Sir.—Methyldopa is used frequently in the long-term management of hypertension in pregnancy because of its documented effectiveness and relative lack of fetal toxicity.1,2 Although not reported in neonates, nasal congestion is a known side effect of methyldopa in 1% to 3% of adults and children receiving long-term therapy.3 We report an association between maternal administration of methyldopa and neonatal nasal obstruction.
Patient Reports.—Patient 1.—A 38-year-old gravida 3, para 1, aborta 1 woman underwent an elective cesarean section at 39 weeks' gestation because of frank breech fetal position, maternal hypertension, and advanced maternal age. She was treated with methyldopa (250 mg orally twice a day) since the eighth week of gestation. At delivery, a loop of cord was noted around the neonate's neck and there was moderate difficulty in delivering the head. The Apgar scores were 3,8, and 9 at 1,5, and 10 minutes, respectively, and