Methyldopa-Induced Autoimmune Antibodies in Pregnant Women—Case Series and Literature Review

Background: Methyldopa is widely used for the treatment of hypertension during pregnancy because of its established maternal and fetal safety profile. However, it can induce red blood cell autoantibodies, occasionally resulting in autoimmune hemolytic anemia. The aim of this study was to summarize current evidence on methyldopa-associated red blood cell autoantibody formation and autoimmune hemolytic anemia in pregnant women, based on a review of the available literature and observations from our center. Methods: A scoping review was conducted using the PubMed/MEDLINE, Web of Science, and Scopus databases to identify studies addressing autoimmune antibodies or hemolytic anemia associated with methyldopa therapy in pregnancy. Two independent reviewers screened titles and abstracts and assessed full-text articles for eligibility. Disagreements were resolved through discussion with a third reviewer. In addition, citation mapping was performed using the Litmaps tool (Litmaps Ltd.) to expand the set of relevant studies. In addition to the literature findings, two cases from our center, consistent with the scope of this review, were included in the study. Results: Four studies met the inclusion criteria, all of which were case-based. In addition, two cases from our center were included. The available data on six pregnancies suggest that methyldopa may induce the production of autoantibodies with variable clinical expression—most often asymptomatic, although in some cases hemolytic anemia may occur. These autoantibodies can cross the placenta. Neonatal outcomes are likewise heterogeneous, ranging from asymptomatic presentations to hemolysis with associated jaundice. Conclusions: Methyldopa-induced autoantibody formation in pregnancy is often a benign finding; however, it requires careful evaluation to exclude hemolytic anemia. Drug discontinuation appears effective in symptomatic patients, whereas management of asymptomatic cases is not well defined and should be individualized. Further studies are needed to clarify the incidence and guide clinical management.