Analysis of prescribing pattern of antihypertensive drugs during pregnancy and neonatal outcome in a tertiary care centre

Abstract

INTRODUCTIONHypertensive disorders are the most common medical complications of pregnancy with an incidence of 2 to 8 %.1,2 It is one of the major causes of maternal and perinatal morbidity and mortality worldwide. There are several major categories of hypertensive disorders in pregnancy ranging from mild to moderate rise in blood pressure without proteinuria usually called pregnancy induced hypertension (PIH), preeclampsia (hypertension with proteinuria), severe preeclampsia and eclampsia. Maternal hypertension, even of the mild to moderate category, can lead to adverse perinatal outcomes like low birth weight, prematurity, stillbirth and intrauterine growth retardation.3 Though hypertension occurs in 2 to 8% of pregnancies, yet information on the safety of antihypertensive medication use during pregnancy is limited. For severe hypertension, anti-hypertensive medication is used to prevent serious maternal and foetal complications; however, there is no consensus on when to treat mild-to-moderate hypertension. According to ACOG (American college of gynaecology) technical bulletin recommends that drugs not to be administered in pregnancy associated with hypertension, if systolic BP is less than 160 and diastolic BP less than 110. 4 Hypertensive pregnant mothers are at increased risks for premature delivery, intrauterine foetal death, growth retardation and abruptio placentae; they also have an increased risk of vascular injury with thrombotic microangioplasty, coagulopathy, cerebral haemorrhage, and multi organ injury especially of kidney and liver. So as to avoid all such complications, it is better to start the treatment with antihypertensive after assessing correct stage and class of hypertension and always prescribe the safe drug to avoid adverse effects over the foetus and ABSTRACT Background: Hypertensive disorders are the most common medical complications of pregnancy with an incidence of 2-8%. Maternal hypertension, even of the mild to moderate category, can lead to adverse perinatal outcomes like low birth weight, prematurity, stillbirth and intrauterine growth retardation. Though hypertension occurs up to 8% of pregnancies, yet information on the safety of antihypertensive medication use during pregnancy is limited. The objective of this study was to analyse the prescription pattern of antihypertensive drugs in pregnant woman and also to assess the neonatal outcome in pregnant woman on antihypertensive drugs. Methods:The retrospective study includes analysis of all the prescriptions from case records of hypertensive pregnant women till the delivery for one year. Results: Total number of 122 hypertensive pregnant patients was included in the study. Mean age of the patients was 25.8 years. 51.6% were primigravida. Most of them were diagnosed after 28±2 weeks of pregnancy. 54% were on monotherapy. Most commonly used drug was alpha methyl dopa followed by nifedipine. Out of 86.9% (n=106) live birth delivered; 29.2% were of low birth weight. Conclusions: All the prescriptions were prescribed rationally. Most ...

Study of prescription patterns of antihypertensive agents in preeclampsia patients: Central India study

“…In our study gestational diabetes was seen most commonly comorbidity associated with hypertension seen in 57 patients out of 98 patients contributing to 58.16% followed by hypothyroidism in 36.73% patients. 5 Calcium channel blockers should not be given as first line drugs because they can inhibit the contractions of uterus. 7…”

“…4 There is increased risk of premature delivery, intrauterine foetal death, abruption placentae, growth retardation in hypertensive pregnant mothers, moreover there is also chances for increased vascular injury with thrombotic microangioplasty, coagulopathy, cerebrovascular haemorrhage and multiorgan injury. 5 Pre-eclampsia is more common among women likely to have a large placenta (such as those with multiple pregnancy) and among women with medical conditions associated with microvascular diseases. 6…”