Regarding the management and pathophysiology of gestational hypertension and preeclampsia, all of the following statements are correct EXCEPT:

Question

Accepted Answer

B. ACE inhibitors and ARBs are safe and recommended as first-line agents for chronic hypertension management in the second and third trimesters. ## Antihypertensive Therapy in Pregnancy: Safety and Evidence

**Key Point:** ACE inhibitors and ARBs are CONTRAINDICATED in pregnancy, especially in the second and third trimesters, due to teratogenicity (renal dysgenesis, oligohydramnios, fetal death). They are NOT safe or recommended in pregnancy.

### Safe vs. Contraindicated Antihypertensives in Pregnancy

| Drug Class | Safety Profile | Use in Pregnancy |
|-----------|-----------------|------------------|
| Labetalol | Safe; combined α and β blockade; no fetal harm | First-line for acute and chronic management |
| Nifedipine (extended-release) | Safe; no adverse fetal effects | First-line for chronic management |
| Methyldopa | Safe; long track record; slow onset | First-line for chronic management |
| Hydralazine | Safe; used acutely in severe hypertension | Acute management (IV/IM) |
| Atenolol | Relatively safe but associated with IUGR | Not preferred; labetalol preferred |
| **ACE inhibitors / ARBs** | **CONTRAINDICATED** | **Cause fetal renal dysgenesis, oligohydramnios, death** |
| Diuretics | Relative caution (volume depletion) | Avoid unless essential |

**High-Yield:** The three safe first-line agents for chronic hypertension in pregnancy are: **labetalol, nifedipine (extended-release), and methyldopa** (mnemonic: **LNM**).

**Clinical Pearl:** Magnesium sulfate 4–6 g IV loading dose, then 1–2 g/h maintenance, is the gold standard for seizure prophylaxis in preeclampsia with severe features and eclampsia. It is NOT an antihypertensive; blood pressure control requires separate agents.

**Warning:** Students often confuse magnesium sulfate's role: it prevents seizures, NOT hypertension. Do not use it as monotherapy for blood pressure control.

Answer

A. Gestational hypertension is defined as new-onset hypertension after 20 weeks without proteinuria, and resolves within 3 months postpartum

Answer

C. Magnesium sulfate is the drug of choice for seizure prophylaxis in preeclampsia, not for blood pressure control

Answer

D. Labetalol is preferred over atenolol in the acute management of hypertensive emergencies in pregnancy

Regarding the management and pathophysiology of gestational hypertension and preeclampsia, all of the following statements are correct EXCEPT:

Explanation

Antihypertensive Therapy in Pregnancy: Safety and Evidence

Safe vs. Contraindicated Antihypertensives in Pregnancy

Practice similar questions

Join our NEET PG community

Drug Class	Safety Profile	Use in Pregnancy
Labetalol	Safe; combined α and β blockade; no fetal harm	First-line for acute and chronic management
Nifedipine (extended-release)	Safe; no adverse fetal effects	First-line for chronic management
Methyldopa	Safe; long track record; slow onset	First-line for chronic management
Hydralazine	Safe; used acutely in severe hypertension	Acute management (IV/IM)
Atenolol	Relatively safe but associated with IUGR	Not preferred; labetalol preferred
ACE inhibitors / ARBs	CONTRAINDICATED	Cause fetal renal dysgenesis, oligohydramnios, death
Diuretics	Relative caution (volume depletion)	Avoid unless essential