Guanfacine in the treatment of hypertension due to pre‐eclamptic toxaemia in thirty women.

Abstract

1 Thirty pregnant women aged 22-34 yr presenting with pre-eclampsia were treated with guanfacine for periods of 16-68 days. 2 Elevated blood pressure was lowered to a statistically and clinically significantly extent in the first week of treatment, falling almost to normal levels before parturition in 24 cases. Four days after delivery all the patients had normal blood pressures. 3 Oedema (localized or generalized) was not reduced to any extent by guanfacine and additional treatment was necessary in 17 cases. There was little effect on proteinuria. 4 Twenty-five patients reported side-effects attributable to the treatment (sedation in 25 cases, dryness of the mouth in 15, and feelings of dizziness in 6 cases). 5 No notable changes were observed in either foetal or maternal heart rate during the period of treatment. Of the 30 deliveries, 19 were spontaneous, 5 by vacuum extraction, and 6 were by Caesarean section because of suspected placental insufficiency. Six of the infants were 'small-for-date babies', but all developed normally later. March 1977 and February 1978, 30 pregnant women aged 22-34 yr suffering from preeclampsia were treated with guanfacine at Kiel University Women's Hospital. The purpose of the trial was explained to the patients, who gave their consent to participate. Ten were nulliparae, twelve were primiparae and eight multiparae. The purpose of the trial was to determine whether the use of guanfacine would reduce the incidence of surgical delivery and/or neonatal morbidity. In addition observations were made regarding the efficiacy and safety of the drug and its interaction with other medication affecting the principal obstetric parameters. The total observation period comprised an antepartum phase of maximum 10, minimum 4 weeks, the period of delivery and hospital confinement (1-2 weeks), and a follow-up phase of 2-8 weeks' duration after the patient's discharge from hospital. The whole period of observation thus ranged from 14-20 weeks, during which time the relevant data were recorded at the following stages: (a) baseline data at entry into trial; (b) checks at intervals until delivery; (c) observations on the course of labour and examination of infant; (d) observations on the course of the postpartum period and checks following discharge and observations on the early development of infant. Methods BETWEENGuanfacine was given in the form of tablets of I mg, the starting dose being 1 tablet twice daily. This was later increased on an individual basis up to a maximum of 6 mg daily.The following clinical information and history were recorded: age at menarche, regularity of menstruation, number of previous deliveries and abortions, time of last menses, probable date of delivery, measurement of circumference of abdomen, pelvimetry, foetal heart rate, symptoms of preeclampsia (oedema, proteinuria, hypertension), cervical score, amnioscopy, ultrasound, documentation of the course of delivery including all the usual obstetric parameters, morphological examination of the placenta, and the record...

Parental ADHD in pregnancy and the postpartum period – A systematic review

“…Foetal or maternal heart rate was not changed during treatment and malformations of infants were not detected after birth. Six of the infants (20%) had low birth weight but all later developed normally (Philipp, 1980). However, low birth weight is also commonly associated with maternal preeclampsia (Spracklen, Ryckman, Harland, & Saftlas, 2014).…”

“…Guanfacine is a selective α2A adrenergic receptor agonist initially developed for the treatment of hypertension, which is also approved as a medication for ADHD in children (Scahill, 2009). The only available study investigated pregnancy outcomes of 30 women with preeclampsia treated with guanfacine for time periods between 16 and 68 days (Philipp, 1980). Foetal or maternal heart rate was not changed during treatment and malformations of infants were not detected after birth.…”

The Effects of Drugs used for the Treatment of Attention Deficit Hyperactivity Disorder (ADHD) on Pregnancy Outcome and Breast-feeding: A Critical Review

“…Phillip et al . [ 85 , 86 ] studied the pregnancy outcome of 30 women with preeclampsia treated with guanfacine in the second half of pregnancy and only for 16-68 days. There were no malformed infants, but 20% had low birth weight.…”

Drug Selection in the Treatment of Pregnancy Hypertension: A survey

“…Sedation is not uncommon, however (35). Thereby they reduce noradrenalin release, particularly in the central parts of the sympathetic nervous system, and hence reduce blood pressure.…”

“…The more recently developed guanfacine has a slower onset and a longer duration of action and is therefore less liable to evoke rebound phenomena. Sedation is not uncommon, however (35). In both cases, no information is available on the transplacental transfer.…”