Stable fetal hemodynamics measured by Doppler flow after initiation of anti-hypertensive treatment with methyldopa in pregnant women with diabetes

Abstract

Aim: To evaluate whether initiation of anti-hypertensive treatment with methyldopa affects fetal hemodynamics in women with pregestational diabetes.

Methods: Prospective study of unselected singleton pregnant women with diabetes (seven type 1 and two type 2 diabetes), normal blood pressure and kidney function at pregnancy booking. Methyldopa treatment was initiated at blood pressure >135/85 mmHg and/or urinary albumin excretion (UAE) >300 mg/g creatinine. Pulsatility indices (PI) of the uterine, umbilical, middle cerebral arteries before and 1 week after initiation of methyldopa treatment (250 mg three times daily) was performed and the cerebro-placental ratio (CPR) was calculated.

Results: Methyldopa treatment was initiated at median 249 (range 192–260) gestational days, mainly due to gestational hypertension (n = 7). Blood pressure declined from 142 (112–156)/92 (76–103) mmHg before to 129 (108–144)/82 (75–90) mmHg after initiation of methyldopa treatment (p = 0.11 and 0.04 for systolic and diastolic blood pressure, respectively). There were no significant changes in the umbilical artery PI (0.82 (0.72–1.40) versus 0.87 (0.64–0.95), p = 0.62) or CPR (1.94 (0.96–2.33) versus 1.78 (1.44–2.76), (p = 0.73). Gestational age was 265 (240–270) d. Apgar scores were normal.

Conclusions: Stable Doppler flow velocity waveforms were documented after initiation of methyldopa treatment for pregnancy-induced hypertensive disorders in this cohort of pregnant women with pregestational diabetes.

Keywords:

• Fetal blood flow
• hypertension
• methyldopa
• preeclampsia
• pregnancy

Acknowledgements

The authors would like to thank Anna Lilja Secher, MD for her assistance on analysing data.

Declaration of interest

No potential conflicts of interest relevant to this article were reported.