Iris Publishers- World Journal of Gynecology & Womens Health| Chronic Hypertension During the First Trimester of Pregnancy

Authored by Lucas Soares Bezerra

Cardiovascular diseases are a major cause of maternal mortality and morbidity worldwide, including developed countries [1]. The first-line drug to treat hypertension in pregnant women is methyldopa, which is an α2-adrenergic agent that has shown maternal and fetal safety and efficacy. However, methyldopa is not effective in all cases, and sometimes it is important to consider other pharmacological agents [1,2]. Angiotensin-converting enzyme inhibitors (ACEIs) are effective first-line antihypertensive drugs, with additional benefit in diabetic subjects [3]. Also, a positive effect to prevent dementia has been reported, especially in patients with diabetes or hypertension [4]. ACEIs are contraindicated during the second and third trimesters of pregnancy due to well-recognized congenital malformations, such as the renin–angiotensin–system (RAS) blockade syndrome [2,3]. Most part of guidelines and studies contraindicate ACEI use during the first trimester of pregnancy [5,6]. Nevertheless, actual risks are not fully cleared in literature, especially because hypertension represents an isolated risk factor for malformations, and in some of those studies the sample presented comorbidities such as diabetes, which were important confounding factor in the analysis of fetal outcomes risk [3,7-9]. Studies about the use of ACEIs during the early pregnancy have been presenting conflicting results [10,11]. Therefore, this work intends to discuss about the state-of-the-art of this subject.

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