Hypertensive Disorders of Pregnancy and Medication Use in the 2015 Pelotas (Brazil) Birth Cohort Study

Abstract

Hypertensive disorders of pregnancy account for approximately 22% of all maternal deaths in Latin America and the Caribbean. Pharmacotherapies play an important role in preventing and reducing the occurrence of adverse outcomes. However, the patterns of medications used for treating women with hypertensive disorders of pregnancy (HDP) living in this country is unclear. A population-based birth cohort study including 4262 women was conducted to describe the pattern of use of cardiovascular agents and acetylsalicylic acid between women with and without HDP in the 2015 Pelotas (Brazil) Birth Cohort. The prevalence of maternal and perinatal outcomes in this population was also assessed. HDP were classified according to Ministry of Health recommendations. Medications were defined using the Anatomical Therapeutic Chemical Classification System and the substance name. In this cohort, 1336 (31.3%) of women had HDP. Gestational hypertension was present in 636 (47.6%) women, 409 (30.6%) had chronic hypertension, 191 (14.3%) pre-eclampsia, and 89 (6.7%) pre-eclampsia superimposed on chronic hypertension. Approximately 70% of women with HDP reported not using any cardiovascular medications. Methyldopa in monotherapy was the most frequent treatment (16%), regardless of the type of HDP. Omega-3 was the medication most frequently reported by women without HDP. Preterm delivery, caesarean section, low birth weight, and neonatal intensive care admissions were more prevalent in women with HDP. Patterns of use of methyldopa were in-line with the Brazilian guidelines as the first-line therapy for HDP. However, the large number of women with HDP not using medications to manage HDP requires further investigation.

Analysis of Antihypertensive Drug Use in Pregnancy

“…At the age of 21-35 years many have plans for pregnancy because at that age is the peak of fertility compared to those aged over 35. (Schlembach et al, 2015;Leal et al, 2020;Poudel et al, 2021).…”

Comparative Pharmacoepidemiological Assessment of Antihypertensive Drugs Administration Structure in Pregnant Women in Routine Medical Practice in Kursk and Chisinau

“…Клонидин (14,3% назначений во 2 группе респондентов) имеет категорию безопасности С, не запрещен к применению во время беременности и в некоторых случаях может быть использован в качестве препарата второй линии [11][12][13]. В аналогичном по дизайну крупном исследовании, проведенном в Бразилии, среди 1336 женщин наиболее часто (в 16,2% от общего числа беременных с АГ) назначалась именно терапия метилдопой, 6,9% получали другую терапию сердечно-сосудистыми средствами [14].…”

Urinary Angiotensinogen-Melatonin Ratio in Gestational Diabetes and Preeclampsia

“…The diagnosis of preeclampsia or gestational diabetes were made by the hospital’s obstetricians using the following criteria. Preeclampsia was defined as de novo hypertension with high blood pressure (systolic ≥140 or diastolic ≥90 mm Hg) on two occasions, at least 4 hours apart, after 20 weeks of pregnancy and proteinuria of 0.3 g in 24 h urine collection, or 2+ in 2 samples with 2 h apart, or more than 0.3 mg in a single sample ( Sousa et al, 2019 ; Leal et al, 2020 ). Gestational diabetes mellitus was defined as carbohydrate intolerance, resulting in hyperglycemia of varying severity with onset or first recognition during pregnancy.…”