Source
BJOG: An International Journal of Obstetrics & Gynaecology. Jun2016, Vol. 123 Issue 7, p1143-1151. 9p.
Subject
*LABETALOL
*METHYLDOPA
*PREGNANCY complications
*HYPERTENSION risk factors
*PRENATAL care
*RANDOMIZED controlled trials
*THERAPEUTICS
*ANTIHYPERTENSIVE agents
*LOW birth weight
*BLOOD pressure
*CARDIOVASCULAR diseases in pregnancy
*HYPERTENSION
*EVALUATION of medical care
*HYPERTENSION in pregnancy
*PREECLAMPSIA
*PREGNANCY
*PREVENTION
Abstract
Objective: To compare pregnancy outcomes, accounting for allocated group, between methyldopa-treated and labetalol-treated women in the CHIPS Trial (ISRCTN 71416914) of 'less tight' versus 'tight' control of pregnancy hypertension.Design: Secondary analysis of CHIPS Trial cohort.Setting: International randomised controlled trial (94 sites, 15 countries).Population or Sample: Of 987 CHIPS recruits, 481/566 (85.0%) women treated with antihypertensive therapy at randomisation. Of 981 (99.4%) women followed to delivery, 656/745 (88.1%) treated postrandomisation.Methods: Logistic regression to compare outcomes among women who took methyldopa or labetalol, adjusted for the influence of baseline factors.Main Outcome Measures: CHIPS primary (perinatal loss or high level neonatal care for >48 hours) and secondary (serious maternal complications) outcomes, birthweight <10th centile, severe maternal hypertension, pre-eclampsia and delivery at <34 or <37 weeks.Results: Methyldopa and labetalol were used commonly at randomisation (243/987, 24.6% and 238/987, 24.6%, respectively) and post-randomisation (224/981, 22.8% and 433/981, 44.1%, respectively). Following adjusted analyses, methyldopa (versus labetalol) at randomisation was associated with fewer babies with birthweight <10th centile [adjusted odds ratio (aOR) 0.48; 95% CI 0.20-0.87]. Methyldopa (versus labetalol) postrandomisation was associated with fewer CHIPS primary outcomes (aOR 0.64; 95% CI 0.40-1.00), birthweight <10th centile (aOR 0.54; 95% CI 0.32-0.92), severe hypertension (aOR 0.51; 95% CI 0.31-0.83), pre-eclampsia (aOR 0.55; 95% CI 0.36-0.85), and delivery at <34 weeks (aOR 0.53; 95% CI 0.29-0.96) or <37 weeks (aOR 0.55; 95% CI 0.35-0.85).Conclusion: These nonrandomised comparisons are subject to residual confounding, but women treated with methyldopa (versus labetalol), particularly those with pre-existing hypertension, may have had better outcomes.Tweetable Abstract: There was no evidence that women treated with methyldopa versus labetalol had worse outcomes. [ABSTRACT FROM AUTHOR]