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 **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.