USE OF METHYLDOPA IN PREGNANCY

Methyldopa is an antihypertensive agent thought to act by stimulating α2-adrenergic receptors.

The National Institute for Health and Care Excellence (NICE) recommends that labetalol is offered as first-line antihypertensive treatment during pregnancy, with alternatives being nifedipine if labetolol is not suitable, and methyldopa if both labetalol and nifedipine are not suitable. If a woman prescribed methyldopa during pregnancy requires ongoing postpartum treatment, NICE recommends that methyldopa is discontinued within two days of delivery and an alternative antihypertensive treatment initiated. This is due to an increased risk of depression with methyldopa use.

The limited available data do not demonstrate increased overall risks of congenital malformation or miscarriage following use of methyldopa in the first trimester but are inadequate to rule this out. While specific associations between first trimester methyldopa use and Ebstein’s anomaly, and digestive, genital and urinary tract defects have been reported in single studies, further analyses are needed to confirm or refute these associations. The limited available data do not currently raise concerns of increased risks of preterm delivery, small for gestational age, perinatal death, neonatal complications or adverse neurodevelopmental outcomes directly related to methyldopa exposure.

Exposure to methyldopa at any stage in pregnancy is not itself an indication for additional fetal monitoring, although pregnant women with hypertension will be offered consultant-led care and additional monitoring of blood pressure, proteinuria, and ultrasound assessment of fetal growth and wellbeing. Other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.