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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
Resumen

Los estudios realizados con fármacos antihipertensivos en el embarazo y en la lactancia son, en general, de escasa magnitud, de pobre calidad metodológica y limitado seguimiento, por lo que los resultados obtenidos sólo proporcionan la evidencia derivada de la opinión de los expertos consultados. Los riesgos maternofetales de la hipertensión arterial en el embarazo dependen de la gravedad de la hipertensión arterial, de la proteinuria, de la presencia de nefropatía y de las complicaciones derivadas del retardo del crecimiento intrauterino. En el embarazo la decisión de establecer tratamiento antihipertensivo depende de la gravedad de la hipertensión arterial y de la presencia de daño orgánico. Todos los fármacos usados para el tratamiento de la hipertensión arterial en el embarazo atraviesan la placenta, por lo que pueden afectar al feto bien indirectamente disminuyendo el flujo útero-placentario o bien directamente a través de la circulación umbilical. Los fármacos antihipertensivos disminuyen la presión arterial de la madre, pero no mejoran los resultados fetales, siendo el único remedio finalizar la gestación; sin embargo, el parto, siempre adecuado para la madre no lo es tanto para el feto. Los fármacos de primera elección en el embarazo son: metildopa, labetalol y nifedipino. La lactancia materna es la forma más natural y efectiva de satisfacer las necesidades del niño, por tanto debe estimularse su utilización, al menos durante el primer y segundo mes. En la lactancia como en el embarazo la decisión de establecer tratamiento antihipertensivo depende de la gravedad de la hipertensión arterial y de la presencia de daño orgánico. Los betabloqueantes, incluido el labetalol, son los fármacos de primera elección en la lactancia.

Resumen

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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