prophylaxis to prevent preeclampsia are 1: There may be a very small positive effect of with aspirin but the study of 30,000 patients were needed to reveal this small effect. The trials evaluating the effects of vitamin C have just started. It would seem however that taking a natural vitamin would be innocuous. However, there are rare cases of renal stone disease associated with megadoses of vitamin C. I currently would use neither here believe a healthy for pregnancy diet suffices.
Expert on Call
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