A comparative randomized controlled parallel group study of efficacy and tolerability of labetalol versus methyldopa in the treatment of mild preeclampsia

Abstract

INTRODUCTIONMaternal mortality represents one of the starkest disparities in health outcomes between developing and developed countries, the rich and the poor. An estimated 358,000 maternal deaths occurred worldwide in 2008 and over 8 million women suffer from illness, infection or injury as a consequence of pregnancy or childbirth. These estimates are likely to be underreported. With 99% of deaths occurring in the developing world it comes as no surprise that the majority of these deaths are preventable and that progress toward Millennium Development Goal 5 "the reduction of maternal mortality by 75% by 2015" is stalling. 1Hypertension is the most common problem encountered during pregnancy. It is estimated that globally 6-8% of pregnancies are complicated by hypertension. It is said that preeclampsia and eclampsia contribute to death of a woman every 3 mins worldwide.2 The incidence of preeclampsia is 7 times higher in developing countries (2.8% of live births) as compare to the developed countries (0.4%) Moreover, it is thought that preeclampsia and eclampsia are also associated with one-quarter of stillbirths and neonatal deaths in developing nations. 1,3,4 Mild hypertension, which is defined as systolic blood pressure (SBP) of 140-159 mm Hg or diastolic BP (DBP) of 90-109 mm Hg or both, is common during pregnancy.Even though a recent systematic review found that there was not enough evidence to show the benefit of antihypertensive drugs for mild hypertension during pregnancy, the risk of developing severe hypertension is reduced to half by using antihypertensive medications, 5 so more research is needed. Methyldopa, labetalol and long-acting nifedipine are acceptable oral antihypertensive agents if drug therapy is required in pregnant women with mild to moderate hypertension. ABSTRACT Background:The objective of the current study was to compare the efficacy and tolerability of labetalol versus methyldopa in the treatment of mild preeclampsia. Methods: We carried out a prospective randomized controlled parallel group study on 100 outpatients of Obstetrics and Gynaecology Department of Government Medical College, Patiala, a tertiary care teaching hospital. Pregnant patients (20-40 weeks gestational age) newly diagnosed with blood pressure (BP) of ≥140/90 mm Hg were included in the study. All patients with systolic BP (SBP) ≥160 mm Hg and diastolic BP (DBP) ≥110 mm Hg after 20 weeks of gestation, history of hypertension, renal diseases, diabetes mellitus, epilepsy, and thyroid diseases were excluded from the study. After taking the informed consent, 50 patients each were randomized to either of the two treatment arm-oral labetalol or oral methyldopa. Difference in the BP measurements at the time of admission and at the time of delivery were analyzed by applying paired t-test. For intergroup analysis, we applied independent t-test using SPSS version 16. A p<0.05 was regarded as significant. Results: Both methyldopa and labetalol cause significant fall in SBP, DBP and mean arterial pressure (MAP) in their group...

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

“…Further exclusions were made following title/abstract review (N=689 plus N=4 ongoing trials) and full-text review (N=8, four of which were designated as awaiting classification because further information was requested from the authors or a specific editorial caution had been issued). 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).…”

Drug-Induced Hypoglycemia in Neonates Born to Nondiabetic Women Treated with Medications during the Pregnancy or the Labor: A Systematic Review of the Literature

“…55 Another retrospective study reported that the risk of hypoglycemia increases in neonates exposed to labetalol and betaxolol compared with other BBs. 56 Risk factors and potential confounders: Some authors highlighted that the association between neonatal hypoglycemia and maternal BBs treatment could be higher in preterm [57][58][59] or SGA infants. 57,60 In a large retrospective cohort study, the risk of hypoglycemia in neonates exposed to BBs adjusted for potential confounders (such as maternal demographics, obstetric and medical conditions, and exposure to other medications) remained elevated in comparison to unexposed newborns (aOR: 1.68, 95% CI: 1.50-1,89).…”