Antihypertensive drug therapy for mild to moderate hypertension during pregnancy

A review of the methodological features of systematic reviews in maternal medicine

“…Of these 68 reviews [8-75] fulfilled the inclusion criteria and were selected for detailed study (Fig 1). A total of 39 (57%) Cochrane reviews [8-46] and 29 (43%) non Cochrane reviews [47-75] were included. Most of the reviews assessed therapeutic interventions (50/68, 74%), and the rest were reviews on prognosis (12/68, 17%) and diagnosis (6/68, 9%).…”

Management of pre-eclampsia

“…Also, when data from all trials are combined using meta-analysis, taking antihypertensive drugs has no overall effect on the relative risk of having a baby who is small for gestational age (relative risk 1.13, 0.91 to 1.42). Among the trials of β blockers, however, an increased risk does seem likely (8 trials, 810 women; relative risk 1.56, 1.10 to 2.22) 11. It therefore remains plausible that the observed association with fetal growth restriction is related to β blockers in particular rather than any general effect of antihypertensive drugs.…”

“…Alternative choices include labetalol and calcium channel blockers. There is insufficient evidence to conclude which is better 11. Drugs to be avoided are atenolol, because of concern about fetal growth restriction, and angiotensin converting enzyme inhibitors and angiotensin receptor antagonists, which are contraindicated in pregnancy.…”

Lowering diastolic blood pressure in non-proteinuric hypertension in pregnancy is not harmful to the fetus and is associated with reduced frequency of severe maternal hypertension

“…Some meta-analyses suggest a possible reduction in fetal birth weight associated with lowering mildly elevated BP 2. However, other analyses found no evidence of fetal harm and a reduction in severe maternal hypertension 3. This clinical trial compared fetal and maternal outcomes associated with lowering diastolic BP (DBP) to 100 mm Hg compared to 85 mm Hg in non-proteinuric hypertensive pregnant women.…”