Maternal Obstetric Outcome Measures in A Randomised Controlled Study of Labetalol in the Treatment of Hypertension in Pregnancy

Cruickshank, D.J.; Robertson, A. A.; Campbell, Doris M.; MacGillivray, Ian

doi:10.3109/10641959109012919

Cited by 11 publications

(5 citation statements)

References 8 publications

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“…Of the 23 articles that were excluded, 14 studies included a mixed population of gestational and chronic hypertension and did not report outcomes separately, 6 studies included only gestational hypertension, 1 article reported no additional outcomes for a trial already included in the meta‐analysis (Table ) . In addition, Leather and colleagues reported a randomized controlled trial in 1968 that recruited 47 chronic hypertensive participants randomized to bendroflumethiazide and methyldopa versus no treatment.…”

Section: Resultsmentioning

confidence: 99%

Impact of Antihypertensive Treatment on Maternal and Perinatal Outcomes in Pregnancy Complicated by Chronic Hypertension: A Systematic Review and Meta‐Analysis

Webster

Conti‐Ramsden

Seed

et al. 2017

JAHA

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BackgroundChronic hypertension complicates around 3% of all pregnancies. There is evidence that treating severe hypertension reduces maternal morbidity. This study aimed to systematically review randomized controlled trials of antihypertensive agents treating chronic hypertension in pregnancy to determine the effect of this intervention.Methods and ResultsMedline (via OVID), Embase (via OVID) and the Cochrane Trials Register were searched from their earliest entries until November 30, 2016. All randomized controlled trials evaluating antihypertensive treatments for chronic hypertension in pregnancy were included. Data were extracted and analyzed in Stata (version 14.1). Fifteen randomized controlled trials (1166 women) were identified for meta‐analysis. A clinically important reduction in the incidence of severe hypertension was seen with antihypertensive treatment versus no antihypertensive treatment/placebo (5 studies, 446 women; risk ratio 0.33, 95%CI 0.19‐0.56; I2 0.0%). There was no difference in the incidence of superimposed pre‐eclampsia (7 studies, 727 women; risk ratio 0.74, 95%CI 0.49‐1.11; I2 28.1%), stillbirth/neonatal death (4 studies, 667 women; risk ratio 0.37, 95%CI 0.11‐1.26; I2 0.0%), birth weight (7 studies, 802 women; weighted mean difference −60 g, 95%CI −200 to 80 g; I2 0.0%), or small for gestational age (4 studies, 369 women; risk ratio 1.01, 95%CI 0.53‐1.94; I2 0.0%) with antihypertensive treatment versus no treatment/placebo.ConclusionsAntihypertensive treatment reduces the risk of severe hypertension in pregnant women with chronic hypertension. A considerable paucity of data exists to guide choice of antihypertensive agent. Adequately powered head‐to‐head randomized controlled trials of commonly used antihypertensive agents are required to inform prescribing.

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Section: Resultsmentioning

confidence: 99%

Impact of Antihypertensive Treatment on Maternal and Perinatal Outcomes in Pregnancy Complicated by Chronic Hypertension: A Systematic Review and Meta‐Analysis

Webster

Conti‐Ramsden

Seed

et al. 2017

JAHA

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“…To estimate the effect of antihypertensive agents in pregnant women with mild to moderate hypertension, we found 18 studies which reported data on stillbirths [ 10 , 14 , 58 - 73 ] and twenty studies which reported data on perinatal mortality [ 14 , 58 , 60 , 61 , 63 - 66 , 68 , 69 , 71 - 80 ] (Table 3 ).The effect of antihypertensive drugs showed no effect for stillbirths (RR= 1.14; 95% CI: 0.60 to 2.17) (Figure 4 ).…”

Section: Resultsmentioning

confidence: 99%

Impact of interventions to prevent and manage preeclampsia and eclampsia on stillbirths

et al. 2011

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BackgroundPre-eclampsia and Eclampsia are relatively common complications of pregnancy, leading to considerable maternal and fetal mortality and morbidity. We sought to review the effect of aspirin, calcium supplementation, antihypertensive agents and magnesium sulphate on risk stillbirths.MethodsA systematic literature search was conducted to identify studies evaluating the above interventions. We used a standardized abstraction and grading format and performed meta-analyses where data were available from more than one studies. The estimated effect on stillbirths was determined by applying the standard Child Health Epidemiology Reference Group (CHERG) rules for multiple outcomes. For interventions with insufficient evidence for overall effect, a Delphi process was undertaken to estimate effectiveness.ResultsWe identified 82 relevant studies. For aspirin, maganesium sulphate and use of antihypertensive we found an insignificant decrease in stillbirth and perinatal mortality. For calcium supplementation, there was a borderline significant reduction in stillbirths (RR 0.81, 95 % CI 0.63-1.03). We undertook a Delphi consultation among experts to assess the potential impact of a package of interventions for the management of pre-eclampsia and eclampsia (antihypertensive, magnesium sulphate and C-section if needed). The Delphi process suggested 20% reduction each in both antepartum and intrapartum stillbirths with the use of this package.ConclusionsDespite promising benefits of calcium supplementation and aspirin use cases on maternal morbidity and eclampsia in high risk cases, further work is needed to ascertain their benefits in relation to stillbirths. The Delphi process undertaken for assessing potential impact of a package of interventions indicated that this could be associated with 20% reduction in stillbirths, for input into LiST.

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“…17–25 Seventy-two trials were included—N=61 trials from the prior Cochrane review 1 and N=11 new trials, N=8 previously excluded from the Cochrane review, because they compared antihypertensives within the same drug class or N=3 because they were trials of differential BP control. 26–96 See Appendix in the Supplemental Material for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram (Figure S1) and checklist (Tables S3 and S4).…”

Section: Resultsmentioning

confidence: 99%

Oral Antihypertensives for Nonsevere Pregnancy Hypertension: Systematic Review, Network Meta- and Trial Sequential Analyses

et al. 2022

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Background: We aimed to address which antihypertensives are superior to placebo/no therapy or another antihypertensive for controlling nonsevere pregnancy hypertension and provide future sample size estimates for definitive evidence. Methods: Randomized trials of antihypertensives for nonsevere pregnancy hypertension were identified from online electronic databases, to February 28, 2021 (registration URL: https://www.crd.york.ac.uk/PROSPERO/ ; unique identifier: CRD42020188725). Our outcomes were severe hypertension, proteinuria/preeclampsia, fetal/newborn death, small-for-gestational age infants, preterm birth, and admission to neonatal care. A Bayesian random-effects model generated estimates of direct and indirect treatment comparisons. Trial sequential analysis informed future trials needed. Results: Of 1246 publications identified, 72 trials were included; 61 (6923 women) were informative. All commonly prescribed antihypertensives (labetalol, other β-blockers, methyldopa, calcium channel blockers, and mixed/multi-drug therapy) versus placebo/no therapy reduced the risk of severe hypertension by 30% to 70%. Labetalol decreased proteinuria/preeclampsia (odds ratio, 0.73 [95% credible interval, 0.54–0.99]) and fetal/newborn death (odds ratio, 0.54 [0.30–0.98]) compared with placebo/no therapy, and proteinuria/preeclampsia compared with methyldopa (odds ratio, 0.66 [0.44–0.99]) and calcium channel blockers (odds ratio, 0.63 [0.41–0.96]). No other differences were identified, but credible intervals were wide. Trial sequential analysis indicated that 2500 to 10 000 women/arm (severe hypertension or safety outcomes) to >15 000/arm (fetal/newborn death) would be required to provide definitive evidence. Conclusions: In summary, all commonly prescribed antihypertensives in pregnancy reduce the risk of severe hypertension, but labetalol may also decrease proteinuria/preeclampsia and fetal/newborn death. Evidence is lacking for many other safety outcomes. Prohibitive sample sizes are required for definitive evidence. Real-world data are needed to individualize care.

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Maternal Obstetric Outcome Measures in A Randomised Controlled Study of Labetalol in the Treatment of Hypertension in Pregnancy

Cited by 11 publications

References 8 publications

Impact of Antihypertensive Treatment on Maternal and Perinatal Outcomes in Pregnancy Complicated by Chronic Hypertension: A Systematic Review and Meta‐Analysis

Impact of Antihypertensive Treatment on Maternal and Perinatal Outcomes in Pregnancy Complicated by Chronic Hypertension: A Systematic Review and Meta‐Analysis

Impact of interventions to prevent and manage preeclampsia and eclampsia on stillbirths

Oral Antihypertensives for Nonsevere Pregnancy Hypertension: Systematic Review, Network Meta- and Trial Sequential Analyses

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