A 32-year-old woman, just past 12 weeks of pregnancy, came to my office with her husband, worry written across their faces. She had finally succeeded in becoming pregnant after numerous fertility treatments. However, her blood pressure was elevated at 160/95mmHg, and her pulse was rapid at 120 beats per minute. Active treatment is necessary as this could pose risks to both mother and baby, but there are limited medication options available in clinical practice.
Hypertension during pregnancy is a serious condition that goes beyond simple elevated blood pressure—it can directly affect the lives of both mother and fetus. It can lead to fatal complications such as premature birth, fetal growth restriction, eclampsia, and cerebral hemorrhage, making appropriate drug treatment not a choice but a necessity. Hypertension during pregnancy is known to occur in approximately 5-10% of all pregnancies, and its frequency has been gradually increasing recently due to advanced maternal age and multiple pregnancies resulting from fertility treatments.
According to a presentation by the Korean Society of Hypertension last year, approximately 30,000 pregnant women are diagnosed with hypertensive disorders. This is not an individual problem but a public health issue that society must address together. Overseas, labetalol, nifedipine, and methyldopa are widely used as standard treatments for hypertension during pregnancy. Among these, labetalol has been used for a long period with sufficient safety data and is suitable for patients with rapid heartbeat due to its pulse-lowering effect. It is actually the most widely used hypertension medication for pregnant women worldwide.
However, oral labetalol is not officially sold in South Korea. While injectable forms exist for emergency situations, pills that need to be taken daily are not marketed, so to administer it to patients, one must separately apply through the Rare Disease Drug Center, undergo review, and import it. This process takes several weeks or more, placing both temporal and administrative burdens on patients and medical institutions.
Why does this happen? The biggest reason is low market viability. While there are over 10 million general hypertension patients, pregnant women with hypertension number only about 30,000. From pharmaceutical companies' perspective, the profits may not justify the costs of licensing and distribution. Ultimately, companies are reluctant to introduce these drugs, and currently the government has no system to mandate or incentivize this. As a result, medications are not sufficiently supplied, and the inconvenience and risks fall on mothers and fetuses.
Treatment for hypertension during pregnancy, though affecting few patients, has public significance similar to rare disease treatment in that it is directly connected to life. South Korea has an essential medicines system designed to ensure stable supply of drugs necessary for citizens' lives and health. However, if certain drugs are excluded from the list because "alternative medications exist," the actual choices available in clinical settings inevitably decrease. This is because medications require customized selection considering patients' conditions and risk factors, not simple functional substitution.
The problems don't end there. Some hypertension medications are used for pregnant women overseas, yet domestic licensing documents still contain phrases like "contraindicated during pregnancy" or "use with caution in pregnant women." Since such expressions become legal standards, medical professionals cannot help but hesitate to prescribe them. If something goes wrong with the fetus, it could lead to legal disputes. From patients' perspective as well, seeing "contraindicated" or "caution" written in medication information sheets causes significant anxiety regardless of the actual level of risk. As a result, patients may refuse or discontinue medication. This can actually pose greater risks to both mother and baby.
We live in an era where low birth rates are discussed as a national crisis. If so, the medical environment surrounding pregnancy and childbirth should be made safer. If we encourage childbirth while pregnant women cannot receive basic necessary medications in a timely manner, the sincerity of such policies will inevitably be questioned. Medication accessibility is an important indicator of a nation's healthcare standards.
We talk about cutting-edge medical technology and precision medicine, but if basic medications needed to treat hypertension in pregnant women are not adequately supplied, there is still room for improvement. Safe childbirth is not solely an individual responsibility. It is an area that society and the state must take responsibility for together. Creating an environment where pregnant women can choose medications appropriate for their health conditions without anxiety—that is the basic condition of a society that values life.