Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

Which antihypertensive agent is considered the safest for a pregnant woman with diabetes and chronic hypertension?

1. Lisinopril

2. Valsartan

3. Fosinopril

4. Methyldopa

The correct answer is: Methyldopa

Methyldopa is considered the safest antihypertensive agent for a pregnant woman with diabetes and chronic hypertension due to its long-standing historical use during pregnancy and favorable safety profile. This medication has been the treatment of choice for managing hypertension in pregnant patients because it does not appear to adversely affect fetal development and has a low risk of causing issues such as fetal growth restriction or congenital anomalies, which is a significant concern with other antihypertensive agents. The other medications listed, such as Lisinopril, Valsartan, and Fosinopril, are angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These classes of medications are contraindicated during pregnancy, particularly in the second and third trimesters, because they can lead to serious complications for both the mother and the fetus, including fetal renal dysfunction and oligohydramnios (low amniotic fluid level). Therefore, the safety profile of Methyldopa makes it the preferred option in this context, especially considering the need for effective blood pressure management while minimizing risk to the developing fetus.