Adherence to drug therapy for hypertensive disorders of pregnancy: a cross-sectional survey

Chen, Haihong; Tang, Yongming; Liu, Chenxi; Liu, Junjie; Wang, Kang; Zhang, Xiaopeng

doi:10.1186/s13690-020-00423-0

Cited by 3 publications

(1 citation statement)

References 25 publications

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“…Nifedipine (calcium channel blocker) is the second most used antihypertensive drug in pregnancy, followed by methyldopa, neither of which is routinely recommended out of pregnancy. Typically, evidence has shown low adherence to antihypertensive medication in pregnancy, which can put the mother and foetus at risk (15,16).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of drugs in pregnancy: evidence from drug target Mendelian randomization

Barry,

Walker,

Burden

et al. 2023

Preprint

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Limited information exists regarding the impact of pharmacotherapy in pregnancy due to ethical concerns of unintended foetal harm. We investigate genetically proxied intrauterine antihypertensive exposure on offspring outcomes, including gestational age and birthweight, using two-sample multivariable Mendelian randomization. Higher levels of maternal protein targets for calcium channel blockers increased gestational age by 3.99 days (95%CI: 0.02, 7.96) per 10mmHg decrease in SBP. Genetically proxied maternal protein targets for beta-adrenoceptor blocking drugs, vasodilator antihypertensive drugs on the KNCJ11 gene, potassium-sparing diuretics and aldosterone antagonists demonstrated little evidence of increased risk to offspring. Both parental genetic protein targets for vasodilator antihypertensive drugs demonstrated similar effects on birthweight, suggesting detrimental offspring effects due to genetic perturbation of these pathways is unlikely. Little evidence for increased risk of adverse offspring outcomes due to maternal antihypertensive drug target perturbation was found. Triangulation of these findings with existing evidence may guide physicians and mothers during pregnancy.

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Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of drugs in pregnancy: evidence from drug target Mendelian randomization

Barry,

Walker,

Burden

et al. 2023

Preprint

View full text Add to dashboard Cite

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Genetic Insights Into Perinatal Outcomes of Maternal Antihypertensive Therapy During Pregnancy

Barry,

Walker,

Burden

et al. 2024

JAMA Netw Open

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ImportanceLimited information exists regarding the impact of pharmacotherapy in pregnancy due to ethical concerns of unintended fetal harm. Yet, maternal prescriptive drug use for chronic conditions such as hypertension is common.ObjectiveTo investigate potential causal relationships between perturbing maternal genetic variants influencing antihypertensive drug targets and perinatal outcomes among offspring using mendelian randomization (MR).Design, Setting, and ParticipantsThis 2-sample MR study used individual-level single-nucleotide variation (SNV) outcome data from mother-father-offspring trios with complete genetic and phenotypic information from the Norwegian Mother, Father and Child Cohort Study (MoBa) and summary-level SNV exposure data from UK Biobank participants sourced from the Integrative Epidemiology Unit OpenGWAS project. Pregnant individuals were recruited across Norway during their routine ultrasonography examination at 18 weeks’ gestation between June 1999 and December 2008, and mothers, fathers, and offspring were followed up after birth. Novel genetic instruments for maternal antihypertensive drug targets that act via systolic blood pressure (SBP) were derived from individual-level data analyzed in January 2018. Two-sample multivariable MR analysis of these maternal drug targets and offspring outcomes were performed between January 2023 and April 2024.ExposuresMaternal genetic variants associated with drug targets for treatments of hypertension, as specified in the National Health Service dictionary of medicines and devices.Main Outcomes and MeasuresOffspring outcomes were Apgar score at 1 minute and 5 minutes, offspring developmental score at 6 months, birth length, birth weight z score, gestational age, head circumference, and congenital malformation. Maternal hypertensive disorders of pregnancy were a positive control.ResultsThe MoBa sample contained 29 849 family trios, with a mean (SD) maternal age of 30.2 (18.6) years and a mean (SD) paternal age of 32.8 (13.1) years; 51.1% of offspring were male. Seven independent SNVs were identified as influencing maternal SBP via the antihypertensive drug target instruments. For higher levels of maternal SBP acting through the CACNB2 calcium channel blocker target, the estimated change in gestational age was 3.99 days (95% CI, 0.02-7.96 days) per 10-mm Hg decrease in SBP. There was no evidence of differential risk for measured perinatal outcomes from maternal SBP acting through drug targets for multiple hypertensive subclasses, such as between the ADRB1 β-adrenoceptor–blocking target and risk of congenital malformation (estimated odds ratio, 0.28 [95% CI, 0.02-4.71] per 10-mm Hg decrease in SBP). Maternal and paternal SBP acting through the EDNRA vasodilator antihypertensive target did not have a potential causal effect on birth weight z score, with respective β estimates of 0.71 (95% CI, −0.09 to 1.51) and 0.72 (95% CI, −0.08 to 1.53) per 10-mm Hg decrease in SBP.Conclusions and RelevanceThe findings provided little evidence to indicate that perturbation of maternal genetic variants for SBP that influence antihypertensive drug targets had potential causal relationships with measures of perinatal development and health within this study. These findings may be triangulated with existing literature to guide physicians and mothers in decisions about antihypertensive use during pregnancy.

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Patient awareness of long‐term cardiovascular and metabolic disease risks after hypertensive disorders of pregnancy in Japan

Ushida,

Tano,

Matsuo

et al. 2024

J of Obstet and Gynaecol

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AimGiven the increasing recognition of the importance of postpartum follow‐up care for women with a history of hypertensive disorders of pregnancy (HDP) to mitigate their future risk of cardiovascular and metabolic diseases, here we aimed to evaluate the current status of postpartum follow‐up care in Japan and explore the challenges to its implementation.MethodsA web‐based survey was conducted using a smartphone application among postpartum women between March and May 2024 to assess their knowledge of HDP‐related future risk and postpartum follow‐up care.ResultsA total of 880 valid responses were obtained, 73 (8.3%) of which were from women with a history of HDP. Of them, 56.2% were aware of the heightened risk of cardiovascular disease and even fewer knew about the risks of metabolic syndrome (37.0%) and the preventive use of low‐dose aspirin (12.3%); in fact, 31.5% reported receiving no information about their risk or preventive measures from healthcare providers. Furthermore, 43.8% did not consult specialists or attend regular checkups after their 1‐month checkup. Among women with a history of HDP, those who received information and guidance were more likely to implement behavioral changes than those who did not.ConclusionsPatient awareness level of HDP‐related risk was low and the information provided by their healthcare professionals was insufficient, indicating that postpartum follow‐up care in Japan is not satisfactory. This study highlights the need for improved educational strategies and systematic follow‐up protocols to ensure that women are adequately informed and supported in managing their long‐term health risks.

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Adherence to drug therapy for hypertensive disorders of pregnancy: a cross-sectional survey

Cited by 3 publications

References 25 publications

Effectiveness and safety of drugs in pregnancy: evidence from drug target Mendelian randomization

Effectiveness and safety of drugs in pregnancy: evidence from drug target Mendelian randomization

Genetic Insights Into Perinatal Outcomes of Maternal Antihypertensive Therapy During Pregnancy

Patient awareness of long‐term cardiovascular and metabolic disease risks after hypertensive disorders of pregnancy in Japan

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