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Hipertensión 2004;21:455-65 - DOI: 10.1016/S1889-1837(04)71509-3
Toxicidad fetal de los fármacos antihipertensivos
Fetal toxicity of antihypertensive drugs
J. Baltar Martín1, , R. Marín Iranzo, J. Álvarez Grande
>Unidad de Investigación de Resultados en Salud. Instituto Reina Sofía de Investigación de la Fundación Renal Íñigo Álvarez de Toledo. Servicio de Nefrología. Hospital Universitario Central de Asturias. Oviedo. España
Recibido 08 junio 2004, Aceptado 08 septiembre 2004

Studies performed with antihypertensive drugs during pregnancy and breast feeding have generally been inadequate, employed poor methodology and lacked sufficient follow-up. As such, results only provide evidence derived from those opinions of consulted experts. Maternal-fetal risk of hypertension during pregnancy depends on the seriousness of the hypertension and proteinuria, presence of nephropathy and complications which might arise from intrauterine growth retardation. In pregnancy, the decision to establish antihypertensive treatment depends on the seriousness of the hypertension and presence of organ damage. All drugs used for the treatment of hypertension during pregnancy cross the placenta. Accordingly, they can affect the fetus either indirectly by decreasing uterine placental circulation or directly through umbilical circulation. Antihypertensive drugs decrease maternal blood pressure but provide no improvement for the fetus. As such, labor might have to be induced which, while ordinarily presenting no problem for the mother, can be difficult for the fetus. Drugs of choice during pregnancy are: methyldopa, labetalol and nifedipine. Breast feeding is the most natural and effective way of meeting the child's needs, and its practice should be encouraged at least during the first and second months. During breast feeding, as in pregnancy, the decision to begin antihypertensive treatment depends on the seriousness of the hypertension and the presence of any organic damage. Betablockers, including labetalol, are those drugs of choice during breast feeding.

Palabras clave
hipertensión arterial, embarazo, preeclampsia, lactancia, antihipertensivos
Key words
hypertension, pregnancy, preeclampsia, breast feeding, antihypertensive drugs
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Correspondencia: Servicio de Nefrología. Hospital Universitario Central de Asturias. C/ Celestino Villamil, s/n. 33006 Oviedo. Asturias. España. (J. Baltar Martín jbaltar@hca.es)
Copyright © 2004. Sociedad Española de Hipertension-Liga Española para la Lucha de la Hipertensión Arterial (SEH-LELHA)