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Diuretics and diuretic-containing anti-hypertensives in pregnancy.

If hypertension is part of the syndrome known as pre-eclampsia, diuretics (alone or in combination) should not be used. This is because their "drying" effect could worsen the poor blood supply to the baby inherent in this condition. In pre-eclampsia, the circulating blood volume is actually reduced.

Chronic hypertension is not associated with this problem of a contracted circulating volume. However, pre-eclampsia could superimpose itself on simple chronic hypertension. For this reason, it is probably best to avoid diuretics in pregnancy altogether, especially if their use is to be long-term. As regards their effect on the fetus, the common diuretics (Bendrofluazide and Furosemide) are probably safe, as there is no evidence of direct ill-effects on the baby.

In summary therefore, diuretics, alone or in combination, should not be used in pre-eclampsia as they can potentially do more harm than good. They can probably be used safely in uncomplicated chronic hypertension but better alternatives are usually available.

Making a case for diuretics use in pregnancy

There are exceptional situations where diuretics may be useful, even essential in pregnancy. If the pregnant woman is in heart failure or has lung edema (water on the lungs), diuretics are indispensable and should be used.

It may be tempting to employ diuretics such as Lasix (Furosemide) to deal with severe edema in conditions such as pre-eclampsia. Such a temptation should be resisted as it is likely to cause more harm than good.