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In MTB 3 it says, women with HTN do not start thiazide diuretics, does this mean we can continue giving them diuretic if they are taking it from prior pregnancy? Won't it cause plasma vol. reduction then? Or is less harmful if they have been taking it..
& also Beta blockers are CI in preg. cz they cause IUGR, but we can give Partial Beta blocker right like labetalol etc?
Please clarify...Thanks alot..
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As far as i know drug of choice for the treatment of nonemergent hypertension during pregnancy is methyldopa (though it is category B) used as first line treatment and as maintenance medication for chronic HTN in pregnancy!!
Diuretics shouldn't be initiated during pregnancy doesn't mean it can be continued if patient was on it from before ( we can always switch on to next drug if that is relatively safe)
Ur concern should be more about when to continue and discontinue antihtn meds in pregnancy rather than which drugs other than methyldopa ,labetalol,hydralazine to use or not during preg? (I think so)
Because only these drugs have been mentioned so far in kaplan,mtb and uw all !!
So the idea is patient who is chronic HTN with BP less than 120/80 discontinue anti-HTN but if bp more than 120/80 continue therapy !!
Also, if patient presents with essential HTN and not on anti-HTN begin anti-HTN if systolic more than 150 and diastolic more than 95 mmhg (and maintain diastolic between 90 and 100 mmhg ) because we donot want to jeopardize placental blood supply by over correcting blood pressure!!
the drugs that can be used are (methyldopa being 1st line and Labetolol /hydralazine as alternatives)
About Labetolol (both alpha and b blocker) has short half life,acts quickly and u can always titrate the dose (advantage) in severe HTN in pregnancy
Dont know about labetalol causing IUGR -though it has been mentioned for bblockers )i think we cant generalize all the drugs even if they belong to the same class , it depends on the individual drug study and clinical trial about which drug is relatively safe than the other.
Anyway, if it did not help u then i am sorry dont know more about it..
GL
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Got it.. Thanks alot, my only query was abt diuretics cz in mtb3 it says that it shouldn't be initiated during pregnancy so that seemed weird.. Anyway bottom line Is that diuretics should be avoided.. Thanks again 😃 & GL
