A woman with chronic hypertension controlled on methyldopa throughout pregnancy delivers at term and plans to breastfeed. Why is methyldopa typically discontinued or replaced in the postpartum period?
- A It causes depression and is poorly suited for long-term outpatient use ✓
- B It suppresses lactation through dopamine agonist activity
- C It is excreted in breast milk and causes neonatal bradycardia
- D It loses its antihypertensive effect once the placenta is delivered
Correct answer: A. It causes depression and is poorly suited for long-term outpatient use
Explanation
Methyldopa is a central alpha-2 agonist and a preferred agent during pregnancy because of its long safety record, but it commonly causes depression, sedation, dry mouth, and orthostatic symptoms, making it unsuitable for long-term use after delivery. It is compatible with breastfeeding and does not suppress lactation, since it lacks clinically meaningful dopamine agonist activity at therapeutic doses. Its antihypertensive action is independent of the placenta. Labetalol, nifedipine, or enalapril are usual postpartum substitutes.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.