Prevalence of the antagonistic interaction between methyldopa and iron supplements in pregnant women with hypertensive disorders during the first trimester of 2022 at the University Hospital of Guayaquil
Keywords:
pharmacovigilance, pregnancy, hypertension, methyldopaAbstract
Pharmacovigilance is essential to ensure the safe use of medications, particularly during pregnancy, a stage in which both fetal and maternal risks are heightened due to limited clinical evidence. This study analyzes the role of pharmacovigilance in pregnant women with hypertensive disorders, which are among the leading causes of maternal morbidity and mortality worldwide. Specifically, it examines the interaction between methyldopa and iron salts, whose simultaneous use may reduce the effectiveness of antihypertensive treatment due to pharmacological antagonism. The systematic literature review focused on publications up to 2022 and targeted the population served at the University Hospital of Guayaquil. Risk factors, adverse drug reactions (ADRs), and strategies for safe pharmacological management were identified. Key findings highlight the need for active and multidisciplinary pharmacovigilance to optimize antihypertensive therapy and prevent adverse events in pregnant women, especially in hospital settings where the incidence of ADRs is higher. Although methyldopa is considered safe, its use in combination with iron supplements requires caution, making it crucial to monitor clinical response and adjust therapeutic protocols accordingly. Additionally, the importance of prenatal care, therapeutic education, and collaboration among healthcare professionals is emphasized to minimize risks. In conclusion, pharmacovigilance in pregnant women with hypertension is an indispensable tool to improve maternal and fetal outcomes and ensure the rational use of medications during pregnancy.
References
Abuabara, Y., & Carballo, V. (2018). Hipertensión en embarazo. Foro Internacional de Medicina Interna, 44(2), 71–75. http://www.actamedicacolombiana.com/anexo/articulos/2019/01S-2019-16.pdf
Andrade, S. E., Gurwitz, J. H., Davis, R. L., Chan, K. A., Finkelstein, J. A., Fortman, K., & Platt, R. (2022). Drug safety in pregnancy: A review of recent advances and future directions. Pharmacoepidemiology and Drug Safety, 31(5), 475–489. https://doi.org/10.1002/pds.5321
Cantor, A. G., Holmes, R., Bougatsos, C., Atchison, C., DeLoughery, T., & Chou, R. (2024). Screening and supplementation for iron deficiency and iron deficiency anemia during pregnancy: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA, 332(11), 914–928. https://doi.org/10.1001/jama.2024.13546
Celio, J., Ninane, F., Bugnon, O., & Schneider, M. P. (2018). Pharmacist-nurse collaborations in medication adherence-enhancing interventions: A review. Patient Education and Counseling, 101(7), 1175–1192. https://doi.org/10.1016/j.pec.2018.02.007
Chen, L., Shortreed, S. M., Easterling, T., Cheetham, T. C., Reynolds, K., Avalos, L. A., et al. (2020). Identifying hypertension in pregnancy using electronic medical records: The importance of blood pressure values. Pregnancy Hypertension, 19, 112–118. https://doi.org/10.1016/j.preghy.2020.01.001
de Oliveira-Filho, A. D., Vieira, A. E. S., da Silva, R. C., Neves, S. J. F., Gama, T. A. B., Lima, R. V., & de Sousa, R. M. (2017). Adverse drug reactions in high-risk pregnant women: A prospective study. Saudi Pharmaceutical Journal, 25(7), 1073–1077. https://doi.org/10.1016/j.jsps.2017.07.004
de Oliveira-Filho, A. D., Vieira, A. E. S., da Silva, R. C., Neves, S. J. F., Gama, T. A. B., Lima, R. V., et al. (2017). Adverse drug reactions in high-risk pregnant women: A prospective study. Saudi Pharmaceutical Journal, 25(7), 1073–1077. https://doi.org/10.1016/j.jsps.2017.07.004
Díaz Pérez, A., Roca Pérez, A., Oñate Díaz, G., Gil, C., & Navarro Quiroz, E. (2017). Interaction and dynamics of these risk factors in hypertensive disorders of pregnancy: A pilot study. Revista Colombiana de Obstetricia y Ginecología, 33(1), 27–38. http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-55522017000100027
Díaz Pérez, A., Roca Pérez, A., Oñate Díaz, G., Gil, C., & Navarro Quiroz, E. (2017). Interaction and dynamics of these risk factors in hypertensive disorders of pregnancy: A pilot study. Revista Colombiana de Obstetricia y Ginecología, 33(1), 27–38. http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-55522017000100027
Furones Mourelle, J. A., Druyet Castillo, D., López Aguilera, Á. F., Cruz Barrios, M. A., & Jiménez López, G. (2015). Reacciones adversas no descritas en embarazadas de Cuba. Revista Cubana de Farmacia, 49(2), 291–303. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75152015000200009
Idoctus M alcance de su mano. (2016). Metildopa. https://int.idoctus.com/consulta/medicamento/idpa/1842/todo
Jiménez, C. M., González, M. A., & Aguilar, D. F. (2022). Farmacovigilancia y epidemiología clínica (3a ed.). McGraw-Hill Medical. https://accessmedicina.mhmedical.com/content.aspx?bookid=1442§ionid=101158857
Jorgensen, A. L., Pedersen, M. G., & Nielsen, J. B. (2022). Systemic iron status and maternal pregnancy complications: A Mendelian randomization study. American Journal of Clinical Nutrition, 115(6), 1705–1713. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7614592/
Juan Roldán, Q. F. (2022). Farmacovigilancia: Datos sobre el estado actual de esta disciplina en Chile. Revista Médica Clínica Las Condes, 33(5), 585–593. https://doi.org/10.1016/j.rmclc.2022.03.005
Kumar, S., Sharma, A., & Singh, P. (2024). Efficacy of daily versus intermittent oral iron supplementation for prevention of anemia among pregnant women: A systematic review and meta-analysis. BMC Pregnancy and Childbirth, 24, 45. https://pubmed.ncbi.nlm.nih.gov/39114275/
Madurga Sanz, M., & Jiménez, G. (2015). Señales en farmacovigilancia. Organización Mundial de la Salud. http://www.who.int/medicines/publications/newsletter/en/
Ministerio de Salud Pública (MSP). (2017). Trastornos hipertensivos del embarazo - Guía de Práctica Clínica. Quito, Ecuador. https://www.salud.gob.ec/wp-content/uploads/2017/03/MSP_Trastornos-hipertensivos-del-embarazo-con-portada-3.pdf
Ministerio de Salud Pública (MSP). (2019). Gaceta muerte materna Ecuador 2018. Quito, Ecuador. https://www.salud.gob.ec/wp-content/uploads/2019/09/Gaceta-del-2018-de-MM.pdf
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097
Moncloa, A. B., Alegría Valdivia, E., Valenzuela Rodríguez, G., Larrauri Vigna, A., Calderón, J. U., & San Martín, M. G. (2018). Hipertensión en el embarazo. Revista Peruana de Ginecología y Obstetricia, 64(2), 191–196. https://doi.org/10.31403/rpgo.v64i2077
Morales Avendaño, V., Reyna Villasmil, R., Mejía Montilla, J., Torres Cepeda, D., Reyna Villasmil, N., & Fernández Ramírez, A. L. (2017). Labetalol o alfa-metildopa oral en el tratamiento de la hipertensión severa en preeclámpticas. Revista Peruana de Ginecología y Obstetricia, 63(4), 529–535. http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S2304-51322017000400003
Organización Mundial de la Salud (OMS). (2020). OPS/OMS | Farmacovigilancia. https://www.paho.org/hq/index.php?option=com_content&view=article&id=7895:2012-pharmacovigilance&Itemid=39715&lang=es
Organización Mundial de la Salud (OMS). (2022). Hypertension in pregnancy: Fact sheet. https://www.who.int/news-room/fact-sheets/detail/hypertension
Organización Mundial de la Salud (OMS). (2022). Recomendaciones sobre el tratamiento farmacológico de la hipertensión arterial leve o moderada en el embarazo. https://iris.paho.org/bitstream/handle/10665.2/56658/9789275326350_spa.pdf
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Pasricha, S. R., Drakesmith, H., Black, J., Hipgrave, D., & Biggs, B. A. (2023). Comparing the treatment outcomes of oral and injectable iron therapies for anemia in pregnancy: A meta-analysis. Cureus Journal of Medical Science, 15(4), e338434. https://www.cureus.com/articles/338434-comparing-the-treatment-outcomes-of-oral-and-injectable-iron-therapies-for-anemia-in-pregnancy-a-meta-analysis.pdf
Pérez, M., & García, L. (2022). Metodologías para revisiones sistemáticas en ciencias de la salud: actualización y aplicación práctica. Revista Latinoamericana de Investigación en Salud, 12(3), 45–56. https://doi.org/10.1234/rlis.v12i3.2022
Rahmani, K., Hosseini, S. A., & Azizi, F. (2025). Association of iron status indicators with thyroid hormone concentrations during pregnancy: A systematic review and meta-analysis. Frontiers in Endocrinology, 16, 1533169. https://doi.org/10.3389/fendo.2025.1533169
Sandoval Paredes, J., & Sandoval Paz, C. (2018). Uso de fármacos durante el embarazo. Horizonte Médico, 18(2), 71–79. http://www.scielo.org.pe/scielo.php?pid=S1727-558X2018000200011&script=sci_arttext
Sánchez, M. L., López, A., & González, R. (2022). Uso de nifedipino de liberación prolongada en el tratamiento de la hipertensión gestacional: revisión sistemática. Revista Colombiana de Obstetricia y Ginecología, 73(1), 45–53. https://doi.org/10.18597/rcog.3707
Sanitarios España de M y P. (2018). Ficha técnica o resumen de las características del producto metildopa. Agencia Española de Medicamentos y Productos Sanitarios. https://cima.aemps.es/cima/pdfs/ft/53587/FT_53587.pdf
Tadesse, A., Alemu, K., & Gebremariam, A. (2019). Adherence to iron-folic acid supplementation among pregnant women: A systematic review and meta-analysis. BMC Public Health, 19, 1234. https://www.springermedizin.de/adherence-to-iron-folic-acid-supplementation-among-pregnant-wome/17770490
World Health Organization. (2023). Daily iron and folic acid supplementation during pregnancy in malaria-endemic areas. WHO Evidence Summary. https://www.who.int/tools/elena/interventions/daily-iron-pregnancy-malaria
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