Patient: Name of drug: Dextran. Dosing instructions: once a day for most of the year. 29 years old, hypertension for 8 years, used to take Betalac in winter, stop taking it in summer. The doctor said that the blood pressure is not well controlled, so I am taking Dextran, and now in April, my blood pressure is around 120-80. I’m trying to get pregnant, and I’ve been consulting with local doctors who say different things about the effects of diphenhydramine on the fetus, one doctor says to stop for 6 months, one says to stop for 2-3 months. One doctor told me to stop the medication completely for 3 months before pregnancy and to take methyldopa or labetalol for high blood pressure after pregnancy, saying that calcium ionizers are no longer recommended. But another doctor advised me to keep taking Loxoprofen before pregnancy. I would like to ask: 1. How many months do I need to stop taking Dextran to eliminate the effect of the drug on the fetus? 2. Methyldopa or Labetalol, Lopressor? Which one is better? 3. Do I need to stop taking the drug completely for a few months before I get pregnant? Assuming I take Labetalol or Lopressor, can I keep taking it before pregnancy and will it have any residual effect on the baby? Yao Li, Department of Traditional Chinese Medicine and Cardiovascular Medicine, The Third Hospital of Zhejiang University of Traditional Chinese Medicine: The management of hypertension in pregnancy is one of the most controversial areas of obstetrical treatment. The debate is mainly about whether the onset and development of severe complications can be reduced in mild and moderate patients after treatment, and if so, whether drug treatment can cause fetal risk. When to start medication in women with combined hypertension during pregnancy, it has been difficult for clinicians to make decisions on when to start medication and what medication should be used to ensure lowering of blood pressure while better protecting the safety of the mother and fetus. For patients with pre-pregnancy hypertension, the presence of target organ damage or the simultaneous use of multiple antihypertensive drugs, drug doses should be adjusted according to blood pressure levels during pregnancy, in principle using as few drug classes and doses as possible. For non-severe hypertension, the recommended first-line drugs include methyldopa and labetalol. The first-line drug for the treatment of hypertension in pregnancy is methyldopa, and the second-line drugs include alpha and beta blockers, which can be used in combination with the first-line drugs, thus reducing the adverse effects caused by excessive doses of the first-line drugs. Methyldopa is the only class B drug in the FDA classification, has over 40 years of clinical use in pregnancy, is not teratogenic, has sufficient data to demonstrate safety in early pregnancy, and is the only antihypertensive drug with 7.5 years of maternal offspring follow-up that is still widely used for the treatment of hypertension during pregnancy. A published study of the offspring of patients with intrauterine exposure to methyldopa found no differences in intellectual and neurocognitive development between the methyldopa and control groups at 7.5 years of age. Adverse effects of methyldopa are caused by a decrease in central α2-agonism or peripheral sympathetic tone. The drug acts on the brainstem, decreases mental alertness, impairs sleep, and leads to feelings of fatigue or depression in some patients. Salivary secretion is reduced, resulting in frequent dry mouth, and a 5% incidence of elevated liver enzymes, hepatitis and hepatic necrosis have been reported. Labetalol is a non-selective β-blocker with vascular α1 receptor blocking properties and is widely used in pregnant women. Although higher doses of labetalol have been reported to cause neonatal hypoglycemia, the safety and efficacy of oral administration in pregnant women with chronic hypertension are comparable to those of methyldopa. From a pharmacological point of view, the body has basically metabolized and cleared it after a week of discontinuing the drug and it will not have an effect on conception. There is no need to wait too long. Patient: Thank you very much, Dr. Yao. Your opinion is that Methyldopa and Labetalol are better than Lopressor, right? And I see that you are from the University of Traditional Chinese Medicine, I would like to ask if I can have Chinese herbal medicine or acupuncture treatment and stop western medicine treatment? Yao Li, Department of Cardiovascular Medicine, The Third Hospital of Zhejiang University of Traditional Chinese Medicine: Methyldopa and labetalol are more suitable. Chinese medicine with western medicine can play a synergistic role, and the comprehensive conditioning of Chinese medicine can also take into account some other problems that you have, and adjust your physique to facilitate pregnancy. You have been taking western medicine for a long time and should not stop taking it. If the Chinese medicine works well, you can reduce the amount of western medicine. You can visit my clinic for consultation and treatment.