A 29-year-old pregnant woman with chronic hypertension has been maintained on methyldopa since 14 weeks of gestation. Which adverse effect is the classical reason methyldopa is avoided in women with a psychiatric history and is usually switched after delivery?
- A Depression and postpartum mood disturbance ✓
- B Rebound hypertension on withdrawal
- C Severe fetal growth restriction
- D Hyperkalemia
Correct answer: A. Depression and postpartum mood disturbance
Explanation
Methyldopa, a central alpha-2 adrenergic agonist, characteristically causes depression, sedation, and orthostatic hypotension, and it may worsen depressive illness, so it is avoided in women with depression and commonly switched to labetalol after delivery. It remains a favoured first-trimester agent because of its long safety record with no significant increase in major fetal malformations. Hyperkalemia is associated with ACE inhibitors and rebound hypertension is a problem with clonidine, not methyldopa.
Reference: Katzung Basic and Clinical Pharmacology, 16th ed.
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