Pregnancy and lactation

Question 1

Drug therapy for HTN in pregnancy is mainly for

Answer 1

Maternal safety. Lack of data to support improvement in fetal outcome

Question 2

Is hydrochlorothiazide safe in lactation

Answer 2

Yes. In doses less than 50mg. Intense diuresis will reduce Breast milk

Question 3

Labetolol and lactation precaution

Answer 3

Nursing a preterm baby other agents may be preferred. Ok for other infants

Question 4

Amlodipine and lactation

Answer 4

An alternate drug may be preferred. If used infants should be carefully observed for adverse effects

Question 5

A beta blocker other than labetolol which can be used in lactation

Answer 5

Metoprolol-No special precaution required

Question 6

4 safe drugs for HTN in lactation

Answer 6

Metoprolol
Labetolol
Nifedipine
Hydrochlorothiazide

Question 7

Atenolol in lactation

Answer 7

Should be avoided

Question 8

Acceptable alternatives to Labetolol in pregnancy

Answer 8

Pindolol and LONG ACTING METOPROLOL are acceptable alternatives though less well studied

Question 9

Definition of normal BP in pregnancy

Answer 9

<140/90

Question 10

Definition of severe HTN in pregnancy

Answer 10

160/110 or more

Question 11

Benefit of treatment of mild to moderate HTN in pregnancy

Answer 11

No proven fetal or maternal benefits

Question 12

Benefits of treatment of Severe HTN in pregnancy

Answer 12

Reduces maternal stroke

Also heart failure & Renal failure

Question 13

Chronic use of Hydralazine more than ——should be avoided to prevent ——-

Answer 13

100 mg /day ; to prevent SLE in mother

Question 14

4 drugs which can be used in HTN in pregnancy

Answer 14

Labetolol, Nifedipine long acting, Alpha methyl dopa, Hydrallazine(4th choice)

Question 15

Moderate HTN in pregnancy is

Answer 15

150/100 or more

Question 16

Treatment of FH in pregnancy

Answer 16

1. Stop statins 3 months prior to attempting to conceive
2. Do not check cholesterol during pregnancy as no therapy is indicated
3. Breast feeding ok but no cholesterol medicines except probably bile acid binding resins

NICE 2008

Question 17

Criteria for HETEROZYGOUS FH

Answer 17

Dutch Lipid Clinic Network Criteria 
Definite-9 points
Probable-6 points
Possible-3 points
2 or less - unlikely

Question 18

Corneal Arcus and FH

Answer 18

If less than 45 yrs FH possible

Question 19

Ascending Aorta diameter and pregnancy

Answer 19

If > 45. Spontaneous dissection at 3 rd trimester esp with BAV

Question 20

Can moderate AS be pregnant

Answer 20

Pregnancy is well tolerated in moderate AS

ALL women with SYMPTOMATIC AS should have valve intervention prior to pregnancy

During pregnancy symptoms- medical mng- if refractory- valvuloplasty or AVR

Question 21

Maternal risk of Severe AS

Answer 21

A/w 10% maternal mortality ( although rare)

Severe AS preferable to do intervention before pregnancy

Cleveland clinic

Question 22

Effect of lowering BP on Pre eclampsia

Answer 22

Does not affect the course of pre eclampsia

As primary abnormality is that of placental vasculature resulting in placental underperfusion

Question 23

Uptodate consensus on treating HTN in pre eclampsia

Answer 23

150/100 or more

Question 24

Pre eclampsia is after

Answer 24

20 wks of pregnancy

Question 25

By 8 weeks of pregnancy cardiac output

Answer 25

increases by 20%

Question 26

Why there is 40% increase in cardiac output during pregnancy

Answer 26

Peripheral vasodilation leads to 25-30% fall in Peripheral Vascular resistance . To compensate for this CO increases

Question 27

Maximum cardiac output during pregnancy is at

Answer 27

20-28 weeks of gestation

Question 28

Blood pressure changes in pregnancy

Answer 28

Reduces-1st and 2nd trimester | 3rd trimester- Reaches pre pregnant levels

Question 29

Most of the cardiac murmurs in pregnancy occur by

Answer 29

10-12 weeks

Question 30

Most common SVT in pregnancy

Answer 30

AVNRT

Question 31

Best first trimester antihypertensive

Answer 31

Labetolol and Methyl dopa

Question 32

Can u give beta blockers in lactation

Answer 32

Yes If indicated- Propranolol, Metoprolol And Labetolol - In all these infant dose is less than 2% Atenolol-STRICT NO Carvedilol, Bisoprolol- Not preferred. No data

Question 33

CCBs considered safe in breast feeding

Answer 33

Nifedipine, Diltiazem, Verapamil Amlodipine can But may be avoided Uptodate

Question 34

Use of ACE/ARB in breastfeeding mothers

Answer 34

Captopril and Enalapril May be used . Very less excretion in milk. Take hemodynamic status of infant into account before starting No data on ARB

Question 35

Role of Hydralazine in breastfeeding mothers in HTN Methyldopa?

Answer 35

Both safe | But use others as first line

Question 36

Grading of hypertension in pregnancy

Answer 36

Normal- upto 139/89 Mild to Moderate- upto 159/109 Severe-160/110 or more Moderate is 150-159/ 100-109

Question 37

BP goal in pregnant patients on anti Hypertensives

Answer 37

130-150/80-100 | Uptodate

Question 38

Normal. BP response in pregnancy

Answer 38

Starts falling by 6weeks. Nadir at 16-20 weeks Then starts raising to prepregnancy levels Uptodate