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Role of antihypertensive therapy in mild to moderate pregnancy-induced hypertension: a prospective randomized study comparing labetalol with alpha methyldopa.
Arch Gynecol Obstet. 2012 Jun; 285(6):1553-62.AG

Abstract

BACKGROUND

Pregnancy-induced hypertension (PIH) is associated with adverse fetal and maternal outcome. The role of medication to control blood pressure (BP) in mild to moderate PIH is controversial.

AIMS

We conducted a prospective study to investigate whether pharmacological treatment of mild to moderate PIH is effective in improving maternal and fetal outcomes.

METHODS

A total of 150 consecutive pregnant women without proteinuria and with physician-recorded systolic BP of 140-160 mmHg and/or diastolic BP of 90-105 mmHg on two occasions ≥6 h apart between 20 and 38 weeks of gestation were randomly allocated to receive either labetalol or methyldopa (50 patients each) plus standard care (treatment group) or only standard care (50 patients) (control group).

RESULTS AND CONCLUSIONS

As compared to the control group, the treatment group had lower rates of severe PIH (28% vs. 10%, P = 0.005), proteinuria (28% vs. 12%, P = 0.016), hospitalization before term (28% vs. 14%, P = 0.041), and delivery by cesarean section (38% vs. 22%, P = 0.042). In a multivariable logistic regression model that adjusted for maternal age, weight, parity, previous PIH, and baseline hemoglobin, resting heart rate, and BP levels, antihypertensive therapy was associated with a lower incidence of adverse maternal events (P = 0.011). Compared to the control group, the treatment group had lower incidence of SGA babies (40% vs. 23%, P = 0.033), preterm birth (36% vs. 14%, P = 0.002), and admission to neonatal unit (30% vs. 15%, P = 0.036). After adjustment for maternal age, weight, baseline hemoglobin, resting heart rate, BP level, parity and previous history of PIH, fetal death, preterm delivery or SGA baby, antihypertensive therapy was associated with a lower incidence of adverse perinatal events (P = 0.016). Maternal and perinatal mortality rates were not significantly different between treatment and control groups. In conclusion, pharmacological treatment of mild to moderate PIH is associated with lower rate of some maternal and fetal-neonatal non-fatal adverse events compared to no routine use of antihypertensive therapy.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Molvi SN
The Department of Obstetrics and Gynecology, Government Lal Ded Hospital for Women, Government Medical College, Srinagar, Jammu and Kashmir, India. drsaba2007@yahoo.com
Mir S
No affiliation info available
Rana VS
No affiliation info available
Jabeen F
No affiliation info available
Malik AR
No affiliation info available

MeSH

AdultAntihypertensive AgentsCesarean SectionFemaleHumansHypertension, Pregnancy-InducedIncidenceInfant, NewbornInfant, Small for Gestational AgeLabetalolMethyldopaPregnancyPremature BirthProteinuriaSeverity of Illness IndexTreatment OutcomeYoung Adult

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

22249781

Citation

Molvi, Shaba N., et al. "Role of Antihypertensive Therapy in Mild to Moderate Pregnancy-induced Hypertension: a Prospective Randomized Study Comparing Labetalol With Alpha Methyldopa." Archives of Gynecology and Obstetrics, vol. 285, no. 6, 2012, pp. 1553-62.
Molvi SN, Mir S, Rana VS, et al. Role of antihypertensive therapy in mild to moderate pregnancy-induced hypertension: a prospective randomized study comparing labetalol with alpha methyldopa. Arch Gynecol Obstet. 2012;285(6):1553-62.
Molvi, S. N., Mir, S., Rana, V. S., Jabeen, F., & Malik, A. R. (2012). Role of antihypertensive therapy in mild to moderate pregnancy-induced hypertension: a prospective randomized study comparing labetalol with alpha methyldopa. Archives of Gynecology and Obstetrics, 285(6), 1553-62. https://doi.org/10.1007/s00404-011-2205-2
Molvi SN, et al. Role of Antihypertensive Therapy in Mild to Moderate Pregnancy-induced Hypertension: a Prospective Randomized Study Comparing Labetalol With Alpha Methyldopa. Arch Gynecol Obstet. 2012;285(6):1553-62. PubMed PMID: 22249781.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of antihypertensive therapy in mild to moderate pregnancy-induced hypertension: a prospective randomized study comparing labetalol with alpha methyldopa. AU - Molvi,Shaba N, AU - Mir,Shahida, AU - Rana,Vikram S, AU - Jabeen,Farhat, AU - Malik,A Rauoof, Y1 - 2012/01/15/ PY - 2011/01/10/received PY - 2011/12/28/accepted PY - 2012/1/18/entrez PY - 2012/1/18/pubmed PY - 2012/9/19/medline SP - 1553 EP - 62 JF - Archives of gynecology and obstetrics JO - Arch Gynecol Obstet VL - 285 IS - 6 N2 - BACKGROUND: Pregnancy-induced hypertension (PIH) is associated with adverse fetal and maternal outcome. The role of medication to control blood pressure (BP) in mild to moderate PIH is controversial. AIMS: We conducted a prospective study to investigate whether pharmacological treatment of mild to moderate PIH is effective in improving maternal and fetal outcomes. METHODS: A total of 150 consecutive pregnant women without proteinuria and with physician-recorded systolic BP of 140-160 mmHg and/or diastolic BP of 90-105 mmHg on two occasions ≥6 h apart between 20 and 38 weeks of gestation were randomly allocated to receive either labetalol or methyldopa (50 patients each) plus standard care (treatment group) or only standard care (50 patients) (control group). RESULTS AND CONCLUSIONS: As compared to the control group, the treatment group had lower rates of severe PIH (28% vs. 10%, P = 0.005), proteinuria (28% vs. 12%, P = 0.016), hospitalization before term (28% vs. 14%, P = 0.041), and delivery by cesarean section (38% vs. 22%, P = 0.042). In a multivariable logistic regression model that adjusted for maternal age, weight, parity, previous PIH, and baseline hemoglobin, resting heart rate, and BP levels, antihypertensive therapy was associated with a lower incidence of adverse maternal events (P = 0.011). Compared to the control group, the treatment group had lower incidence of SGA babies (40% vs. 23%, P = 0.033), preterm birth (36% vs. 14%, P = 0.002), and admission to neonatal unit (30% vs. 15%, P = 0.036). After adjustment for maternal age, weight, baseline hemoglobin, resting heart rate, BP level, parity and previous history of PIH, fetal death, preterm delivery or SGA baby, antihypertensive therapy was associated with a lower incidence of adverse perinatal events (P = 0.016). Maternal and perinatal mortality rates were not significantly different between treatment and control groups. In conclusion, pharmacological treatment of mild to moderate PIH is associated with lower rate of some maternal and fetal-neonatal non-fatal adverse events compared to no routine use of antihypertensive therapy. SN - 1432-0711 UR - https://www.unboundmedicine.com/medline/citation/22249781/Role_of_antihypertensive_therapy_in_mild_to_moderate_pregnancy_induced_hypertension:_a_prospective_randomized_study_comparing_labetalol_with_alpha_methyldopa_ L2 - https://dx.doi.org/10.1007/s00404-011-2205-2 DB - PRIME DP - Unbound Medicine ER -