Maternal and neonatal outcomes of antihypertensive treatment in pregnancy: A retrospective cohort study

Abstract

Objective To compare maternal and infant outcomes with different antihypertensive medications in pregnancy. Design Retrospective cohort study. Setting Kaiser Permanente, a large healthcare system in the United States. Population Women aged 15–49 years with a singleton birth from 2005–2014 treated for hypertension. Methods We identified medication exposure from automated pharmacy data based on the earliest dispensing after the first prenatal visit. Using logistic regression, we calculated weighted outcome prevalences, adjusted odds ratios (aORs) and 95% confidence intervals, with inverse probability of treatment weighting to address confounding. Main outcome measures Small for gestational age, preterm delivery, neonatal and maternal intensive care unit (ICU) admission, preeclampsia, and stillbirth or termination at > 20 weeks. Results Among 6346 deliveries, 87% with chronic hypertension, the risk of the infant being small for gestational age (birthweight < 10th percentile) was lower with methyldopa than labetalol (prevalence 13.6% vs. 16.6%; aOR 0.77, 95% CI 0.63 to 0.92). For birthweight < 3rd percentile the aOR was 0.57 (0.39 to 0.80). Compared with labetalol (26.0%), risk of preterm delivery was similar for methyldopa (26.5%; aOR 1.10 [0.95 to 1.27]) and slightly higher for nifedipine (28.5%; aOR 1.25 [1.06 to 1.46]) and other β-blockers (31.2%; aOR 1.58 [1.07 to 2.23]). Neonatal ICU admission was more common with nifedipine than labetalol (25.9% vs. 23.3%, aOR 1.21 [1.02 to 1.43]) but not elevated with methyldopa. Risks of other outcomes did not differ by medication. Conclusions Risk of most outcomes was similar comparing labetalol, methyldopa and nifedipine. Risk of the infant being small for gestational age was substantially lower for methyldopa, suggesting this medication may warrant further consideration.

Pharmaceutical administration for severe hypertension during pregnancy: Network meta-analysis

“…Methyldopa can lower blood pressure by binding to α2-adrenergic receptor as an agonist ( Dublin et al, 2022 ), and it was very popular pharmaceutical of choice in the 70s, but it was replaced by other pharmaceuticals mainly for tolerability ( Mah et al, 2009 ). Diuretics are the mainstay of treatment for non-gestational hypertension because they theoretically act on plasma volume depletion to cause reactive vasoconstriction, but in some earlier studies, diuretics were found to be safe during pregnancy ( Garovic et al, 2022 ).…”

Perbedaan Efektivitas Terapi Antihipertensi Nifedipin dan Metildopa Pada pasien preeklamsia di RSUD Dr. H. Moch. Ansari Saleh

“…Namun, beberapa studi yang mengevaluasi kedua obat ini tidak mempunyai jumlah sampel yang besar dan menyebabkan hasil penelitiannya tidak terlalu signifikan. Salah satu studi kohort retrospektif membandingkan nifedipin, labetalol, metildopa, dan β-blocker lainnya di pasien hipertensi pada ibu hamil namun tidak meneliti perbedaan efektivitas penurunan tekanan darah pada obat-obatan tersebut (Dublin et al, 2022).…”

Chronic Hypertension During Pregnancy: Prevalence and Treatment in the United States, 2008–2021

“…3,7 However, comparative effectiveness studies of methyldopa, labetalol, and nifedipine as antihypertensive medications in pregnancy have not been conclusive. [11][12][13] Furthermore, prescribing patterns of different antihypertensive medications, including among patients with high-risk comorbidities, have not been assessed in contemporary, large cohorts.…”