Use and Abuse of Diuretics

To the Editor.  —The Archives article by Francisco and Ferris (1982;142:28-32) may potentiate the abuse of diuretics in pregnancy. We agree with the benign effect of edema if the BP remains normal. However, we strongly disagree with the unqualified use of diuretics in toxemia of pregnancy. As they have appropriately noted, arterial BP rises, venous capacity decreases, and salt retention contributes to hypertension.It is known that preeclampsia is associated with a decreased intravascular volume. The administration of thiazides will further reduce this volume. Gant et al¹ have demonstrated a reduced metabolic clearance rate of dehydroepiandrosterone sodium sulfate in studies of nine pregnant women on the seventh day of thiazide therapy. This reduction may represent decreased placental perfusion and suggests that the use of thiazides may compromise optimal fetal oxygenation and nutrition in these cases. Furthermore, the thiazides cross the placenta and may cause symptomatic neonatal hyponatremia, hypokalemia, and