Maternal and neonatal outcomes of antihypertensive treatment in pregnancy: A retrospective cohort study

• Published in: PloS one Vol. 17; no. 5; p. e0268284
• Main Authors: Dublin, Sascha, Idu, Abisola, Avalos, Lyndsay A, Cheetham, T Craig, Easterling, Thomas R, Chen, Lu, Holt, Victoria L, Nance, Nerissa, Bider-Canfield, Zoe, Neugebauer, Romain S, Reynolds, Kristi, Badon, Sylvia E, Shortreed, Susan M
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 16.05.2022; Public Library of Science (PLoS)
• Subjects: Age; Antihypertensive Agents - adverse effects; Antihypertensives; Birth certificates; Birth Weight; Births; Blood pressure; Cohort analysis; Confidence intervals; Electronic health records; Female; Gestational age; Health aspects; Health risks; Humans; Hypertension; Hypertension, Pregnancy-Induced - epidemiology; Infant; Infant, Newborn; Infant, Newborn, Diseases - drug therapy; Infants; Labetalol - therapeutic use; Medicine and Health Sciences; Meta-analysis; Methyldopa; Methyldopa - therapeutic use; Neonates; Newborn babies; Nifedipine; Nifedipine - therapeutic use; Pediatrics; Population; Pre-eclampsia; Preeclampsia; Pregnancy; Pregnancy Outcome - epidemiology; Pregnant women; Premature Birth - drug therapy; Premature Birth - epidemiology; Prevention; Retrospective Studies; Risk; Small for gestational age; Statistical analysis; Stillbirth; Values; Womens health; United States; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0268284

To compare maternal and infant outcomes with different antihypertensive medications in pregnancy. Retrospective cohort study. Kaiser Permanente, a large healthcare system in the United States. Women aged 15-49 years with a singleton birth from 2005-2014 treated for hypertension. We identified medication exposure from automated pharmacy data based on the earliest dispensing after the first prenatal visit. Using logistic regression, we calculated weighted outcome prevalences, adjusted odds ratios (aORs) and 95% confidence intervals, with inverse probability of treatment weighting to address confounding. Small for gestational age, preterm delivery, neonatal and maternal intensive care unit (ICU) admission, preeclampsia, and stillbirth or termination at > 20 weeks. Among 6346 deliveries, 87% with chronic hypertension, the risk of the infant being small for gestational age (birthweight < 10th percentile) was lower with methyldopa than labetalol (prevalence 13.6% vs. 16.6%; aOR 0.77, 95% CI 0.63 to 0.92). For birthweight < 3rd percentile the aOR was 0.57 (0.39 to 0.80). Compared with labetalol (26.0%), risk of preterm delivery was similar for methyldopa (26.5%; aOR 1.10 [0.95 to 1.27]) and slightly higher for nifedipine (28.5%; aOR 1.25 [1.06 to 1.46]) and other β-blockers (31.2%; aOR 1.58 [1.07 to 2.23]). Neonatal ICU admission was more common with nifedipine than labetalol (25.9% vs. 23.3%, aOR 1.21 [1.02 to 1.43]) but not elevated with methyldopa. Risks of other outcomes did not differ by medication. Risk of most outcomes was similar comparing labetalol, methyldopa and nifedipine. Risk of the infant being small for gestational age was substantially lower for methyldopa, suggesting this medication may warrant further consideration.