The efficacy of antihypertensive treatment in pregnant women with chronic and gestational hypertension: a population-based study

Abstract

The efficacy of antihypertensive treatment was investigated in pregnant women with chronic hypertension (CH) or gestational hypertension (GH) on the basis of the occurrence of pregnancy complications and adverse birth outcomes. Medically recorded pregnancy complications and birth outcomes of 1579 pregnant women with CH and 1098 pregnant women with GH were compared to 34 633 pregnant women without CH, GH, preeclampsia-eclampsia or any secondary hypertension who delivered newborn infants without defects in the population-based data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996. Of 1579 (4.1%) pregnant women with CH, 1522 (96.4%) were treated with antihypertensive drugs. Of 1098 (2.9%) pregnant women with GH, 657 (59.8%) were treated. Pregnant women with treated CH had a higher risk of threatened abortion, preterm delivery, and placental disorders, in addition to low-birthweight newborns. However, pregnant women with untreated CH and GH had no higher risk of pregnancy complications or adverse pregnancy outcomes. Antihypertensive treatments were not able to neutralize the harm of severe CH in pregnant women, the antihypertensive treatments were not appropriate and/or effective, or related drug treatments may contribute to these adverse effects.

Chronic hypertension with related drug treatment of pregnant women and congenital abnormalities in their offspring: a population-based study

“…Furthermore, pregnant women with CH also require treatment during pregnancy. 12 Another possible explanation for this association is unevaluated/ unknown confounders. Finally, multiple comparisons may produce non-causal associations because a significant difference is expected at every 20th estimation due to chance.…”

“…(iv) Other pregnancy outcomes, for example, miscarriages, were not known; the rate of low birth weight (including intrauterine fetal growth retardation) and preterm birth were evaluated in another study. 12 (v) Nearly all treated pregnant women with CH had previously undergone polytherapy; therefore, we were not able to differentiate the effect of each drug. Related drug treatment did not modify the association of CH and isolated CA, which was shown only in cases with multiple CAs.…”

“…13 The diagnosis was later modified, if necessary, on the basis of recent medical examination within the HCCSCA. 12 However, this data set also has limitations. (i) The severity of CH was not based on the changing blood pressure values, but only on related drug treatments.…”

“…[4][5][6][7][8][9][10][11] However, as our previous study showed, the efficacy of antihypertensive treatment in pregnant women is not good because they have a higher risk for some pregnancy complications and adverse birth outcomes, such as low birth weight newborns. 12 The objective of our study was to evaluate the possible association of maternal CH and related drug treatments in pregnant women with the risk of structural birth defects, that is, congenital abnormalities (CAs) in their offspring, from among the population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA). 13 …”

Maternal hypertension with nifedipine treatment associated with a higher risk for right-sided obstructive defects of the heart: a population-based case-control study

“…Unfortunately, current antihypertensive drugs cannot protect the fetus from maternal hypertension 18 19. The association of chronic hypertension with a greater risk for RSODH is supported by the higher incidence of gestational hypertension and pre-eclampsia in the mothers of cases with RSODH.…”