Impact of Antihypertensive Treatment on Maternal and Perinatal Outcomes in Pregnancy Complicated by Chronic Hypertension: A Systematic Review and Meta‐Analysis

Abstract

BackgroundChronic hypertension complicates around 3% of all pregnancies. There is evidence that treating severe hypertension reduces maternal morbidity. This study aimed to systematically review randomized controlled trials of antihypertensive agents treating chronic hypertension in pregnancy to determine the effect of this intervention.Methods and ResultsMedline (via OVID), Embase (via OVID) and the Cochrane Trials Register were searched from their earliest entries until November 30, 2016. All randomized controlled trials evaluating antihypertensive treatments for chronic hypertension in pregnancy were included. Data were extracted and analyzed in Stata (version 14.1). Fifteen randomized controlled trials (1166 women) were identified for meta‐analysis. A clinically important reduction in the incidence of severe hypertension was seen with antihypertensive treatment versus no antihypertensive treatment/placebo (5 studies, 446 women; risk ratio 0.33, 95%CI 0.19‐0.56; I2 0.0%). There was no difference in the incidence of superimposed pre‐eclampsia (7 studies, 727 women; risk ratio 0.74, 95%CI 0.49‐1.11; I2 28.1%), stillbirth/neonatal death (4 studies, 667 women; risk ratio 0.37, 95%CI 0.11‐1.26; I2 0.0%), birth weight (7 studies, 802 women; weighted mean difference −60 g, 95%CI −200 to 80 g; I2 0.0%), or small for gestational age (4 studies, 369 women; risk ratio 1.01, 95%CI 0.53‐1.94; I2 0.0%) with antihypertensive treatment versus no treatment/placebo.ConclusionsAntihypertensive treatment reduces the risk of severe hypertension in pregnant women with chronic hypertension. A considerable paucity of data exists to guide choice of antihypertensive agent. Adequately powered head‐to‐head randomized controlled trials of commonly used antihypertensive agents are required to inform prescribing.

Labetalol Versus Nifedipine as Antihypertensive Treatment for Chronic Hypertension in Pregnancy

“…Randomized controlled trials comparing antihypertensive treatment of chronic hypertension in pregnancy are limited and most were conducted at least 20 years ago; only 3 previous head-to-head studies (total 101 women) have compared the incidence of severe hypertension between randomized treatment groups (RR, 1.1; 0.71-1.81). 1 This study was not powered to assess variation in the secondary maternal and perinatal outcomes, so further larger trials should evaluate differences in the incidence of superimposed preeclampsia, preterm delivery, and small for gestational age infants. Variation in treatment effect by ethnicity was also noted, with labetalol having a greater effect on reducing diastolic BP in non-black women, as previously demonstrated with β-blocker use outside pregnancy.…”

“…1,2 The prevalence of chronic hypertension in pregnancy is estimated at 3%, 3 but this figure is set to increase with rising maternal age and the global obesity epidemic. 4,5 Given that chronic hypertension is associated with significantly increased adverse maternal and perinatal outcomes compared with the general pregnant population, 6 defining optimal antihypertensive treatment(s) is warranted.…”

Perinatal outcome of hypertensive pregnant women is related to the severity of preeclampsia

“…However, less-tight control was associated with a significantly higher frequency of severe maternal hypertension 11 . In pregnant women with chronic hypertension, antihypertensive treatment was found to reduce the risk of severe hypertension 12 . Hypertension is one of the leading causes of maternal death in several countries.…”

Effects of high-quality nursing on puerpera with pregnancy hypertension

“…This condition is characterized by serious symptoms and high incidence [4]. Delayed treatment will cause pre-eclampsia, eclampsia, and placental abruption, thus influencing health of both puerpera and newborns.…”