Planning medication for a woman with chronic hypertension planning to conceive

A woman with hypertension should ideally talk to her doctor before embarking on a quest for pregnancy. The reason is, while continuing to use medication is desirable, there are some types of antihypertensive drugs which have been associated with adverse effects on the growing fetus in the womb or whose safety in relation to the fetus cannot be guaranteed.

In such a situation, the accepted advice is to switch to the type of medication known to be safe in pregnancy. This should ideally be done before conception. When medication has been taken in the critical first ten to twelve weeks of pregnancy, for whatever reason, it is debatable whether advising to change at this stage is worthwhile.

The exception will be those types of drugs which affect on-going fetal development. Such anti-hypertensives are contra-indicated at any stage of pregnancy. The woman’s physician, together with her obstetrician, should be able to explain and discuss this with her, depending on which medication she is on.

There are many classes of antihypertensive drugs and no blanket rule can apply to all or even to most of them.

When an expectant mother is diagnosed with pre-eclampsia

The only effective treatment of pre-eclampsia is delivery but this does not have to be immediately.

It is, however, important to be clear that, whatever other measures the doctor may institute, the aim is to try to control the condition normally to buy time and not to cure it.

Pre-eclampsia can have quite devastating effects on both fetus and mother and the doctor will try to prevent those complications. The doctor will therefore try to ensure that the condition does not worsen, that the fetus continues to grow at an acceptable rate and that neither the mother's life nor that of the fetus is put at risk.

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Many types of modern and classic anti-hypertensives including ACE-inhibitors, most calcium-channel blockers, beta-blockers and others are known to be unsafe to use in pregnancy hence the need for pre-pregnancy planning for those with chronic hypertension.