Abstract
Objective:
We assessed whether requiring >1 medication for blood pressure control is associated with adverse pregnancy outcomes.
Study Design:
Retrospective cohort of 974 singletons with chronic hypertension at a tertiary care center. Subjects on >1 antihypertensive agent were compared with those on one agent <20 weeks gestational age with results stratified by average blood pressure (<140/90 and ⩾140/90 mm Hg) from prenatal visits. The primary maternal outcome was preeclampsia; the primary neonatal outcome was small for gestational age (<10th percentile).
Result:
Among women with blood pressure ⩾140/90 mm Hg, women on multiple agents had the greatest risk of preeclampsia, severe preeclampsia, antenatal admissions to rule out preeclampsia, preterm birth <35 weeks and composite neonatal adverse outcomes.
Conclusion:
Compared with use of a single agent when blood pressure is ⩾140/90 mm Hg, use of multiple agents increases adverse risks, while no such finding exists when blood pressure is controlled below 140/90 mm Hg.
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References
Vanek M, Sheiner E, Levy A, Mazor M . Chronic hypertension and the risk for adverse pregnancy outcome after superimposed preeclampsia. Int J Gynaecol Obstet 2004; 86: 7–11.
Sibai BM . Chronic hypertension in pregnancy. Obstet Gynecol 2002; 100: 369–377.
Sibai BM, Abdella TN, Anderson GD . Pregancy outcomes in 211 patients with mild chronic hypertension. Obstet Gynecol 1983; 61: 571–576.
Sibai BM, Lindheimer M, Hauth J, Caritis S, VanDorsten P, Klebanoff M et al. Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension. N Eng J Med 1998; 339: 667–671.
Rey E, Couturier A . The prognosis of pregnancy in women with chronic hypertension. Am J Obstet Gynecol 1994; 171: 410–416.
McCowan LM, Buist RG, North RA, Gamble G . Perinatal morbidity in chronic hypertension. Br J Obstet Gynecol 1996; 103: 123–129.
Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynceol 2000; 183: S1–S22.
American Congress of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy. Hypertension in Pregnancy. American Congress of Obstetricians and Gynecologists: Washington, DC, USA, 2013.
The American College of Obstetricians and Gynecologists Committee on Obstetrics Practice, The Society for Maternal-Fetal Medicine. Medically Indicated Late-Preterm and Early-Term Deliveries. Committee Opinion Number 560, April 2013.
Magee LA, von Dadelszen P, Rey E, Ross S, Asztalos E, Murphy KE et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med. 2015; 372 (5): 407–417.
Ankumah NA, Cantu J, Jauk V, Biggio J, Hauth J, Andrews W et al. Risk of adverse pregnancy outcomes in women with mild chronic hypertension before 20 weeks of gestation. Obstet Gynecol. 2014; 123 (5): 966–972.
Spong C . Defining “Term” pregnancy: recommendations from the defining “Term” pregnancy workgroup. JAMA 2013; 309 (23): 2445–2446.
Ray JG, Vermeulen MJ, Burrows EA, Burrows RF . Use of antihypertensive medications in pregnancy and the risk of adverse perinatal outcomes: McMaster Outcome Study of Hypertension In Pregnancy 2 (MOS HIP 2. BMC Pregnancy Childbirth 2001; 1: 6.
Su C-Y, Lin H-C, Cheng H-C, AM-F Yen, Chen Y-H et al. Pregnancy outcomes of anti-hypertensives for women with chronic hypertension: a population-based study. PLoS One 2013; 8 (2): e53844.
Acknowledgements
LMH is supported by K12HD001258 (PI WW Andrews, NICHD), which partially supports this work.
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Allen, S., Tita, A., Anderson, S. et al. Is use of multiple antihypertensive agents to achieve blood pressure control associated with adverse pregnancy outcomes?. J Perinatol 37, 340–344 (2017). https://doi.org/10.1038/jp.2016.247
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DOI: https://doi.org/10.1038/jp.2016.247