PREGNANCY OUTCOMES OF NIFEDIPINE COMPARED WITH LABETALOL FOR ORAL TREATMENT OF MILD CHRONIC HYPERTENSION
Main Article Content
Keywords
Chronic hypertension, pregnancy, Nifedipine, Labetalol, blood pressure control, preeclampsia, preterm delivery, NICU admissions, maternal outcomes, fetal outcomes
Abstract
Background: Chronic hypertension during pregnancy poses significant risks to both maternal and fetal health, with complications such as preeclampsia, preterm birth, and intrauterine growth restriction (IUGR). Nifedipine and Labetalol are widely used antihypertensive drugs during pregnancy, but their comparative effects on mild chronic hypertension remain under-researched, especially in resource-constrained settings like Pakistan.
Objective: The study aimed to compare the maternal and fetal outcomes of pregnant women with mild chronic hypertension treated with Nifedipine versus Labetalol at Ayub Teaching Hospital Abbottabad focusing on the efficacy in controlling blood pressure and assessing related pregnancy complications.
Methods: This retrospective cohort study included 200 pregnant women with mild chronic hypertension, divided into two groups: 100 treated with Nifedipine and 100 with Labetalol. Data were collected from hospital records, including blood pressure readings, incidence of preeclampsia, preterm delivery rates, neonatal intensive care unit (NICU) admissions, and birth weight. Statistical analyses, including t-tests, Chi-square tests, and multivariate logistic regression, were conducted to compare outcomes.
Results: Nifedipine resulted in a significantly greater reduction in systolic blood pressure (20 mm Hg vs. 18 mm Hg, p = 0.012). The incidence of preeclampsia was lower in the Nifedipine group (8%) compared to the Labetalol group (12%), though not statistically significant (p = 0.24). Similarly, NICU admissions were lower in the Nifedipine group (12% vs. 20%), but the difference was not significant (p = 0.19). Preterm delivery rates and birth weight differences were also not statistically significant.
Conclusion: Both Nifedipine and Labetalol are effective in managing mild chronic hypertension during pregnancy. However, Nifedipine may offer slightly better blood pressure control and improved neonatal outcomes. Further studies with larger sample sizes are recommended to confirm these findings.
References
2. August, P., &Sibai, B. M. (2017). Hypertension in pregnancy. Clinical Obstetrics and Gynecology, 60(1), 190-202.
3. Brown, M. A., Magee, L. A., Kenny, L. C., Karumanchi, S. A., McCarthy, F. P., Saito, S., ... & von Dadelszen, P. (2018). Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension, 72(1), 24-43.
4. Henderson, J. T., Whitlock, E. P., O'Connor, E., Senger, C. A., & Thompson, J. H. (2019). Low-dose aspirin for the prevention of morbidity and mortality from preeclampsia: A systematic evidence review for the US Preventive Services Task Force. Annals of Internal Medicine, 160(10), 695-703.
5. Magee, L. A., von Dadelszen, P., Rey, E., Ross, S., Asztalos, E., Murphy, K. E., &Moutquin, J. M. (2014). Labetalol versus methyldopa in the treatment of hypertension in pregnancy: A randomized controlled trial. American Journal of Obstetrics and Gynecology, 207(6), 502.e1-502.e7.
6. Podymow, T., & August, P. (2012). Antihypertensive drugs in pregnancy. Seminars in Nephrology, 31(1), 70-85.
7. Raheem, I. A., Saaid, R., Omar, S. Z., & Tan, P. C. (2012). Oral nifedipine versus intravenous labetalol for acute blood pressure control in hypertensive emergencies of pregnancy: A randomized trial. BJOG: An International Journal of Obstetrics &Gynaecology, 119(1), 78-85.
8. Roberge, S., Bujold, E., Nicolaides, K. H., & von Dadelszen, P. (2017). Maternal risk factors for preeclampsia: Identification and strategies for prevention. Current Hypertension Reports, 19(6), 38.
9. Seely, E. W., & Ecker, J. (2019). Chronic hypertension in pregnancy. Circulation, 129(11), 1250-1256.
10. Sibai, B. M., Lindheimer, M., Hauth, J., Caritis, S., MacPherson, C., Klebanoff, M., & Thurnau, G. (2007). Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension. New England Journal of Medicine, 339(10), 667-671.
11. Vigil-De Gracia, P., Montufar-Rueda, C., & Ruiz, J. (2013). Expectant management of severe preeclampsia remote from term: The MEXPRE randomized study. American Journal of Obstetrics and Gynecology, 209(5), 425.e1-425.e8.
12. Von Dadelszen, P., Sawchuck, D., McMaster, R., McManus, K., &Helewa, M. (2015). Hypertension in pregnancy: Should we intervene earlier? Journal of Obstetrics and Gynaecology Canada, 37(11), 915-917.
13. Zhang, J., Zeisler, H., Hatch, M. C., & Berkowitz, G. (2019). Epidemiology of pregnancy-induced hypertension. Epidemiologic Reviews, 19(2), 239-245.
14. Abalos, E., Duley, L., Steyn, D. W., & Henderson-Smart, D. J. (2014). Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database of Systematic Reviews, 2.
15. August, P., &Sibai, B. M. (2017). Hypertension in pregnancy. Clinical Obstetrics and Gynecology, 60(1), 190-202.
16. Brown, M. A., Magee, L. A., Kenny, L. C., Karumanchi, S. A., McCarthy, F. P., Saito, S., ... & von Dadelszen, P. (2018). Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension, 72(1), 24-43.
17. Henderson, J. T., Whitlock, E. P., O'Connor, E., Senger, C. A., & Thompson, J. H. (2019). Low-dose aspirin for the prevention of morbidity and mortality from preeclampsia: A systematic evidence review for the US Preventive Services Task Force. Annals of Internal Medicine, 160(10), 695-703.
18. Magee, L. A. A., von Dadelszen, P., Rey, E., Ross, S., Asztalos, E., Murphy, K. E., &Moutquin, J. M. (2014). Labetalol versus methyldopa in the treatment of hypertension in pregnancy: A randomized controlled trial. American Journal of Obstetrics and Gynecology, 207(6), 502.e1-502.e7.
19. Podymow, T., & August, P. (2012). Antihypertensive drugs in pregnancy. Seminars in Nephrology, 31(1), 70-85.
20. Raheem, I. A., Saaid, R., Omar, S. Z., & Tan, P. C. (2012). Oral nifedipine versus intravenous labetalol for acute blood pressure control in hypertensive emergencies of pregnancy: A randomized trial. BJOG: An International Journal of Obstetrics &Gynaecology, 119(1), 78-85.
21. Roberge, S., Bujold, E., Nicolaides, K. H., & von Dadelszen, P. (2017). Maternal risk factors for preeclampsia: Identification and strategies for prevention. Current Hypertension Reports, 19(6), 38.
22. Seely, E. W., & Ecker, J. (2019). Chronic hypertension in pregnancy. Circulation, 129(11), 1250-1256.
23. Sibai, B. M., Lindheimer, M., Hauth, J., Caritis, S., MacPherson, C., Klebanoff, M., & Thurnau, G. (2007). Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension. New England Journal of Medicine, 339(10), 667-671.
24. Vigil-De Gracia, P., Montufar-Rueda, C., & Ruiz, J. (2013). Expectant management of severe preeclampsia remote from term: The MEXPRE randomized study. American Journal of Obstetrics and Gynecology, 209(5), 425.e1-425.e8.
25. Von Dadelszen, P., Sawchuck, D., McMaster, R., McManus, K., &Helewa, M. (2015). Hypertension in pregnancy: Should we intervene earlier? Journal of Obstetrics and Gynaecology Canada, 37(11), 915-917.
26. Zhang, J., Zeisler, H., Hatch, M. C., & Berkowitz, G. (2019). Epidemiology of pregnancy-induced hypertension. Epidemiologic Reviews, 19(2), 239-245.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Atyya Bibi Khan
Assistant Professor Gynae C Ward, Ayub Medical College, Abbottabad
Shandana Mustafa Jadoon
Associate Professor, Ayub Teaching Hospital, Abbottabad
Ayat Ul Burr
PGR Gynae C Ward, Ayub Medical College, Abbottabad
Sumaira Fareed
PGR Gynae C Ward, Ayub Medical College, Abbottabad
Hajra Amjad
PGR Gynae C Ward, Ayub Medical College, Abbottabad
Nasima Tayyab
PGR Gynae C Ward, Ayub Medical College, Abbottabad