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Treatment of hypertension in pregnancy

Treatment of hypertension in pregnancy

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Hypertension in pregnancy requires special attention. Most of the recommendations that a person suffering from high blood pressure hears are not valid during pregnancy. It is impossible to imagine that the future mother would reduce body weight or focus on physical activity aimed at losing weight.

Hypertension in pregnancy: non-pharmacological treatment

From the non-pharmacological methods of treating hypertension in pregnancy, i.e. those not requiring the use of medications, and therefore completely safe, it is worth introducing:

  • diet during hypertension in pregnancy should be easily digestible, rich in vitamins, microelements, protein and nutrients;
  • physical activity - both professional and home-based should be limited
  • it is recommended to rest for a long time in the supine position on the left side each day;
  • Particularly important in hypertension is compliance with the ban on smoking and the prohibition of alcohol consumption.

What not to do

Contrary to what you can hear or read in many places it is not recommended for pregnant women with hypertension to limit the amount of salt in their diet. The exception is women with post-susceptible hypertension whose dietary sodium limit is below 2.4 g / d. was observed before pregnancy and caused a significant drop in blood pressure.

It is also a contraindication in pregnancy weight loss to reduce blood pressureAlthough obesity is a risk factor for preeclampsia, weight loss of the mother may have a negative impact on the child's development.

In pregnancy, large is also not recommended, strongly engaging physical activity, typically recommended for hypertension. It is also associated with the possibility of a negative impact on the child's development.

Decision on choosing a non-pharmacological treatment belongs to the doctor. The specialist decides what treatment is sufficient, whether natural methods are sufficient or whether it should be carried out in conjunction with taking medication. Hypertension, pregnancy advancement, and the presence of fetal and maternal risk factors remain key.

Drug treatment of hypertension in pregnancy

All blood pressure lowering drugs (antihypertensives) cross the placental barrier. The factor determining the possibility of using the drug in a pregnant woman is the absence of adverse effects on fetal development. Only well-studied preparations are used in pregnancy. Of course, choosing the right medicine is up to your doctor.

drugs first wave (i.e. used primarily) to treat mild to moderate hypertension in pregnancy are:

  • METYLDOPA - a drug safe for the development of the child at any time of pregnancy and causing few side effects in the mother. The advantage of its use is stable uteroplacental flow and undisturbed hemodynamics in the fetus.
  • LABETALOL - used in mild, moderate and severe hypertension as well as in emergencies. It is recommended mainly in the third trimester of pregnancy and in the perinatal period. Labetalol reduces peripheral resistance, having little effect on cardiac output.

drugs second wave are:

  • CALCIUM ANTAGONISTS - Nifedipine is the most commonly used drug in this group for the treatment of mild and moderate hypertension in pregnancy. Nifedipine works quickly by lowering blood pressure within 10-20 minutes after oral ingestion. Another calcium antagonist that can be used during pregnancy is felodipin - which acts selectively on vascular muscle. Verapamil - a non-dihydropyridine calcium antagonist - is a safe drug, but less commonly used in antihypertensive therapy. It is also characterized by a relaxing effect on the uterine muscle. Objections to calcium antagonists refer to use in the first trimester of pregnancy because of the increased risk of fetal malformations.
  • β-ADRENOLITICS (e.g. atenolol and metoprolol) - may be used as monotherapy for light and moderate hypertension, however they should not be used in the first trimester due to the risk of having a low birth weight of the newborn.
  • DIHYDRALASINE - used in combination therapy for severe chronic and pregnancy-induced hypertension, as well as in preeclampsia and eclampsia, as well as in hypertension during the puerperium. It is administered intravenously or intramuscularly.

Most often, the treatment of hypertension in a pregnant woman begins with methyldopa, in the event of unsatisfactory effects adding dihydralazine or a calcium antagonist.

In emergencies, at high blood pressure, it is recommended: labetalol administered intravenously and orally administered methyldopa or nifedipine.

Blood pressure cannot be reduced rapidly due to the risk of decreased uterine and placental perfusion as well as ischemia of internal organs and central nervous system of a pregnant woman.

An ideal antihypertensive drug should lower blood pressure to the desired values ​​quickly, but in a controlled manner, do not reduce cardiac output, do not cause adverse effects on the mother and fetus, and endure uteroplacental vasoconstriction.

ATTENTION: during pregnancy and during feeding, drugs from the group of angiotensin converting enzyme inhibitors and angiotensin AT1 receptor antagonists (sartans) are absolutely contraindicated due to possible side effects, i.e. limitation of intrauterine growth of the fetus, pulmonary hypoplasia, oligohydramnios, transient renal failure and increased fetal and neonatal mortality.

Based on the articles: "Treatment of hypertension in pregnant women" Ludwina Szczepaniak-Chicheł, Grzegorz Bręborowicz, Andrzej Tykarski "Education, care and treatment of pregnant women with various forms of hypertension" Izabela Mężyk, Barbara Kotlarz, Beata Naworska, Celina Gogola, Iwona Gałązka, Beata Podsiadło "Hypertension and pregnancy" Renata Cífková, Danuta Czarnecka, Kalina Kawecka-Jaszcz


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