AHA2020 | Prof. Nanette K.Wenger:What should I do if I have high blood pressure or diabetes during pregnancy?

In clinical diagnosis and treatment, some women may develop hypertension or diabetes during pregnancy, which is very harmful to pregnant women and babies. How to manage blood glucose and blood pressure during pregnancy, how to choose medication, and how to intervene? With these series of questions, the journal specially invited Prof. Nanette K.Wenger of Emory University School of Medicine, Atlanta, Georgia, USA to answer them.

Question 1：Hypertension and diabetes during pregnancy are long-term hazards for women. What is your opinion about the management of blood sugar and blood pressure ?

Prof. Nanette K. Wenger: Every country has slightly different guidelines. Certainly we have to control diabetes during pregnancy, but we don’t want the blood sugar to get too low because we don’t want the woman to be hypoglycemic. The most important thing is to maintain placental perfusion. It is the same with blood pressure. If the blood pressure is very high, it must be controlled, but we don’t want it to get below 140/90 mm Hg, because we worry about placental perfusion.

Question 2:Pregnant women have many restrictions on medication choices. What medication recommendations are in the guidelines for lowering blood pressure or blood sugar?

Prof. Nanette K. Wenger: Certainly, you never use an angiotensin-converting enzyme inhibitor or an ARB during pregnancy. Those are absolutely contraindicated. There are a number of safe medications. The calcium channel blockers are safe. The beta blockers are safe. Alpha-methyldopa is safe. Hydralazine. The ones that would concern me most would be the ACEs and the ARBs because they are contraindicated. As far as we know, there is not a problem with the drugs used to manage diabetes, but for the newer drugs, we don’t have much information.

Question 3:What are the long-term effects of gestational diabetes mellitus on the mother?

Prof. Nanette K. Wenger: I think the important thing is that for the woman who has hypertension during pregnancy or diabetes during pregnancy, even though they may subside at the end of the pregnancy, that identifies a woman of increased risk. She must be followed very carefully for the recurrent development of diabetes and for the return of hypertension. All of the standard lifestyle measures should be applied - weight control, heart healthy diet, no smoking, physical activity. But it is very important to do long term surveillance.