Hypertension and antihypertensive drugs in pregnancy and perinatal outcomes

Objective Despite high rates of hypertension in pregnancy, the effects of hypertension have not been separated appropriately from the effects of the medications that are used. We evaluated the safety of exposure to antihypertensive medications during pregnancy, while accounting for disease effects....

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 2013-04, Vol.208 (4), p.301.e1-301.e6
Main Authors: Orbach, Hagay, MD, Matok, Ilan, PhD, Gorodischer, Rafael, MD, Sheiner, Eyal, MD, PhD, Daniel, Sharon, MD, MPH, Wiznitzer, Arnon, MD, Koren, Gideon, MD, Levy, Amalia, MPH, PhD
Format: Article
Language:English
Subjects:
Adolescent
Adult
Antihypertensive Agents - adverse effects
Antihypertensive Agents - therapeutic use
atenolol
Chronic Disease
chronic hypertension
Female
Humans
Hypertension - complications
Hypertension - drug therapy
Infant, Newborn
methyldopa
Middle Aged
Obstetrics and Gynecology
Pregnancy
Pregnancy Complications, Cardiovascular - drug therapy
Pregnancy Complications, Cardiovascular - etiology
Pregnancy Outcome
Retrospective Studies
Young Adult
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Summary:Objective Despite high rates of hypertension in pregnancy, the effects of hypertension have not been separated appropriately from the effects of the medications that are used. We evaluated the safety of exposure to antihypertensive medications during pregnancy, while accounting for disease effects. Study Design A population-based retrospective cohort study was performed that compared all pregnancies of women with hypertension who were either exposed or unexposed to antihypertensive medications. A computerized database of the medications that were dispensed to pregnant women from 1998-2008 was linked with computerized databases that contained maternal and infant hospitalization records from the district hospital during the same period. Results During the study period, 100,029 deliveries occurred; of those, 1964 pregnant women experienced chronic hypertension, and 620 neonates (0.6%) were exposed to at least 1 antihypertensive medication (methyldopa or atenolol) during pregnancy. A higher rate of intrauterine growth restriction (7.2% vs 2.1%, respectively; adjusted odds ratio [OR], 4.37; 95% confidence interval [CI], 3.00–6.36; P < .001), small for gestational age (3% vs 1.7%, respectively; adjusted OR, 2.23; 95% CI, 1.27–3.92; P = .005), and preterm deliveries (
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2012.11.011