Use of diuretics during pregnancy.

QUESTION: Several of my pregnant patients use diuretics for hypertension. I have heard that diuretics cannot be used in pregnancy because of the reduction of plasma volume and the potential for decreasing placental perfusion, as well as a possible diabetogenic effect. ANSWER: Many studies--including a meta-analysis of almost 7000 neonates exposed to diuretics during pregnancy--did not find an increased risk of adverse effects, such as birth defects, fetal growth restriction, thrombocytopenia, or diabetes, among neonates exposed to diuretics in utero.