Methyldopa versus no drug treatment in the management of mild pre-eclampsia

Elhassan, Elhassan M.; Mirghani, Omer Ahmed; Habour, A. B.; Adam, Ishag

doi:10.4314/eamj.v79i4.8872

Cited by 28 publications

(22 citation statements)

References 9 publications

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“…[101][102][103] RCTs with methyldopa pointed to better pregnancy outcome in cases of mild PIH and mild PE with regard to mid-pregnancy abortions and progression to severe PE, respectively. 104,105 Another trial of methyldopa in mild PIH demonstrated a significant prolongation of pregnancy, by about 10.3 days, with no adverse effect on birth weight. 106 An RCT of 100 pregnant women with mild PIH who were treated either with methyldopa or labetalol and 50 controls confirmed the positive effect of antihypertensive treatment on pregnancy outcome.…”

Section: Follow-upmentioning

confidence: 99%

Pregnancy-Induced hypertension

et al. 2015

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pregnancy-induced hypertension (pIh) complicates 6-10% of pregnancies. It is defined as systolic blood pressure (sbp) >140 mmhg and diastolic blood pressure (dbp) >90 mmhg. It is classified as mild (sbp 140-149 and dbp 90-99 mmhg), moderate (sbp 150-159 and dbp 100-109 mmHg) and severe (SBP ≥160 and DBP ≥110 mmHg). PIH refers to one of four conditions: a) pre-existing hypertension, b) gestational hypertension and preeclampsia (pe), c) pre-existing hypertension plus superimposed gestational hypertension with proteinuria and d) unclassifiable hypertension. pIh is a major cause of maternal, fetal and newborn morbidity and mortality. women with pIh are at a greater risk of abruptio placentae, cerebrovascular events, organ failure and disseminated intravascular coagulation. fetuses of these mothers are at greater risk of intrauterine growth retardation, prematurity and intrauterine death. ambulatory blood pressure monitoring over a period of 24 h seems to have a role in predicting deterioration from gestational hypertension to pe. antiplatelet drugs have moderate benefits when used for prevention of pe. treatment of pIh depends on blood pressure levels, gestational age, presence of symptoms and associated risk factors. non-drug management is recommended when sbp ranges between 140-149 mmhg or dbp between 90-99 mmhg. blood pressure thresholds for drug management in pregnancy vary between different health organizations. according to 2013 esh/esc guidelines, antihypertensive treatment is recommended in pregnancy when blood pressure levels are ≥150/95 mmHg. Initiation of antihypertensive treatment at values ≥140/90 mmHg is recommended in women with a) gestational hypertension, with or without proteinuria, b) pre-existing hypertension with the superimposition of gestational hypertension or c) hypertension with asymptomatic organ damage or symptoms at any time during pregnancy. methyldopa is the drug of choice in pregnancy. atenolol and metoprolol appear to be safe and effective in late pregnancy, while labetalol has an efficacy comparable to methyldopa. angiotensin-converting enzyme (ace) inhibitors and angiotensin II antagonists are contraindicated in pregnancy due to their association with increased risk of fetopathy.

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Section: Follow-upmentioning

confidence: 99%

Pregnancy-Induced hypertension

et al. 2015

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“…4 In clinical trials, the benefits of antihypertensive treatment in PIH have been inconsistent. [5][6][7][8][9] The choice of antihypertensive drugs in pregnancy is often limited due to fetal safety concerns. Three antihypertensive drugsnifedipine, methyldopa and labetalol have been demonstrated to be safe for use in the pregnant women and are commonly used for the management of various hypertensive disorders during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Comparative evaluation of antihypertensive drugs in the management of pregnancy-induced hypertension

Patel

Gadhavi

Gorasia

et al. 2012

Int J Basic Clin Pharmacol

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Background: Pregnancy-induced hypertension is associated with various adverse fetal and maternal outcomes. The use of anti-hypertensive drugs in pregnancy is controversial. We conducted a prospective study to evaluate the comparative effectiveness and safety of nifedipine, methyldopa and labetalol monotherapy in patients with pregnancy-induced hypertension. Methods: A total of 60 pregnant women with blood pressure of 140/90 mm Hg or more with ≥1+ proteinuria between 20 and 38 weeks of gestation were randomly allocated to receive nifedipine (n=20), methyldopa (n=20) or labetalol (n=20). Blood pressure was measured at 0, 6, 24, 48 and 72 h of initiation of antihypertensive drugs. Patients were also followed up for development of adverse drug effects during this period. Results: Antihypertensive treatment with methyldopa was associated with reduction in systolic blood pressure (SBP) by 50 mmHg and diastolic blood pressure (DBP) by 30 mmHg at 72 h. For the same period treatment with nifedipine was associated with reduction in SBP by 54 mmHg and DBP by 30 mmHg. Treatment with labetalol was associated with reduction in SBP by 70 mmHg and DBP by 36 mmHg at 72 h. Conclusions: Labetalol was more effective than methyldopa and nifedipine in controlling blood pressure in patients with pregnancy-induced hypertension while methyldopa and nifedipine are equally effective in controlling blood pressure. [Int J Basic Clin Pharmacol 2012; 1(3.000): 174-177

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“…Não compromete a maturidade fetal, o peso ao nascer ou o resultado neonatal 6 . É usada na dose de 750 mg a 2.000 mg/dia.…”

Section: -Anti-hipertensivosunclassified

“…Contudo, as classes funcionais III e IV relacionam-se à má evolução, necessitando-se, nessa situação, ponderar sobre a necessidade de medidas terapêuticas intervencionistas 3,4 . De um modo geral, os parâmetros clínicos que se correlacionam com o mau prognóstico materno na gravidez em portadoras de valvulopatias são: classe funcional III e IV, obstrução do VE, disfunção do VE (fração de ejeção < 40%), hipertensão pulmonar grave (acima de 75% da pressão arterial sistêmica), cianose materna, fibrilação atrial e antecedentes de tromboembolismo ou endocardite infecciosa 5,6 . Para estimar o prognóstico fetal, além dos parâmetros maternos, adicionam-se a gestação múltipla, o uso de anticoagulante oral e tabagismo 5 .…”

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