BACKGROUND: We investigated the relation between fetoplacental growth and the use of oral antihypertensive medication to treat mild-to-moderate pregnancy hypertension. METHODS: The study design was a metaregression analysis of published data from randomised controlled trials. Data from a paper that was regarded as an extreme statistical outliner were excluded from primary analyses. The change in (group) mean arterial pressure (MAP) from enrolment to delivery was compared with indicators of fetoplacental growth. FINDINGS: Greater mean difference in MAP with antihypertensive therapy was associated with the birth of a higher proportion of small-for-gestational-age (SGA) infants (slope: 0.09 [SD 0.03], r2=0.48, p=0.006, 14 trials) and lower mean birthweight significant after exclusion of data from another paper regarded as an extreme statistical outliner (slope: -14.49 [6.98] r=0.16, p=0.049, 27). No relation with mean placental weight was seen (slope -2.01 [1.62], r2=0.15, p=0.25, 11 trials). INTERPRETATION: Treatment-induced falls in maternal blood pressure may adversely affect fetal growth. Given the small maternal benefits that are likely to be derived from therapy, new data are urgently needed to elucidate the relative maternal and fetal benefits and risks of oral antihypertensive drug treatment of mild-to-moderate pregnancy hypertension.
BACKGROUND: We investigated the relation between fetoplacental growth and the use of oral antihypertensive medication to treat mild-to-moderate pregnancy hypertension. METHODS: The study design was a metaregression analysis of published data from randomised controlled trials. Data from a paper that was regarded as an extreme statistical outliner were excluded from primary analyses. The change in (group) mean arterial pressure (MAP) from enrolment to delivery was compared with indicators of fetoplacental growth. FINDINGS: Greater mean difference in MAP with antihypertensive therapy was associated with the birth of a higher proportion of small-for-gestational-age (SGA) infants (slope: 0.09 [SD 0.03], r2=0.48, p=0.006, 14 trials) and lower mean birthweight significant after exclusion of data from another paper regarded as an extreme statistical outliner (slope: -14.49 [6.98] r=0.16, p=0.049, 27). No relation with mean placental weight was seen (slope -2.01 [1.62], r2=0.15, p=0.25, 11 trials). INTERPRETATION: Treatment-induced falls in maternal blood pressure may adversely affect fetal growth. Given the small maternal benefits that are likely to be derived from therapy, new data are urgently needed to elucidate the relative maternal and fetal benefits and risks of oral antihypertensive drug treatment of mild-to-moderate pregnancy hypertension.
Authors: Vera Regitz-Zagrosek; Christa Gohlke-Bärwolf; Annette Geibel-Zehender; Markus Haass; Harald Kaemmerer; Irmtraut Kruck; Christoph Nienaber Journal: Clin Res Cardiol Date: 2008-09 Impact factor: 5.460
Authors: Suzanne D Burke; Zsuzsanna K Zsengellér; Eliyahu V Khankin; Agnes S Lo; Augustine Rajakumar; Jennifer J DuPont; Amy McCurley; Mary E Moss; Dongsheng Zhang; Christopher D Clark; Alice Wang; Ellen W Seely; Peter M Kang; Isaac E Stillman; Iris Z Jaffe; S Ananth Karumanchi Journal: J Clin Invest Date: 2016-06-06 Impact factor: 14.808
Authors: Feng Li; Tomofumi Fushima; Gen Oyanagi; H W Davin Townley-Tilson; Emiko Sato; Hironobu Nakada; Yuji Oe; John R Hagaman; Jennifer Wilder; Manyu Li; Akiyo Sekimoto; Daisuke Saigusa; Hiroshi Sato; Sadayoshi Ito; J Charles Jennette; Nobuyo Maeda; S Ananth Karumanchi; Oliver Smithies; Nobuyuki Takahashi Journal: Proc Natl Acad Sci U S A Date: 2016-11-07 Impact factor: 11.205