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Role of antihypertensive therapy in mild to moderate pregnancy-induced hypertension: a prospective randomized study comparing labetalol with alpha methyldopa

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

Pregnancy-induced hypertension (PIH) is associated with adverse fetal and maternal outcome. The role of medication to control blood pressure (BP) in mild to moderate PIH is controversial.

Aims

We conducted a prospective study to investigate whether pharmacological treatment of mild to moderate PIH is effective in improving maternal and fetal outcomes.

Methods

A total of 150 consecutive pregnant women without proteinuria and with physician-recorded systolic BP of 140–160 mmHg and/or diastolic BP of 90–105 mmHg on two occasions ≥6 h apart between 20 and 38 weeks of gestation were randomly allocated to receive either labetalol or methyldopa (50 patients each) plus standard care (treatment group) or only standard care (50 patients) (control group).

Results and conclusions

As compared to the control group, the treatment group had lower rates of severe PIH (28% vs. 10%, P = 0.005), proteinuria (28% vs. 12%, P = 0.016), hospitalization before term (28% vs. 14%, P = 0.041), and delivery by cesarean section (38% vs. 22%, P = 0.042). In a multivariable logistic regression model that adjusted for maternal age, weight, parity, previous PIH, and baseline hemoglobin, resting heart rate, and BP levels, antihypertensive therapy was associated with a lower incidence of adverse maternal events (P = 0.011). Compared to the control group, the treatment group had lower incidence of SGA babies (40% vs. 23%, P = 0.033), preterm birth (36% vs. 14%, P = 0.002), and admission to neonatal unit (30% vs. 15%, P = 0.036). After adjustment for maternal age, weight, baseline hemoglobin, resting heart rate, BP level, parity and previous history of PIH, fetal death, preterm delivery or SGA baby, antihypertensive therapy was associated with a lower incidence of adverse perinatal events (P = 0.016). Maternal and perinatal mortality rates were not significantly different between treatment and control groups. In conclusion, pharmacological treatment of mild to moderate PIH is associated with lower rate of some maternal and fetal-neonatal non-fatal adverse events compared to no routine use of antihypertensive therapy.

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Acknowledgments

We thank two anonymous reviewers for helpful comments and Arvind Kavishwar (MSc.), Bio-Statistician Regional Medical Research Centre for Tribals, Indian Council of Medical Research, RMRCT Complex, Garha, Jabalpur 482003 (MP) India for help in statistical analyses.

Conflict of interest

We declare that we have no conflict of interest relevant to this study.

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Authors and Affiliations

  1. The Department of Obstetrics and Gynecology, Government Lal Ded Hospital for Women, Government Medical College, Srinagar, Jammu and Kashmir, India

    Shaba N. Molvi, Shahida Mir & Farhat Jabeen

  2. Department of Medicine, SK Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

    Vikram S. Rana

  3. K-353, Sarita Vihar, New Delhi, 110076, India

    Shaba N. Molvi

  4. Department of Cardiology, SK Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

    A. Rauoof Malik

Authors
  1. Shaba N. Molvi
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  2. Shahida Mir
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  3. Vikram S. Rana
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  5. A. Rauoof Malik
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Correspondence to Shaba N. Molvi.

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Molvi, S.N., Mir, S., Rana, V.S. et al. Role of antihypertensive therapy in mild to moderate pregnancy-induced hypertension: a prospective randomized study comparing labetalol with alpha methyldopa. Arch Gynecol Obstet 285, 1553–1562 (2012). https://doi.org/10.1007/s00404-011-2205-2

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