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Use of Antihypertensive Medications During Delivery Hospitalizations Complicated by Preeclampsia

Cleary, Kirsten, L., MD, MSCE; Siddiq, Zainab, MS; Ananth, Cande, V., PhD, MPH; Wright, Jason, D., MD; Too, Gloria, MD; D'Alton, Mary, E., MD; Friedman, Alexander, M., MD, MPH

doi: 10.1097/AOG.0000000000002479
Contents: Original Research
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OBJECTIVE: To evaluate temporal trends in use of antihypertensive medications during delivery hospitalizations complicated by preeclampsia and risk of maternal stroke over the same time period.

METHODS: The Perspective database was used to perform a retrospective cohort study evaluating antihypertensive drugs dispensed during delivery hospitalizations complicated by preeclampsia from 2006 to the first quarter of 2015. Medications evaluated included nifedipine, hydralazine, and oral and intravenous labetalol. Adjusted models for receipt of antihypertensive agents accounting for demographic and hospital factors were created. Hospital-level rates of antihypertensive administration for women with severe preeclampsia were analyzed. Risk of stroke during delivery hospitalization was evaluated.

RESULTS: A total of 239,454 patients with preeclampsia were included in the analysis including 126,595 women with mild, 31,628 with superimposed, and 81,231 with severe preeclampsia. Overall, 105,409 women received a hypertensive agent. From 2006 to 2014, for all patients with preeclampsia, receipt of oral labetalol increased from 20.3% to 31.4%, intravenous labetalol from 13.3% to 21.4%, hydralazine from 12.8% to 16.9%, nifedipine from 15.0% to 18.2%, and more than one medication from 16.5% to 25.8%. The proportion of patients with preeclampsia receiving any antihypertensive medication rose from 37.8% in 2006 to 49.4% in 2015. In adjusted models, temporal trends retained significance. Rates of antihypertensive administration for severe preeclampsia varied significantly by hospital. For severe preeclampsia, the risk for stroke decreased from 13.5 per 10,000 deliveries in 2006–2008 (n=27) to 9.7 in 2009–2011 (n=25) to 6.0 in 2012–2014 (n=20) (P=.02).

CONCLUSION: Use of multiple antihypertensive agents to treat preeclamptic women increased over the study period for women with mild, superimposed, and severe preeclampsia. There was substantial hospital variation in use of antihypertensive agents. This trend was associated with decreased risk of maternal stroke.

Use of antihypertensive agents during delivery hospitalizations increased over the study period for women with mild, severe, and superimposed preeclampsia, and the risk of stroke decreased.

Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, and the Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York.

Corresponding author: Alexander M. Friedman, MD, MPH, Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, New York, NY 10032; email: amf2104@cumc.columbia.edu.

Dr. Friedman is supported by a career development award (K08HD082287) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.

Financial Disclosure Dr. Wright has served as a consultant for Tesaro and Clovis Oncology. The other authors did not report any potential conflicts of interest.

Presented at the Society for Maternal-Fetal Medicine's Annual Pregnancy Meeting, January 29–February 3, 2018, Dallas, Texas.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.