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      Antihypertensive drugs in pregnancy

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          Abstract

          Chronic hypertension complicates 3%-5% of pregnancies and gestational hypertension occurs in 6% of pregnancies. Preeclampsia complicates 25% of the pregnancies with chronic hypertension, and approximately 15%-45% of the patients with gestational hypertension will develop preeclampsia, a dangerous condition that harms the maternal and fetal safety. Antihypertensive medication is used to treat severe hypertension to prevent serious maternal and fetal complications, but there is no consensus on when and how to treat mild-to-moderate hypertension in pregnancy. This article reviews the usage, effect and safety of first, second and third line antihypertensive drugs for mild-to-moderate hypertension in pregnancy.

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          Most cited references 79

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          Diagnosis and management of gestational hypertension and preeclampsia.

           A. Sibai (2003)
          Gestational hypertension and preeclampsia are common disorders during pregnancy, with the majority of cases developing at or near term. The development of mild hypertension or preeclampsia at or near term is associated with minimal maternal and neonatal morbidities. In contrast, the onset of severe gestational hypertension and/or severe preeclampsia before 35 weeks' gestation is associated with significant maternal and perinatal complications. Women with diagnosed gestational hypertension-preeclampsia require close evaluation of maternal and fetal conditions for the duration of pregnancy, and those with severe disease should be managed in-hospital. The decision between delivery and expectant management depends on fetal gestational age, fetal status, and severity of maternal condition at time of evaluation. Expectant management is possible in a select group of women with severe preeclampsia before 32 weeks' gestation. Steroids are effective in reducing neonatal mortality and morbidity when administered to those with severe disease between 24 and 34 weeks' gestation. Magnesium sulfate should be used during labor and for at least 24 hours postpartum to prevent seizures in all women with severe disease. There is an urgent need to conduct randomized trials to determine the efficacy and safety of antihypertensive drugs in women with mild hypertension-preeclampsia. There is also a need to conduct a randomized trial to determine the benefits and risks of magnesium sulfate during labor and postpartum in women with mild preeclampsia.
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            Chemically Induced Birth Defects

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              Effects of diuretics on plasma volume in pregnancies with long-term hypertension.

              The purpose of this randomized, prospective study was to investigate the effects of diuretics on plasma volume findings and perinatal outcome in pregnancies complicated by mild long-term hypertension. Twenty patients were in their first trimester and were receiving diuretics at time of entry to the study: Ten patients were allowed to continue their diuretic medication throughout pregnancy (diuretic group), whereas for the other 10 patients, diuretics were discontinued immediately. Plasma volume was serially measured throughout pregnancy with the use of the Evans blue dye-dilution technique. Initial plasma volume was similar in the two groups. However, in the diuretic group, subsequent plasma volume findings at various stages of gestation were markedly reduced when compared to respective plasma volume findings in the other group. In addition, plasma volume expansion was minimal in the diuretic group (mean increase of 18%), whereas it was normal in the other group (mean increase of 52%). Two patients in the diuretic group and one patient in the other group required other antihypertensive medication. There was no difference in perinatal outcome between the two groups. These results suggest that in hypertensive pregnancies, diuretics prevent normal plasma volume expansion without influencing perinatal outcome.
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                Author and article information

                Journal
                FMCH
                Family Medicine and Community Health
                FMCH
                Family Medicine and Community Health & American Chinese Medical Education Association (USA )
                xxx-xxx
                2305-6983
                March 2013
                February 2014
                : 1
                : 1
                : 37-50
                Affiliations
                1Post Graduate Program in Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Brazil
                2Service of Obstetrician and Gynecology, Hospital de Clínicas de Porto Alegre, Brazil
                3Service of Obstetrician and Gynecology, Hospital de Clínicas de Porto Alegre, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
                Author notes
                CORRESPONDING AUTHOR: Rose Gasnier, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Brazil gasnier.rose@ 123456gmail.com
                Article
                fmch20130106
                10.15212/FMCH.2013.0106
                Copyright © 2013 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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