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Pregnancy Outcomes of Nifedipine Compared With Labetalol for Oral Treatment of Mild Chronic Hypertension.
Sanusi, Ayodeji A; Leach, Justin; Boggess, Kim; Dugoff, Lorraine; Sibai, Baha; Lawrence, Kirsten; Hughes, Brenna L; Bell, Joseph; Aagaard, Kjersti; Edwards, Rodney K; Gibson, Kelly S; Haas, David M; Plante, Lauren; Metz, Torri D; Casey, Brian; Esplin, Sean; Longo, Sherri; Hoffman, Matthew K; Saade, George R; Hoppe, Kara K; Foroutan, Janelle; Tuuli, Methodius; Owens, Michelle Y; Simhan, Hyagriv N; Frey, Heather; Rosen, Todd; Palatnik, Anna; Baker, Susan; August, Phyllis; Reddy, Uma M; Su, Emily J; Krishna, Iris; Nguyen, Nguyet A; Norton, Mary E; Skupski, Daniel; El-Sayed, Yasser Y; Ogunyemi, Dotun; Galis, Zorina S; Harper, Lorie; Ambalavanan, Namasivayam; Geller, Nancy L; Kuo, Hui-Chien; Sinkey, Rachel G; Librizzi, Ronald; Pereira, Leonardo; Magann, Everett F; Habli, Mounira; Williams, Shauna; Mari, Giancarlo; Pridjian, Gabriella.
Affiliation
  • Sanusi AA; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Leach J; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Boggess K; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Dugoff L; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Sibai B; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Lawrence K; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Hughes BL; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Bell J; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Aagaard K; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Edwards RK; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Gibson KS; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Haas DM; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Plante L; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Metz TD; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Casey B; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Esplin S; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Longo S; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Hoffman MK; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Saade GR; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Hoppe KK; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Foroutan J; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Tuuli M; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Owens MY; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Simhan HN; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Frey H; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Rosen T; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Palatnik A; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Baker S; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • August P; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Reddy UM; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Su EJ; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Krishna I; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Nguyen NA; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Norton ME; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Skupski D; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • El-Sayed YY; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Ogunyemi D; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Galis ZS; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Harper L; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Ambalavanan N; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Geller NL; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Kuo HC; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Sinkey RG; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Librizzi R; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Pereira L; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Magann EF; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Habli M; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Williams S; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
  • Mari G; Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, and University of South Alabama at Mobile, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel Universi
  • Pridjian G; University of California San Francisco, San Francisco, and Stanford University, Stanford, California, and Arrowhead Regional Medical Center/Beaumont Hospital, Michigan, Detroit, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics and the Division of Neonatology, Dep
Obstet Gynecol ; 144(1): 126-134, 2024 Jul 01.
Article in En | MEDLINE | ID: mdl-38949541
ABSTRACT

OBJECTIVE:

To evaluate maternal and neonatal outcomes by type of antihypertensive used in participants of the CHAP (Chronic Hypertension in Pregnancy) trial.

METHODS:

We conducted a planned secondary analysis of CHAP, an open-label, multicenter, randomized trial of antihypertensive treatment compared with standard care (no treatment unless severe hypertension developed) in pregnant patients with mild chronic hypertension (blood pressure 140-159/90-104 mm Hg before 20 weeks of gestation) and singleton pregnancies. We performed three comparisons based on medications prescribed at enrollment labetalol compared with standard care, nifedipine compared with standard care, and labetalol compared with nifedipine. Although active compared with standard care groups were randomized, medication assignment within the active treatment group was not random but based on clinician or patient preference. The primary outcome was the occurrence of superimposed preeclampsia with severe features, preterm birth before 35 weeks of gestation, placental abruption, or fetal or neonatal death. The key secondary outcome was small for gestational age (SGA) neonates. We also compared medication adverse effects between groups. Relative risks (RRs) and 95% CIs were estimated with log binomial regression to adjust for confounding.

RESULTS:

Of 2,292 participants analyzed, 720 (31.4%) received labetalol, 417 (18.2%) received nifedipine, and 1,155 (50.4%) received no treatment. The mean gestational age at enrollment was 10.5±3.7 weeks; nearly half of participants (47.5%) identified as non-Hispanic Black; and 44.5% used aspirin. The primary outcome occurred in 217 (30.1%), 130 (31.2%), and 427 (37.0%) in the labetalol, nifedipine, and standard care groups, respectively. Risk of the primary outcome was lower among those receiving treatment (labetalol use vs standard adjusted RR 0.82, 95% CI, 0.72-0.94; nifedipine use vs standard adjusted RR 0.84, 95% CI, 0.71-0.99), but there was no significant difference in risk when labetalol was compared with nifedipine (adjusted RR 0.98, 95% CI, 0.82-1.18). There were no significant differences in SGA or serious adverse events between participants receiving labetalol and those receiving nifedipine.

CONCLUSION:

No significant differences in predetermined maternal or neonatal outcomes were detected on the basis of the use of labetalol or nifedipine for treatment of chronic hypertension in pregnancy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02299414.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pregnancy Outcome / Nifedipine / Hypertension / Labetalol / Antihypertensive Agents Limits: Adult / Female / Humans / Newborn / Pregnancy Language: En Journal: Obstet Gynecol Year: 2024 Document type: Article
Fulltext
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pregnancy Outcome / Nifedipine / Hypertension / Labetalol / Antihypertensive Agents Limits: Adult / Female / Humans / Newborn / Pregnancy Language: En Journal: Obstet Gynecol Year: 2024 Document type: Article