The Impact of Multi-Drug Therapy on Pregnancies of Chronic Hypertensive Women [26K

Abstract

INTRODUCTION: Our group has previously described the high frequency of preterm birth and superimposed preeclampsia in women treated during pregnancy for chronic hypertension (CHTN). We hypothesized that women with CHTN requiring more than one medication for control may be at increased risk for these adverse perinatal outcomes. METHODS: This was a retrospective study of pregnant women with CHTN who delivered from June 2009 to January 2016. These women were treated with a-adrenergic agonists, combined a-B blockers, calcium channel blockers, or a combination thereof. Regimens were adjusted to achieve blood pressures <150 mm Hg systolic and <100 mm Hg diastolic based on recommendations of the ACOG Task Force of Hypertension in Pregnancy. Perinatal outcomes were analyzed by the number of medications needed to achieve the desired blood pressure (BP). RESULTS: There were a total of 419 women with treated CHTN. Fifty (12%) required the use of more than one medication for BP control. There were no differences in maternal baseline characteristics other than duration of diagnosis in those requiring more than one medication (P=.037). Requiring more than one anti-hypertensive medication during pregnancy was associated with a greater risk for superimposed severe preeclampsia (P=.011), delivery <34 weeks (P<.001), and birthweight <2,500 g (P<.001). This burden of preterm birth correlated with an increased frequency of admission to neonatal intensive care (P=.037), development of bronchopulmonary dysplasia (P=.003), surfactant use (P=.02), and phototherapy (P=.015). CONCLUSION: Women who require more than one medication for BP control have increased frequencies of adverse perinatal outcomes specifically linked to indicated, early preterm birth.