A 32-year-old woman with pre-eclampsia delivered at 34 weeks. On postpartum day 2, her blood pressure rises to 172/114 mmHg. She is breastfeeding. According to current guidelines, which of the following antihypertensives is considered SAFE during breastfeeding and is appropriate for postpartum blood pressure control?
- A Enalapril
- B Spironolactone
- C Labetalol ✓
- D Hydrochlorothiazide
Correct answer: C. Labetalol
Explanation
Labetalol is considered compatible with breastfeeding and is a first-line agent for postpartum hypertension. ACE inhibitors like enalapril are generally avoided in breastfeeding, though captopril and enalapril have low levels in breast milk. Spironolactione is contraindicated due to anti-androgenic effects. Hydrochlorothiazide may suppress milk supply. Nifedipine and labetalol are preferred postpartum per ACOG guidelines.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.