L29. Pathophysiology and treatment of hypertension in women in the different phases of life

Abstract

as a class, they are well tolerated and exhibit a low sideeffect profile. In recent years, CCBs have found their way in obstetrics and gynecology, especially in the management of hypertensive disorders of pregnancy and preterm labor. The lack of adequate data had created uncertainty about the safety of CCBs in pregnancy. Teratogenicity with these agents has been demonstrated in animals, but no cases of possible human malformation or deformity have been reported. Data from human studies suggest that CCBs may cause a clinically insignificant fall in maternal mean arterial pressure, but have little to no effect on uterine perfusion. In many countries, CCBs remain unlicensed for use in pregnancy and it is unlikely the manufacturers will ever apply for this status to change. In case of such off-label prescription, prenatal counseling is mandatory, particularly even when the risk of malformations is above that of the baseline risk. Counselling should include thebackgroundhumanbaseline risk formajormalformations,whether the fetus is at increased risk,whichanomaly has been associated with the agent in question, a risk assessment, methods of prenatal detection, when available, limitations in our knowledge, and limitations of prenatal diagnostic capabilities. Additional aspects include the potential risk of the medical condition for which a drug is prescribed, known interactions (in both directions) between the disease state and the pregnancy andpreventivemeasures, when applicable. The reported differences in pregnancy outcomes for others side effects in women treated with CCBs may be not surprising because the treatment effect is superimposed to maternal diseases associated to higher maternal and perinatal morbidity and mortality, such as hypertension disorders or preterm labor. In a critical view the safety of CCBs in pregnancy may be underestimated since they are not even licensed in most countries for that use, despite this class of drugs is widely administered in practice and reported in literature. At present, it is recommended that a drug only be used during pregnancy if the potential benefit outweighs any potential risk to the fetus. We do believe that this is the situation of CCBs for those critical secondand third-trimester conditions such as Gestational hypertension, Preeclampsia, HELLP syndrome and preterm labor.