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Maternal and neonatal outcomes of antihypertensive treatment in pregnancy: A retrospective cohort study.
PLoS One. 2022; 17(5):e0268284.Plos

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.

Authors+Show Affiliations

Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America. Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America.Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America.School of Pharmacy, Chapman University, Irvine, California, United States of America.Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, United States of America.Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America.Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America.Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, United States of America.Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America.Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, United States of America.Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America.Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America. Department of Biostatistics, University of Washington, Seattle, Washington, United States of America.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

35576217

Citation

Dublin, Sascha, et al. "Maternal and Neonatal Outcomes of Antihypertensive Treatment in Pregnancy: a Retrospective Cohort Study." PloS One, vol. 17, no. 5, 2022, pp. e0268284.
Dublin S, Idu A, Avalos LA, et al. Maternal and neonatal outcomes of antihypertensive treatment in pregnancy: A retrospective cohort study. PLoS One. 2022;17(5):e0268284.
Dublin, S., Idu, A., Avalos, L. A., Cheetham, T. C., Easterling, T. R., Chen, L., Holt, V. L., Nance, N., Bider-Canfield, Z., Neugebauer, R. S., Reynolds, K., Badon, S. E., & Shortreed, S. M. (2022). Maternal and neonatal outcomes of antihypertensive treatment in pregnancy: A retrospective cohort study. PloS One, 17(5), e0268284. https://doi.org/10.1371/journal.pone.0268284
Dublin S, et al. Maternal and Neonatal Outcomes of Antihypertensive Treatment in Pregnancy: a Retrospective Cohort Study. PLoS One. 2022;17(5):e0268284. PubMed PMID: 35576217.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maternal and neonatal outcomes of antihypertensive treatment in pregnancy: A retrospective cohort study. AU - Dublin,Sascha, AU - Idu,Abisola, AU - Avalos,Lyndsay A, AU - Cheetham,T Craig, AU - Easterling,Thomas R, AU - Chen,Lu, AU - Holt,Victoria L, AU - Nance,Nerissa, AU - Bider-Canfield,Zoe, AU - Neugebauer,Romain S, AU - Reynolds,Kristi, AU - Badon,Sylvia E, AU - Shortreed,Susan M, Y1 - 2022/05/16/ PY - 2021/09/03/received PY - 2022/04/26/accepted PY - 2022/5/16/entrez PY - 2022/5/17/pubmed PY - 2022/5/20/medline SP - e0268284 EP - e0268284 JF - PloS one JO - PLoS One VL - 17 IS - 5 N2 - 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. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/35576217/Maternal_and_neonatal_outcomes_of_antihypertensive_treatment_in_pregnancy:_A_retrospective_cohort_study. DB - PRIME DP - Unbound Medicine ER -