CASE OF MANAGING POSTPARTUM HYPERTENSION IN BREASTFEEDING WOMEN IN PRIMARY CARE

Abstract

Postpartum hypertension requires careful management, particularly in breastfeeding women, to prevent complications like eclampsia and future cardiovascular issues. This case involves a 40-year-old Southeast Asian woman, G3P3, who presented at a primary care clinic for a 6-week postnatal check-up. The patient, with a history of gestational hypertension, managed with labetalol during pregnancy, reported elevated blood pressure (average 140/90 mmHg) while breastfeeding. Postpartum management initially included nifedipine, which was tapered due to concerns about drug transfer into breast milk. Her blood pressure was 145/95 mmHg at the clinic without significant symptoms. Guidelines suggest that beta blockers like labetalol, propranolol, metoprolol, and calcium channel blockers like nifedipine and verapamil have minimal transfer into breast milk and are generally safe. Caution is advised with atenolol and acebutolol due to higher transfer levels. ACE inhibitors like enalapril are considered safe but require monitoring of infant hemodynamics. High-dose diuretics may reduce milk production and are typically avoided. In managing postpartum hypertension in breastfeeding women, it is crucial to balance maternal health needs with infant safety. The use of antihypertensive agents with the lowest transfer into breast milk is recommended. International guidelines suggest a multidisciplinary approach involving pediatricians to monitor and ensure the well-being of both mother and infant. Individualized care and adherence to current guidelines are essential in these cases.