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

Autor: Dublin S; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America.; Department of Epidemiology, University of Washington, Seattle, Washington, United States of America., Idu A; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America., Avalos LA; Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America., Cheetham TC; School of Pharmacy, Chapman University, Irvine, California, United States of America., Easterling TR; Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, United States of America., Chen L; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America., Holt VL; Department of Epidemiology, University of Washington, Seattle, Washington, United States of America., Nance N; Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America., Bider-Canfield Z; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, United States of America., Neugebauer RS; Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America., Reynolds K; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, United States of America., Badon SE; Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America., Shortreed SM; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America.; Department of Biostatistics, University of Washington, Seattle, Washington, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 May 16; Vol. 17 (5), pp. e0268284. Date of Electronic Publication: 2022 May 16 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0268284
Abstrakt: Objective: To compare maternal and infant outcomes with different antihypertensive medications in pregnancy.
Design: Retrospective cohort study.
Setting: Kaiser Permanente, a large healthcare system in the United States.
Population: Women aged 15-49 years with a singleton birth from 2005-2014 treated for hypertension.
Methods: 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.
Main Outcome Measures: Small for gestational age, preterm delivery, neonatal and maternal intensive care unit (ICU) admission, preeclampsia, and stillbirth or termination at > 20 weeks.
Results: 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.
Conclusions: 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.
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: SD received a grant to support this work from the National Institute on Child Health and Human Development. She has also received grant support from GSK for unrelated work. LC received a postdoctoral fellowship from the Group Health Foundation. She is now employed by Genentech (a member of Roche Group). ZBC is now employed by Roche Pharmaceuticals. TRE has consulted for Alnylam Pharmaceuticals, DiabetOmics, and Ferring Pharmaceuticals. SMS has received grant funding through her institutions from Syneos Health for work unrelated to this study. LAA received funding through her institution from Bausch Health Companies and KR from Amgen, Novartis and Merck & Co, all for work unrelated to this study. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Databáze: MEDLINE
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