Prenatal exposure to methyldopa leading to hypertensive crisis and cardiac failure in a neonate

Pediatrics. 2014 May;133(5):e1392-5. doi: 10.1542/peds.2013-1438.

Abstract

A 2-week-old infant with normal intracardiac anatomy presented to the emergency department in a hypertensive crisis with acute cardiac failure. Despite extensive evaluation, no underlying disease was found. The patient's hypertension and cardiac dysfunction resolved after 1 week of supportive care in the PICU, and she was discharged within 2 weeks of presentation. The patient's history revealed transplacental exposure to the α-adrenergic agonist methyldopa for 10 weeks before delivery. Her age at presentation and the self-limited nature of cardiac sequelae with complete resolution of cardiac dysfunction suggest withdrawal effects from this exposure. Whereas the rebound hypertensive effects of α-adrenergic agonists are well established in the adult population, this report shows an unusual adverse outcome of in utero exposure to methyldopa.

Keywords: heart failure; hypertension; methyldopa; newborn; withdrawal.

Publication types

  • Case Reports

MeSH terms

  • Adrenergic Agonists / adverse effects*
  • Adrenergic Agonists / therapeutic use*
  • Female
  • Heart Failure / chemically induced*
  • Humans
  • Hypertension / chemically induced*
  • Hypertension, Pregnancy-Induced / drug therapy*
  • Infant, Newborn
  • Methyldopa / adverse effects*
  • Methyldopa / therapeutic use*
  • Pregnancy
  • Prenatal Exposure Delayed Effects*
  • Substance Withdrawal Syndrome / diagnosis*

Substances

  • Adrenergic Agonists
  • Methyldopa