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Do labetalol and methyldopa have different effects on pregnancy outcome? Analysis of data from the Control of Hypertension In Pregnancy Study (CHIPS) trial.
BJOG. 2016 Jun; 123(7):1143-51.BJOG

Abstract

OBJECTIVE

To compare pregnancy outcomes, accounting for allocated group, between methyldopa-treated and labetalol-treated women in the CHIPS Trial (ISRCTN 71416914) of 'less tight' versus 'tight' control of pregnancy hypertension.

DESIGN

Secondary analysis of CHIPS Trial cohort.

SETTING

International randomised controlled trial (94 sites, 15 countries).

POPULATION OR SAMPLE

Of 987 CHIPS recruits, 481/566 (85.0%) women treated with antihypertensive therapy at randomisation. Of 981 (99.4%) women followed to delivery, 656/745 (88.1%) treated postrandomisation.

METHODS

Logistic regression to compare outcomes among women who took methyldopa or labetalol, adjusted for the influence of baseline factors.

MAIN OUTCOME MEASURES

CHIPS primary (perinatal loss or high level neonatal care for >48 hours) and secondary (serious maternal complications) outcomes, birthweight <10th centile, severe maternal hypertension, pre-eclampsia and delivery at <34 or <37 weeks.

RESULTS

Methyldopa and labetalol were used commonly at randomisation (243/987, 24.6% and 238/987, 24.6%, respectively) and post-randomisation (224/981, 22.8% and 433/981, 44.1%, respectively). Following adjusted analyses, methyldopa (versus labetalol) at randomisation was associated with fewer babies with birthweight <10th centile [adjusted odds ratio (aOR) 0.48; 95% CI 0.20-0.87]. Methyldopa (versus labetalol) postrandomisation was associated with fewer CHIPS primary outcomes (aOR 0.64; 95% CI 0.40-1.00), birthweight <10th centile (aOR 0.54; 95% CI 0.32-0.92), severe hypertension (aOR 0.51; 95% CI 0.31-0.83), pre-eclampsia (aOR 0.55; 95% CI 0.36-0.85), and delivery at <34 weeks (aOR 0.53; 95% CI 0.29-0.96) or <37 weeks (aOR 0.55; 95% CI 0.35-0.85).

CONCLUSION

These nonrandomised comparisons are subject to residual confounding, but women treated with methyldopa (versus labetalol), particularly those with pre-existing hypertension, may have had better outcomes.

TWEETABLE ABSTRACT

There was no evidence that women treated with methyldopa versus labetalol had worse outcomes.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Magee LA
Medicine, University of British Columbia, Vancouver, BC, Canada. Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
CHIPS Study Group
No affiliation info available
von Dadelszen P
Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Singer J
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, BC, Canada.
Lee T
Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, BC, Canada.
Rey E
Medicine and Obstetrics and Gynaecology, University of Montreal, Montreal, QC, Canada.
Ross S
Obstetrics and Gynaecology, University of Alberta, Edmonton, AB, Canada.
Asztalos E
Paediatrics, University of Toronto, Toronto, ON, Canada. Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada. The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
Murphy KE
Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada. The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
Menzies J
Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.
Sanchez J
The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
Gafni A
Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Gruslin A
Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON, Canada.
Helewa M
Obstetrics and Gynaecology, University of Manitoba, Winnipeg, MB, Canada.
Hutton E
Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada.
Koren G
Paediatrics, University of Toronto, Toronto, ON, Canada.
Lee SK
Paediatrics, University of Toronto, Toronto, ON, Canada.
Logan AG
Medicine, University of Toronto, Toronto, ON, Canada.
Ganzevoort JW
Obstetrics and Gynaecology, University of Amsterdam, Amsterdam, the Netherlands.
Welch R
Obstetrics and Gynaecology, Derriford Hospital, Devon, UK.
Thornton JG
Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK.
Moutquin JM
Obstetrics and Gynaecology, Universite de Sherbrooke, Sherbrooke, QC, Canada.

MeSH

AdultAntihypertensive AgentsBlood PressureFemaleHumansHypertensionHypertension, Pregnancy-InducedInfant, Low Birth WeightLabetalolMethyldopaPre-EclampsiaPregnancyPregnancy Complications, CardiovascularPregnancy Outcome

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

26265372

Citation

Magee, L A., et al. "Do Labetalol and Methyldopa Have Different Effects On Pregnancy Outcome? Analysis of Data From the Control of Hypertension in Pregnancy Study (CHIPS) Trial." BJOG : an International Journal of Obstetrics and Gynaecology, vol. 123, no. 7, 2016, pp. 1143-51.
Magee LA, CHIPS Study Group, von Dadelszen P, et al. Do labetalol and methyldopa have different effects on pregnancy outcome? Analysis of data from the Control of Hypertension In Pregnancy Study (CHIPS) trial. BJOG. 2016;123(7):1143-51.
Magee, L. A., von Dadelszen, P., Singer, J., Lee, T., Rey, E., Ross, S., Asztalos, E., Murphy, K. E., Menzies, J., Sanchez, J., Gafni, A., Gruslin, A., Helewa, M., Hutton, E., Koren, G., Lee, S. K., Logan, A. G., Ganzevoort, J. W., Welch, R., ... Moutquin, J. M. (2016). Do labetalol and methyldopa have different effects on pregnancy outcome? Analysis of data from the Control of Hypertension In Pregnancy Study (CHIPS) trial. BJOG : an International Journal of Obstetrics and Gynaecology, 123(7), 1143-51. https://doi.org/10.1111/1471-0528.13569
Magee LA, et al. Do Labetalol and Methyldopa Have Different Effects On Pregnancy Outcome? Analysis of Data From the Control of Hypertension in Pregnancy Study (CHIPS) Trial. BJOG. 2016;123(7):1143-51. PubMed PMID: 26265372.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Do labetalol and methyldopa have different effects on pregnancy outcome? Analysis of data from the Control of Hypertension In Pregnancy Study (CHIPS) trial. AU - Magee,L A, AU - ,, AU - von Dadelszen,P, AU - Singer,J, AU - Lee,T, AU - Rey,E, AU - Ross,S, AU - Asztalos,E, AU - Murphy,K E, AU - Menzies,J, AU - Sanchez,J, AU - Gafni,A, AU - Gruslin,A, AU - Helewa,M, AU - Hutton,E, AU - Koren,G, AU - Lee,S K, AU - Logan,A G, AU - Ganzevoort,J W, AU - Welch,R, AU - Thornton,J G, AU - Moutquin,J-M, Y1 - 2015/08/11/ PY - 2015/05/12/accepted PY - 2015/8/13/entrez PY - 2015/8/13/pubmed PY - 2018/7/31/medline KW - CHIPS trial KW - hypertension KW - labetalol KW - methyldopa KW - pregnancy SP - 1143 EP - 51 JF - BJOG : an international journal of obstetrics and gynaecology JO - BJOG VL - 123 IS - 7 N2 - OBJECTIVE: To compare pregnancy outcomes, accounting for allocated group, between methyldopa-treated and labetalol-treated women in the CHIPS Trial (ISRCTN 71416914) of 'less tight' versus 'tight' control of pregnancy hypertension. DESIGN: Secondary analysis of CHIPS Trial cohort. SETTING: International randomised controlled trial (94 sites, 15 countries). POPULATION OR SAMPLE: Of 987 CHIPS recruits, 481/566 (85.0%) women treated with antihypertensive therapy at randomisation. Of 981 (99.4%) women followed to delivery, 656/745 (88.1%) treated postrandomisation. METHODS: Logistic regression to compare outcomes among women who took methyldopa or labetalol, adjusted for the influence of baseline factors. MAIN OUTCOME MEASURES: CHIPS primary (perinatal loss or high level neonatal care for >48 hours) and secondary (serious maternal complications) outcomes, birthweight <10th centile, severe maternal hypertension, pre-eclampsia and delivery at <34 or <37 weeks. RESULTS: Methyldopa and labetalol were used commonly at randomisation (243/987, 24.6% and 238/987, 24.6%, respectively) and post-randomisation (224/981, 22.8% and 433/981, 44.1%, respectively). Following adjusted analyses, methyldopa (versus labetalol) at randomisation was associated with fewer babies with birthweight <10th centile [adjusted odds ratio (aOR) 0.48; 95% CI 0.20-0.87]. Methyldopa (versus labetalol) postrandomisation was associated with fewer CHIPS primary outcomes (aOR 0.64; 95% CI 0.40-1.00), birthweight <10th centile (aOR 0.54; 95% CI 0.32-0.92), severe hypertension (aOR 0.51; 95% CI 0.31-0.83), pre-eclampsia (aOR 0.55; 95% CI 0.36-0.85), and delivery at <34 weeks (aOR 0.53; 95% CI 0.29-0.96) or <37 weeks (aOR 0.55; 95% CI 0.35-0.85). CONCLUSION: These nonrandomised comparisons are subject to residual confounding, but women treated with methyldopa (versus labetalol), particularly those with pre-existing hypertension, may have had better outcomes. TWEETABLE ABSTRACT: There was no evidence that women treated with methyldopa versus labetalol had worse outcomes. SN - 1471-0528 UR - https://www.unboundmedicine.com/medline/citation/26265372/Do_labetalol_and_methyldopa_have_different_effects_on_pregnancy_outcome_Analysis_of_data_from_the_Control_of_Hypertension_In_Pregnancy_Study__CHIPS__trial_ DB - PRIME DP - Unbound Medicine ER -