Bibliographic Info
GuidelineWHO recommendations on maternal health: guidelines approved by the WHO Guidelines Review Committee, second edition. Geneva: World Health Organization; 2025
Year of Publication2023
Issuing InstitutionWorld Health Organization
Recommendation
Status
Maintained
Context specific recommendation
Only in specific contexts
Certainty of evidence
Very low
Oral alpha-agonist (methyldopa) and beta-blockers should be considered as effective treatment options for non-severe hypertension during pregnancy.
Notes and Remarks
- 1.The Guideline Development Group (GDG) considered that while the use of an antihypertensive drug for the treatment of non-severe hypertension in pregnancy may confer health benefits, pregnant women who are prescribed these drugs require regular outpatient monitoring and review by an antenatal care provider. Access to antenatal care services for monitoring of blood pressure and complications (such as proteinuria), or side-effects due to treatment, is considered integral to initiating antihypertensive treatment.
- 2.The GDG acknowledged that, based on available evidence, alpha-agonist (methyldopa) and beta-blockers are reasonable antihypertensive drug treatment options. The group considered it important that clinicians select an antihypertensive drug regimen appropriate to the woman’s individual clinical situation. The choice of antihypertensive should be based on pre-existing antihypertensive treatment, side-effect profiles, risks (including potential fetal effects), cost, local availability and the woman’s preferences. Methyldopa has the fewest safety concerns, is listed for use as an antihypertensive agent during pregnancy in the WHO Model List of Essential Medicines, and is widely available in many countries. Available evidence suggests that calcium channel blockers should be avoided.
- 3.Available trials used several different oral beta-blockers (including acebutolol, atenolol, labetalol, mepindolol, metoprolol, oxprenolol, pindolol and propranolol) at different doses. It is therefore not possible to determine the optimal beta-blocker option or dosing regimen for this indication. Atenolol and metoprolol are listed on the WHO Model List of Essential Medicines and are widely available in many countries.
- 4.The use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and sodium nitroprusside should be avoided due to safety concerns.
Also Featured In
This recommendation also appears in the following guidelines:
Originally Developed
Guideline
WHO recommendations on drug treatment for non-severe hypertension in pregnancy
Year2020
InstitutionWorld Health Organization