Blood Pressure Medication

Hi Liz,

My name is Nic, im 40, and i've been 'spying' on your site for the past six months. I developed severe pre-eclampsia very early on in my pregnancy and had to have my baby girl, Freya, by caesarean at 25 weeks. Sadly she died at 6 days old. This all happened back in March this year. Don't think i'm dismissing her by this post as its more about me but like everyone else on this site who's lost a baby and had pre-eclampsia, its heartbreaking and someday i may tell my story. I think about her everyday and wish things could have been different but life just isn't fair sometimes.

Anyway back to what i'm asking..... a kidney consultant wants to put me on medication for high blood pressure which hasn't settled down since I had Freya. I had a kidney operation 3 years ago because i had a blockage (they were ok during pregnancy believe it or not) but everything is fine with that apart from my high bp. I asked if i could be put on a medication that i could take during pregnancy even though we're not even thinking about that until next year, but i would like to be settled on a suitable medication rather than having to change before we try to conceive. I took nifedipine and labetalol when i was pregnant but i had terrible swollen ankles from the nifedipine (i took nifedipine first thing in the morning and my ankles used to swell straight away then took labetalol later). I had shivers and flushes as well. I continued to take the same tablets after pregnancy and was still having the same symptoms (i thought it was down to the pre-eclampsia). So i've asked to avoid nifedipine but i don't know if the other symptoms were due to the labetalol or not. The consultant took me off medication as he thought i had white coat syndrome and the bp would come down on its own. Anyway, to cut a long story short i've been prescribed Bisoprolol, i haven't taken it yet as i've still got to get the prescription from my gp, and i was wondering what you know about that medication. I know its a beta-blocker but haven't seen much info on the internet that its widely used in pregnancy. The only ones that i know of are nifedipine, labetalol and methyldopa.

I know the odds are stacked against me and the chances of getting pre-eclampsia again are high, being 40, having high bp and kidney problems in the past but myself and my obstetrician are hopeful for a happier outcome next time.

Hope you can help me Liz.... btw, this site has been a godsend to me. I didn't want to speak to any counsellors but reading what other ladies have been and are going through with their pregnancies has been really helpful. I wish you all luck xx

Nic x

Hi Nic,
I just wanted to say how sorry I am to read about your little girl. I and unfortunately too many of us on here know what it feels like to lose our much loved babies. This site has been such a support to me since losing my daughter who I still grieve terribly for and always will. It has also been great throughout a very nerve wracking second pregnancy. I'm sorry to hear about your problems with bp, I always took labetalol in pregnancy (once pe came) and post pregnancy last time like yourself and was fine. Hope you get it sorted, lots of luck.
Lizzie

Hi Nic and welcome,

I can't really help with your medication question as I was on labetelol which I managed to wean off six weeks or so after giving birth to my little man. However, I just want to say that I am so sorry to hear about your little girl. PE is such a horrible and cruel disease which has taken too many babies lives and I know it's no consilation but there are (sadly!) quite a few of us on here who know what you're experiencing.

I really hope that you are doing ok and you can get help and advice on a second pregnancy and it can have a successful outcome.

Take care
Emma xxx

Hi Nic,

Just re-iterating, I am 39 now, have a diagnosis of stage 2 chronic kidney disease (though no hypertension), and have had several miscarriages as well as stillbirth at 26 weeks due to PE / HELLP.

But I am now 25 weeks pregnant and touch wood things seem to be going a lot better this time. So don't give up hope just because of your age and past medical history --- though the last 18 months have of cousse been so very very hard for me x

Hi Nic,

Welcome to the site, I am so sorry to hear that you experienced PE and that your precious little girl Freya couldnt stay.

I do hope you will continue to find the support & information you are looking for here.

To answer your question, there are actually very few drugs that are clinically proven to not effect a pregnancy or indeed the unborn baby. The ones you have listed, methyldopa, labetalol and nifedipine are the 'usuals'. This is because we know that these medicines are very unlikely to interfere with growth whilst baby is intra-uterine or to cross over in to breast milk.

The nifedipine is notorious for causing ankle swelling. The way calcium channel blockers work is by relaxing the muscle around the artery so that the artery itself becomes more 'springy'. Obviously in your feet & ankles, your blood has a much harder job to get back uphill to your heart and with relaxed muscles this doesnt help. This is often associated with 'flushing'.

Labetalol can cause tiredness and cold hands / feet. All types of beta blockers work in a similar way. They interfere with the adrenalin your body produces and slows down its uptake. By lowering your adrenalin levels this slows down the signals to your kidney. When your kidney works hard you produce a variety of hormones which can all put your blood pressure up.
Bisoprolol also does the same thing but helps to improve the hearts effectiveness as a pump at the same time.
This medicine can cause intra-uterine growth restriction equally, when baby is born to have a slow heart rate or low blood sugars. This is less likely on labetalol.

Methyldopa has been around for years and is a well tried and trusted medication. It is whats known as a centrally acting medicine so it works by slowing down the production of hormones that are known to trigger the cycle of blood pressure. The down side to this medicine is because it is centrally acting, it can cause post nantal depression so the 'whole you' must be carefully monitored.

There is one other drug called hydralizine which is sometimes used but rarely so and only when blood pressure is very high.
If you like, I have some fact sheets on these medicines I can email to you?

All this said Nic, you are only 6 months post delivery. You have been through a terrible emotional and physical trauma. Women who have babies without complication can take at least 9 months for their bodies to recover. When you factor in all that has happened to you, it is perfectly reasonable to think that your recovery might need the same or a little longer.

My suggestion would be to seek the opinion of a PE expert if you can. I can let you have the names of some near to you (although please forgive me in advance, my geography is awful).
Maybe a chat to go through your pregnancy with Freya (if nothing else to rule out underlying things like sticky blood) and plan a way forward with someone well qualified to give you an opinion. Only you will truly know when you are ready to try again.

If it offers you any comfort, I had a long chat with one of our experts not long ago. He told me i all his years (and there are many!) he had only ever told one woman not to try again. This was because her body was so weak it would not stand another pregnancy PE or not.

If you want to talk anything through I am available from 11am-3pm Mon Fri on 0845 241 0989

Warmest wishes to you Nic.
Liz

I don't have anything groundbreaking to add except that like you I was on on labetalol for my first pregnancy to control my BP and they put me on it again for my second but this time I developed severe jaundice and after a week's stay in hospital and numerous scans and blood tests they realised it was a reaction to labetalol. From then on I was on Nifedapine and like you the side effects of swelling of my ankles and knees were horrendous, my knees at times felt as it they were sun burnt from the inside - and I kept telling my midwife how bad things were but they just said its because you're pregnant!! I'm still on the bloody things now 12 weeks after and the swelling is still as bad so I know it wasn't the pregnancy! However the frightening thing was that the nifedapine controlled my BP really well to the extend that on the day I had my emergency c section my BP never went above 140/90 yet my bloods and the protein in my urine (which was 4+'s) indicate severe PE so I thank god I was being monitored every other day at the maternity assessment unit or I don't think I would be here now

I'm so sorry you lost your baby and I'm wishing you all the luck if you do decide to try for another baby, I'm so glad to have found this support forum as if we ever have another I know to seek the help of a consultant who specialises in PE, hopefully your next pregnancy will be different x

Hi Nic,

Just wanted to say welcome to the site and i am so sorry to hear about your beautiful baby daughter Freya.

I was treated with labetalol for my pre eclampsia and continue on it until this day which is 4 years later. I am now 25 weeks pregnant and consultant is happy for me to continue on labetalol throughout this pregnancy.

Best wishes

Bell.xxx

Hi everyone,

Thank you all for your replies. I've been to see my gp today and asked him if the medication was suitable for pregnancy and he just said come and see me when you get a positive pregnancy test, which didnt fill me with much confidence. Hes a new doctor at the practice!!! I've decided to continue with the Bisoprolol and then think again when we decide to try for another baby, which won't be until next year at least as I want to make sure i'm in the best shape possible physically (and mentally).

Thank you all again anyway...

Nic x