Hypertension and antihypertensive drugs in pregnancy and perinatal outcomes

Orbach, Hagay; Matok, Ilan; Gorodischer, Rafael; Sheiner, Eyal; Daniel, Sharon; Wiznitzer, Arnon; Koren, Gideon; Levy, Amalia

doi:10.1016/j.ajog.2012.11.011

Cited by 85 publications

(65 citation statements)

References 18 publications

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“…blood pressure < 160/110 mmHg), remains controversial. [16][17][18] Our study adds to previous findings on the association between antihypertensive medications and adverse perinatal outcomes, with an emphasis on the potential adverse impacts of beta-blockers in treating chronic hypertension during pregnancy. Future studies with larger samples should examine the effect of individual beta-blockers.…”

Section: Resultsmentioning

confidence: 49%

Beta‐Blockers increase the risk of being born small for gestational age or of being institutionalised during infancy

Xie

Yang

Krewski

et al. 2014

BJOG

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ObjectiveTo compare infant outcomes between mothers with hypertension treated by beta‐blockers alone and by methyldopa alone during pregnancy.DesignHistorical cohort study.SettingSaskatchewan, Canada.PopulationWomen who delivered a singleton birth in Saskatchewan during the periods from 1 January 1980 to 30 June 1987 or from 1 January 1990 to 31 December 2005 (women who delivered between 1 July 1987 and 31 December 1989 were excluded because the information recorded on maternal drug use during pregnancy is incomplete) with a diagnosis of a hypertensive disorder during pregnancy, and who were dispensed only beta‐blockers (n = 416) or only methyldopa (n = 1000).MethodsOccurrences of adverse infant outcomes were compared between women who received beta‐blockers only and women who received methyldopa only during pregnancy, first in all eligible women, and then in women with chronic hypertension and in women with gestational hypertension or pre‐eclampsia/eclampsia, separately. Multiple logistic regression analyses were performed to adjust for potential confounding. Main outcome measuresSmall for gestational age (SGA) < 10th percentile, SGA < 3rd percentile, preterm birth, stillbirth, institutionalisation for respiratory distress syndrome (RDS), sepsis, seizure during infancy, and infant death.ResultsAdjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for infants born to mothers with chronic hypertension who were dispensed beta‐blockers only, as compared with infants born to mothers who were dispensed methyldopa only, during pregnancy were: 1.95 (1.21–3.15), 2.17 (1.06–4.44), and 2.17 (1.09–4.34), respectively, for SGA < 10th percentile, SGA < 3rd percentile, and being institutionalised during infancy.ConclusionsFor infants born to mothers with chronic hypertension, compared with those treated by methyldopa alone, those treated by beta‐blockers appear to be at increased rates of SGA and hospitalisation during infancy.

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Section: Resultsmentioning

confidence: 49%

Beta‐Blockers increase the risk of being born small for gestational age or of being institutionalised during infancy

Xie

Yang

Krewski

et al. 2014

BJOG

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“…Orbach et al, in a study of 433 treated women, reported that exposure to antihypertensive agents was associated with increase rates of growth restriction [OR 4.37; CI 3.00–6.36] and preterm delivery [OR 3.69; CI 2.90–4.69] compared to non-hypertensive pregnant women. 21 A similar risk was reported for untreated hypertensive women compared to normotensive women. In a study of 2459 women exposed to pure β-blockers or labetalol compared to women not prescribed medication, Meidahl also found an increased risk of SGA [aOR 1.98; CI 1.75–2.23] preterm birth [aOR 2.26; CI 2.03–2.52] and perinatal mortality [aOR 1.89; CI 1.25–2.84].…”

Section: Impact Of Antihypertensive Therapy On Maternal and Fetal Outsupporting

confidence: 57%

“…23 In contrast, Orbach reported a higher incidence of preeclampsia (27% vs. 17%) and preterm delivery (17% vs. 9%) in pregnant women treated with methyldopa compared to β-blockers. 21 Associated with the observed increased rate of delivery at term in the atenolol cohort was an increased rate of SGA (5.6%) compared to methyldopa (2.4%) but comparable rates of IUGR, (4.32% vs. 5.19%). 21 They did not find differences based on early therapy as were reported by Lydakis.…”

Section: Impact Of Antihypertensive Therapy On Maternal and Fetal Outmentioning

confidence: 84%

Pharmacological management of hypertension in pregnancy

Easterling

2014

Seminars in Perinatology

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Hypertension in pregnancy remains a significant public health problem. Pharmacological management of blood pressure in pregnancy is impacted by changes in maternal drug disposition and by the pharmacodynamic effects of specific agents. This paper will review the impact of pregnancy on pathways of drug elimination and the associated clinical implications, the pharmacodynamic effects of specific drugs and classes of drugs in pregnancy, and the data to date on the impact of antihypertensive therapy on mothers and their fetuses.

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“…An Israeli study noted odds ratios for preterm delivery of 1.89 and 3.23 for treated and untreated chronic hypertension, respectively, with 22.9% of those in the group who received a prescription for antihypertensives (treated group) delivering at <37 weeks of gestation compared with just 8% of the control group with no diagnosis of chronic hypertension. 26 Such early deliveries are often the result of the decisions patients make with their obstetric providers when worsening maternal or fetal health argues for induction at an early gestational age. Prematurity certainly contributes to the recognized increased risk of perinatal mortality among pregnancies in women with chronic hypertension.…”

Section: Preterm Birth and Cesarean Deliverymentioning

confidence: 99%

Chronic Hypertension in Pregnancy

2014

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1254C hronic hypertension in pregnancy is defined by the American College of Obstetrics and Gynecology (ACOG) as blood pressure ≥140 mm Hg systolic and/or 90 mm Hg diastolic before pregnancy or, in recognition that many women seek medical care only once pregnant, before 20 weeks of gestation, use of antihypertensive medications before pregnancy, or persistence of hypertension for >12 weeks after delivery. 1Chronic hypertension needs to be distinguished from new-onset hypertensive complications of pregnancy such as preeclampsia (elevated blood pressure and proteinuria often accompanied by evidence of maternal organ injury and fetal compromise from placental dysfunction) 2 and gestational hypertension (elevated blood pressure alone after 20 weeks of gestation and most commonly in the mid to late third trimester without evidence or history of hypertension before pregnancy; Table 1). EpidemiologyChronic hypertension is estimated to be present in ≈3% to 5% of pregnancies 1,3,4 and is increasingly more commonly encountered. Factors contributing to the increase in prevalence include 2 major risk factors for hypertension, obesity and older age, which are of increasing prevalence in pregnancy. These shifts in risk and childbearing have resulted in an increased number of women who will require counseling on the risks of chronic hypertension in pregnancy and management of their antihypertensive medications both in anticipation of and during pregnancy.5 Because many pregnancies are unplanned, 6 all women with chronic hypertension should receive regular counseling so that they can anticipate any issues that may arise if they become pregnant and optimize their health and care to temper risk. Because blacks have a higher prevalence of chronic hypertension 7 and onset occurs at younger ages, 8 it is more common to encounter chronic hypertension in blacks during pregnancy.Despite its increasing prevalence, the majority of women with chronic hypertension do well in pregnancy, but as we discuss below, some women develop complications such as superimposed preeclampsia, fetal growth restriction, placental abruption, 4,9,10 and preterm birth, and women with chronic hypertension have an increased likelihood of cesarean delivery. Physiological Changes in Blood Pressure During PregnancyWomen who are normotensive entering pregnancy typically experience a decrease in blood pressure toward the end of the first trimester. This decrease is thought to be secondary to the marked vasodilation that occurs despite the increase in plasma volume that comes with pregnancy. Blood pressure usually falls by 5 to 10 mm Hg and remains at this lower level throughout pregnancy until the third trimester, when it rises to return to prepregnancy values. For the majority of women with chronic hypertension, blood pressure changes also follow this same pattern. As a result, some hypertensive women become normotensive during pregnancy, and others who remain hypertensive can have their antihypertensive medications tapered. These physiological changes may confuse t...

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Hypertension and antihypertensive drugs in pregnancy and perinatal outcomes

Cited by 85 publications

References 18 publications

Beta‐Blockers increase the risk of being born small for gestational age or of being institutionalised during infancy

Beta‐Blockers increase the risk of being born small for gestational age or of being institutionalised during infancy

Pharmacological management of hypertension in pregnancy

Chronic Hypertension in Pregnancy

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