Antihypertensive drug therapy for mild to moderate hypertension during pregnancy

Ábalos, Edgardo; Duley, Lelia; Steyn, D.W.; Henderson‐Smart, David J

doi:10.1002/14651858.cd002252.pub2

Cited by 148 publications

(64 citation statements)

References 104 publications

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“…122 The ratio of maternal-fetal benefit to risk for fetal adverse effects, such as low birth weight, need to be further evaluated. 116,123,124 A Cochrane systematic review on the control of blood pressure in mild to moderate PIH did not reach conclusive results due to insufficient data. 125 In general, non-pharmacological treatment is suggested for pregnant women with mild to moderate PIH that do not fulfil the criteria for pharmacologic treatment.…”

Section: Mild To Moderate Hypertensionmentioning

confidence: 99%

Pregnancy-Induced hypertension

et al. 2015

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pregnancy-induced hypertension (pIh) complicates 6-10% of pregnancies. It is defined as systolic blood pressure (sbp) >140 mmhg and diastolic blood pressure (dbp) >90 mmhg. It is classified as mild (sbp 140-149 and dbp 90-99 mmhg), moderate (sbp 150-159 and dbp 100-109 mmHg) and severe (SBP ≥160 and DBP ≥110 mmHg). PIH refers to one of four conditions: a) pre-existing hypertension, b) gestational hypertension and preeclampsia (pe), c) pre-existing hypertension plus superimposed gestational hypertension with proteinuria and d) unclassifiable hypertension. pIh is a major cause of maternal, fetal and newborn morbidity and mortality. women with pIh are at a greater risk of abruptio placentae, cerebrovascular events, organ failure and disseminated intravascular coagulation. fetuses of these mothers are at greater risk of intrauterine growth retardation, prematurity and intrauterine death. ambulatory blood pressure monitoring over a period of 24 h seems to have a role in predicting deterioration from gestational hypertension to pe. antiplatelet drugs have moderate benefits when used for prevention of pe. treatment of pIh depends on blood pressure levels, gestational age, presence of symptoms and associated risk factors. non-drug management is recommended when sbp ranges between 140-149 mmhg or dbp between 90-99 mmhg. blood pressure thresholds for drug management in pregnancy vary between different health organizations. according to 2013 esh/esc guidelines, antihypertensive treatment is recommended in pregnancy when blood pressure levels are ≥150/95 mmHg. Initiation of antihypertensive treatment at values ≥140/90 mmHg is recommended in women with a) gestational hypertension, with or without proteinuria, b) pre-existing hypertension with the superimposition of gestational hypertension or c) hypertension with asymptomatic organ damage or symptoms at any time during pregnancy. methyldopa is the drug of choice in pregnancy. atenolol and metoprolol appear to be safe and effective in late pregnancy, while labetalol has an efficacy comparable to methyldopa. angiotensin-converting enzyme (ace) inhibitors and angiotensin II antagonists are contraindicated in pregnancy due to their association with increased risk of fetopathy.

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Section: Mild To Moderate Hypertensionmentioning

confidence: 99%

Pregnancy-Induced hypertension

et al. 2015

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“…In order to reduce these risks, mild or moderate hypertension is usually carefully supervised and treated during pregnancy. According to a recent Cochrane review of the substantial relevant literature [5], the risk of severe hypertension can be reduced this way, but little effect is seen on maternal and neonatal complications.…”

Section: Introductionmentioning

confidence: 99%

Maternal use of antihypertensive drugs in early pregnancy and delivery outcome, notably the presence of congenital heart defects in the infants

Lennestål

Olausson

Källén

2009

Eur J Clin Pharmacol

122

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Purpose To investigate the association between maternal use of antihypertensives in early pregnancy and delivery outcome, notably infant congenital malformations. Methods A cohort study of 1,418 women who had used antihypertensive drugs in early pregnancy but had no diabetes diagnosis were identified from the Swedish Medical Birth Register. Results There was an excess risk for placental abruption, caesarean section, delivery induction, and post-delivery hemorrhage in women taking hypertensives. Infants were more often than expected born preterm, were small for gestational age, and had an excess of various neonatal symptoms. Cardiovascular defects occurred with an adjusted odds ratio of 2.59 (95% CI 1.92-3.51). The results were similar when the woman had used ACE inhibitors or other antihypertensives, notably beta blockers. Stillbirth rate was increased (risk ratio 1.87, 95% CI 1.02-3.02), again without any clear drug specificity. Conclusions There seems to be little drug specificity in the association between maternal use of antihypertensives and an increased risk for infant cardiovascular defects.

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“…unemployment, unmarried and lower educational status. Moderate high BP require antihypertensive treatment and there seems to be less risk of developing severe hypertension, but no difference in outcomes of preeclampsia, neonatal death, preterm birth, and small for gestational age babies with treatment (Abalos, et al 2007). We also found that mothers having shorter gestational period [32-37 weeks] were almost five times more likely to suffer an adverse pregnancy outcome compared to longer gestational period [38 -42 weeks].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with adverse pregnancy outcomes among women who delivered at intermediate hospital oshakati, Namibia

Mungoba

2016

IJM

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Background: Globally, the leading cause of death among females aged 15-49 years old is maternal mortality. More than 1,500 women die each day from pregnancy related causes resulting in an estimated 550,000 maternal deaths annually. We identified risk factors associated with adverse pregnancy outcomes. Methods: We conducted a descriptive, cross-sectional study, in which we administered a structured questionnaire through face to face interviews. We also applied the multivariate logistic regression model to determine factors associated with adverse pregnancy outcomes. Results: We enrolled a total of 306 pregnant women of whom 50% (n=153) were 12-19 years old and 50% (n=153) Conclusion:In this study, we identified living in a rural area, shorter gestational period, haemoglobin level < 10gm%, obesity, and having moderately high blood pressure to be risk factors for adverse pregnancy outcomes. All the maternal deaths were in the 20-45 years old pregnant mothers. We recommend educating women on these risk factors in order to reduce the burden of adverse pregnancy outcomes.

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Antihypertensive drug therapy for mild to moderate hypertension during pregnancy

Cited by 148 publications

References 104 publications

Pregnancy-Induced hypertension

Pregnancy-Induced hypertension

Maternal use of antihypertensive drugs in early pregnancy and delivery outcome, notably the presence of congenital heart defects in the infants

Factors associated with adverse pregnancy outcomes among women who delivered at intermediate hospital oshakati, Namibia

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