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It appears that methyldopa does not harm an unborn baby and is considered the drug of choice for the treatment of high blood pressure during pregnancy. Tell your doctor if you become pregnant or are planning to become pregnant while taking methyldopa. It can pass into breast milk. If you are taking methyldopa, talk with your doctor before breastfeeding your newborn.
Methyldopa is a Class B drug for pregnancy and for breastfeeding. It is commonly given during pregnancy for Gestational Hypertension and for Chronic HTN during pregnancy. I have seen it used in many pregnancies and the mother did breastfeed later. It is an inexpensive drug and most patients only take it BiD, some only Q day. The most common doses I have seen are 250 mgs BID or 500 mg BID when the BP is elevated above 140/90. It seems to be tolerated well. Any slight risk is better than the complications which uncontrolled "HTN" lead to. i.e. Damage to the kidneys, decreased blood supply to the uterus (needs to be 500 ml) per minute for optimum utero-placental circulation. Anything which causes a decrease in this needed blood supply leads to the risk of preterm labor, damage to the placenta (infarcts), an IUGR (intrauterine growth retardation)fetus, or a SGA (small for gestational age). Uncontrolled "HTN" causes damage to all of the organ systems in the maternal body, and therefore it is essential that it be controlled during pregnancy to promote a healthy pregnancy and a good outcome - a healthy normal baby.
It is true that high blood pressure (hypertension) can be dangerous during pregnancy for both mother and baby. Therefore, methyldopa is a safe and effective drug to try to control elevated blood pressure. Although there are other more effective anti-hypertensive drugs, they are associated with more risks for baby and are avoided. Methyldopa has an excellent safety profile and a long history of use during pregnancy with good outcomes. It is listed as a "Category B" drug which is considered safe during pregnancy.
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