Methyldopa is considered a first-line medication for managing pregnancy-induced hypertension due to its established safety and efficacy in pregnant patients. It has been widely studied and is particularly favored for its ability to lower blood pressure without adversely affecting uteroplacental blood flow or fetal well-being. Methyldopa works by stimulating central alpha-adrenergic receptors, which leads to a decrease in peripheral vascular resistance and, consequently, a reduction in blood pressure.
Furthermore, the medication has a long history of use during pregnancy, with a favorable side effect profile, making it a reliable choice for both maternal and fetal safety. The American College of Obstetricians and Gynecologists (ACOG) endorses methyldopa as a suitable option for treating chronic hypertension in pregnancy, which aligns with its use for pregnancy-induced hypertension as well.
Other medications like nifedipine, hydralazine, and labetalol serve essential roles in specific situations or as second-line options. However, methyldopa remains the primary recommendation for initial management because of its long-standing presence in clinical practice, aligning with guiding principles for the well-being of both mother and child.