Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What treatment option is appropriate for a pregnant patient with gestational diabetes and consistently high blood pressure readings?

1. Methyldopa

2. Low dose ACE inhibitor (lisinopril)

3. Low to moderate dose diuretic (e.g., furosemide)

4. No medical treatment necessary, continue lifestyle modifications

The correct answer is: Methyldopa

Methyldopa is considered the appropriate treatment option for a pregnant patient with gestational diabetes and consistently high blood pressure readings. This medication has a long history of use in managing hypertension during pregnancy and is classified as a safe choice for both the mother and the developing fetus. It works as an alpha-2 adrenergic agonist, leading to reduced sympathetic outflow, which lowers blood pressure. Other treatment options are less suitable in this context. Low-dose ACE inhibitors, such as lisinopril, are contraindicated during pregnancy due to their association with significant fetal risks, particularly in the second and third trimesters. Similarly, low to moderate doses of diuretics like furosemide are typically avoided during pregnancy unless absolutely necessary, as they can lead to reduced plasma volume and potential adverse effects on both maternal and fetal health. While lifestyle modifications are crucial in managing gestational diabetes and hypertension, they may not suffice if blood pressure remains consistently high, thus making medication necessary for proper management. In summary, Methyldopa stands out as a safe and effective choice for controlling hypertension in pregnant patients with gestational diabetes, addressing the mother's condition without compromising fetal wellbeing.