Pregnancy Outcomes of Anti-Hypertensives for Women with Chronic Hypertension: A Population-Based Study

Su, Chen Yi; Lin, Herng Ching; Cheng, Hsin Chung; Yen, Amy Ming Fang; Chen, Yi Hua; Kao, Senyeong

doi:10.1371/journal.pone.0053844

Cited by 27 publications

(17 citation statements)

References 34 publications

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“…This study, which has recently completed recruitment of more than 1000 women with hypertension in pregnancy, but is yet to report, was designed to determine whether tight or less tight blood pressure control influences the likelihood of pregnancy loss or neonatal intensive care unit admission 90. A recent study showing that women with chronic hypertension taking antihypertensive drugs have worse perinatal outcomes than do those not on treatment was unable to adjust for severity of underlying hypertension and indicates the need for future prospective studies to explore the influence of pre-existing disease severity 91…”

Section: Discussionmentioning

confidence: 99%

Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis

Bramham

Parnell

Nelson‐Piercy

et al. 2014

BMJ

583

363

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Objective To provide an accurate assessment of complications of pregnancy in women with chronic hypertension, including comparison with population pregnancy data (US) to inform pre-pregnancy and antenatal management strategies.Design Systematic review and meta-analysis.Data sources Embase, Medline, and Web of Science were searched without language restrictions, from first publication until June 2013; the bibliographies of relevant articles and reviews were hand searched for additional reports.Study selection Studies involving pregnant women with chronic hypertension, including retrospective and prospective cohorts, population studies, and appropriate arms of randomised controlled trials, were included. Data extractionPooled incidence for each pregnancy outcome was reported and, for US studies, compared with US general population incidence from the National Vital Statistics Report (2006).Results 55 eligible studies were identified, encompassing 795 221 pregnancies. Women with chronic hypertension had high pooled incidences of superimposed pre-eclampsia (25.9%, 95% confidence interval 21.0% to 31.5 %), caesarean section (41.4%, 35.5% to 47.7%), preterm delivery <37 weeks' gestation (28.1% (22.6 to 34.4%), birth weight <2500 g (16.9%, 13.1% to 21.5%), neonatal unit admission (20.5%, 15.7% to 26.4%), and perinatal death (4.0%, 2.9% to 5.4%). However, considerable heterogeneity existed in the reported incidence of all outcomes (τ 2 =0.286-0.766), with a substantial range of incidences in individual studies around these averages; additional meta-regression did not identify any influential demographic factors. The incidences (the meta-analysis average from US studies) of adverse outcomes in women with chronic hypertension were compared with women from the US national population dataset and showed higher risks in those with chronic hypertension: relative risks were 7.7 (95% confidence interval 5.7 to 10.1) for superimposed pre-eclampsia compared with pre-eclampsia, 1.3 (1.1 to 1.5) for caesarean section, 2.7 (1.9 to 3.6) for preterm delivery <37 weeks' gestation, 2.7 (1.9 to 3.8) for birth weight <2500 g, 3.2 (2.2 to 4.4) for neonatal unit admission, and 4.2 (2.7 to 6.5) for perinatal death.Conclusions This systematic review, reporting meta-analysed data from studies of pregnant women with chronic hypertension, shows that adverse outcomes of pregnancy are common and emphasises a need for heightened antenatal surveillance. A consistent strategy to study women with chronic hypertension is needed, as previous study designs have been diverse. These findings should inform counselling and contribute to optimisation of maternal health, drug treatment, and pre-pregnancy management in women affected by chronic hypertension.

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Section: Discussionmentioning

confidence: 99%

Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis

Bramham

Parnell

Nelson‐Piercy

et al. 2014

BMJ

583

363

View full text Add to dashboard Cite

show abstract

“…The above findings seem to suggest that uncomplicated chronic hypertension in pregnancy is associated with normal birth weight which might be comparable to that of normal uncomplicated pregnancy. However, a recent study has demonstrated that chronic hypertension is associated with increased risk of preterm delivery, LBW and SGA infants and these adverse outcomes were more common in those managed on antihypertensives [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Perinatal outcomes of hypertensive disorders in pregnancy at a tertiary hospital in Ghana

Adu‐Bonsaffoh

Ntumy

Obed

et al. 2017

BMC Pregnancy Childbirth

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BackgroundHypertensive disorders in pregnancy remain a major global health issue not only because of the associated high adverse maternal outcomes but there is a close accompaniment of significant perinatal morbidity and mortality especially in Sub-Saharan Africa (SSA). However, the perinatal burden of HDP in Ghana has not been explored. We conducted this study to determine the perinatal outcomes of HDP at a tertiary hospital in Ghana.MethodsA cross-sectional study conducted between January to February 2013 at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. Data collection involved baseline review of all the obstetric population who had just delivered to identify those with HDP. An informed consent was obtained after which a structured questionnaire was adminstered to the hypertensive mothers. The medical records of the mothers and their babies were also reviewed to determine the perinatal outcome indicators of relevance to the study. Data obtained were analyzed using SPSS version 20.ResultsWe included 368 women with HDP and singleton births with a mean gestational age at delivery of 37.4 ± 3.3 weeks. Adverse perinatal outcomes determined include the following: 91 (24.7%) neonates were admitted to the Neonatal Intensive Care Unit, 56 (15.2%) had neonatal respiratory distress/asphyxia with 14 (3.8%) requiring ventilatory support and 80 (21.7%) were delivered preterm. Also, stillbirth, early neonatal death, intrauterine growth restriction and low birth weight occurred in 25 (6.8%), 14 (3.8%), 23 (6.1%) and 91 (24.7%) respectively with a perinatal mortality rate of 106 per 1000 births. One and 5 minute APGAR scores <7 occurred in 125 (34.0%) and 55 (14.7%) neonates respectively. Most of the adverse perinatal outcomes were significantly more common in those with preeclampsia compared to the other hypertensive disorders.ConclusionThere is a significant burden of perinatal morbidity and mortality associated with HDP in the Ghanaian obstetric population and these adverse outcomes were more prevalent in preeclampsia compared to the other hypertensive disorders. Regular goal-oriented clinical audit into perinatal morbidity and mortality associated with HDP and an active multidisciplinary approach to the management of these disorders in the hospital might improve the clinical outcomes of women with maternal hypertension.

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“…4 Only 1 other recent investigation reported a higher risk for preterm birth in pregnancies with central alpha agonists compared with treatment with β-blockers. 43 Finally, because of the limited sample size, we cannot rule out any embryotoxic and teratogenic risk of methyldopa. With a baseline risk of 3%, we are only able to detect a 2.5-fold increased risk of major birth defects in the exposed cohort with a power of 80%.…”

Section: Pregnancy Complicationsmentioning

confidence: 99%

Pregnancy Outcome After First Trimester Use of Methyldopa

et al. 2017

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Published experience on first trimester exposure to methyldopa is still limited, although it is recommended as first-line treatment for hypertensive disorders in pregnancy in most countries. The primary aim of this prospective observational cohort study was to analyze the rate of major birth defects and spontaneous abortions in women with methyldopa therapy for chronic hypertension. Outcomes of 261 pregnancies with first trimester exposure to methyldopa and 526 comparison pregnancies without chronic hypertension reported to the German Embryotox pharmacovigilance institute were evaluated. The rate of major birth defects in the exposed cohort was not significantly increased compared with the comparison cohort (3.7% versus 2.5%; adjusted odds ratio, 1.24; 95% confidence interval, 0.4–4.0). There was a tendency toward a higher rate of spontaneous abortions in exposed women. The risk of preterm birth was significantly higher, and adjusted birth weight scores were significantly lower in the methyldopa group. Head circumferences were significantly reduced in exposed boys only. There was neither evidence for an increased risk for birth defects or increase in early pregnancy loss nor evidence for growth restriction or a reduced head circumference in a sensitivity analysis comparing monotherapies with methyldopa to metoprolol. However, the significantly increased risk of preterm birth in methyldopa-treated pregnancies was confirmed. In conclusion, our study does not indicate a teratogenic risk of methyldopa. Further studies are needed to confirm its safety in the first trimester and clarify the influence of hypertension and methyldopa on preterm birth and intrauterine growth. Clinical Trial Registration— URL: https://drks-neu.uniklinik-freiburg.de/drks_web/ . Unique identifier: DRKS00010502.

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Pregnancy Outcomes of Anti-Hypertensives for Women with Chronic Hypertension: A Population-Based Study

Cited by 27 publications

References 34 publications

Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis

Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis

Perinatal outcomes of hypertensive disorders in pregnancy at a tertiary hospital in Ghana

Pregnancy Outcome After First Trimester Use of Methyldopa

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