engleski

Antihypertensive drugs during pregnancy: an observational study

Prescribing drugs during pregnancy poses a challenge to the physician to balance optimal treatment of the maternal symptoms and disease against the possible harm to the fetus. For many drugs including antihypertensives, data are still inadequate to confirm their safety during pregnancy. The aim of the study was to assess the prevalence of antihypertensive drug use and the rate of congenital malformations in neonates at in utero exposure to these drugs. Hypertensive disorders are the most common medical complications of pregnancy and an important cause of maternal and perinatal morbidity and mortality worldwide.The study was performed at departments of gynecology and obstetrics in four medical institutions in Zagreb and was conducted by use of a simply structured standardized questionnaire that consisted of two parts: mother's interview and hospital records. The epidemiological study involved 893 pregnant women. At least one drug was used during pregnancy and early postpartum period by 96, 2% of 893 study women, with a mean of 2, 7 drugs per woman. Permanently is present the dilemma about treatment medium and benign hypertension, because one of the outcome can be intrauterine growth restriction. During the first trimester of gestation, which is most important for fetal development, drugs were taken by 859 (96.2%) women. Women during pregnancy used a total of 86 all drugs. In our study relatively large number of women used atenolol during pregnancy (a total of 82 or 9.2%) ; before pregnancy it took seven women, in the first trimester 17 pregnant women, in the second 32 and in third 62 pregnant women, which indicates that the number of pregnant women taking this medicine increased in parallel with the duration of pregnancy. According to FDA classification atenolol belongs to category D. In our study of the women who have birth children with heart and blood vessels malformations, one have taken atenolol during the entire pregnancy. It is a negligible percentage of impressions malformations and can not relate taking atenolol with the emergence of congenital malformations of the heart and blood vessels. Five pregnant women have been used antihypertensive urapidil, and only after admission to maternity hospital for delivery. It belongs to class D drugs according to FDA classification. In spite of this, there were no offspring teratogenic effects. Calcium channel blockers verapamil have been taken one woman in the first, 11 in the second and 17 in the third trimester. Nifedipine have used negligible number of women (three in the first, two in the second and four in the third trimester). In our study, eight women have been used ACE inhibitors (lisinopril four, cilazapril and enalapril two). Cardiovascular disorders can be present in women before pregnancy or can develop during gestation. In caring for pregnant women with hypertension, it is important to differentiate among chronic hypertension, gestational hypertension, and preeclampsia. Profound hemodynamic alterations occur during pregnancy, labor and delivery, and in the post-partum period. Accordingly, the use of ATC group C agents increases with pregnancy advancement, as also indicated by our results. The usage of the most common used antihypertesive drugs, assume to be safe during lactation.

antihypertensive drugs ; pregnancy ; Zagreb

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