Pregnancy and lactation Flashcards
Drug therapy for HTN in pregnancy is mainly for
Maternal safety. Lack of data to support improvement in fetal outcome
Is hydrochlorothiazide safe in lactation
Yes. In doses less than 50mg. Intense diuresis will reduce Breast milk
Labetolol and lactation precaution
Nursing a preterm baby other agents may be preferred. Ok for other infants
Amlodipine and lactation
An alternate drug may be preferred. If used infants should be carefully observed for adverse effects
A beta blocker other than labetolol which can be used in lactation
Metoprolol-No special precaution required
4 safe drugs for HTN in lactation
Metoprolol
Labetolol
Nifedipine
Hydrochlorothiazide
Atenolol in lactation
Should be avoided
Acceptable alternatives to Labetolol in pregnancy
Pindolol and LONG ACTING METOPROLOL are acceptable alternatives though less well studied
Definition of normal BP in pregnancy
<140/90
Definition of severe HTN in pregnancy
160/110 or more
Benefit of treatment of mild to moderate HTN in pregnancy
No proven fetal or maternal benefits
Benefits of treatment of Severe HTN in pregnancy
Reduces maternal stroke
Also heart failure & Renal failure
Chronic use of Hydralazine more than ——should be avoided to prevent ——-
100 mg /day ; to prevent SLE in mother
4 drugs which can be used in HTN in pregnancy
Labetolol, Nifedipine long acting, Alpha methyl dopa, Hydrallazine(4th choice)
Moderate HTN in pregnancy is
150/100 or more
Treatment of FH in pregnancy
- Stop statins 3 months prior to attempting to conceive
- Do not check cholesterol during pregnancy as no therapy is indicated
- Breast feeding ok but no cholesterol medicines except probably bile acid binding resins
NICE 2008
Criteria for HETEROZYGOUS FH
Dutch Lipid Clinic Network Criteria Definite-9 points Probable-6 points Possible-3 points 2 or less - unlikely
Corneal Arcus and FH
If less than 45 yrs FH possible
Ascending Aorta diameter and pregnancy
If > 45. Spontaneous dissection at 3 rd trimester esp with BAV
Can moderate AS be pregnant
Pregnancy is well tolerated in moderate AS
ALL women with SYMPTOMATIC AS should have valve intervention prior to pregnancy
During pregnancy symptoms- medical mng- if refractory- valvuloplasty or AVR
Maternal risk of Severe AS
A/w 10% maternal mortality ( although rare)
Severe AS preferable to do intervention before pregnancy
Cleveland clinic
Effect of lowering BP on Pre eclampsia
Does not affect the course of pre eclampsia
As primary abnormality is that of placental vasculature resulting in placental underperfusion
Uptodate consensus on treating HTN in pre eclampsia
150/100 or more
Pre eclampsia is after
20 wks of pregnancy
By 8 weeks of pregnancy cardiac output
increases by 20%
Why there is 40% increase in cardiac output during pregnancy
Peripheral vasodilation leads to 25-30% fall in Peripheral Vascular resistance . To compensate for this CO increases
Maximum cardiac output during pregnancy is at
20-28 weeks of gestation
Blood pressure changes in pregnancy
Reduces-1st and 2nd trimester
3rd trimester- Reaches pre pregnant levels
Most of the cardiac murmurs in pregnancy occur by
10-12 weeks
Most common SVT in pregnancy
AVNRT
Best first trimester antihypertensive
Labetolol and Methyl dopa
Can u give beta blockers in lactation
Yes
If indicated- Propranolol, Metoprolol And Labetolol - In all these infant dose is less than 2%
Atenolol-STRICT NO
Carvedilol, Bisoprolol- Not preferred. No data
CCBs considered safe in breast feeding
Nifedipine, Diltiazem, Verapamil
Amlodipine can But may be avoided
Uptodate
Use of ACE/ARB in breastfeeding mothers
Captopril and Enalapril May be used . Very less excretion in milk. Take hemodynamic status of infant into account before starting
No data on ARB
Role of Hydralazine in breastfeeding mothers in HTN
Methyldopa?
Both safe
But use others as first line
Grading of hypertension in pregnancy
Normal- upto 139/89
Mild to Moderate- upto 159/109
Severe-160/110 or more
Moderate is 150-159/ 100-109
BP goal in pregnant patients on anti Hypertensives
130-150/80-100
Uptodate
Normal. BP response in pregnancy
Starts falling by 6weeks.
Nadir at 16-20 weeks
Then starts raising to prepregnancy levels
Uptodate
