TY - JOUR
T1 - Fail in mean arterial pressure and fetal growth restriction in pregnancy hypertension
T2 - A meta-analysis
AU - Von Dadelszen, P.
AU - Ornstein, M. P.
AU - Bull, S. B.
AU - Logan, A. G.
AU - Koren, G.
AU - Magee, L. A.
N1 - Funding Information:
This work was supported by the Physicians' Services Incorporated and an educational grant from the Department of Medicine, Mount Sinai Hospital, Toronto, Canada. S B Bull and A G Logan are senior scientists of the Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Toronto. G Koren is the CIBC World Market Children's Miracle Foundation Chair in child health research, Hospital for Sick Children, Toronto, Canada.
PY - 2000/1/8
Y1 - 2000/1/8
N2 - Background. We investigated the relation between fetoplacental growth and the use of oral antihypertensive medication to treat mild-to-moderate pregnancy hypertension. Methods. The study design was a metaregression analysis of published data from randomised controlled trials. Data from a paper that was regarded as an extreme statistical outliner were excluded from primary analyses. The change in (group) mean arterial pressure (MAP) from enrolment to delivery was compared with indicators of fetoplacental growth. Findings. Greater mean difference in MAP with antihypertensive therapy was associated with the birth of a higher proportion of small-for-gestational-age (SGA) infants (slope: 0.09 [SD 0.03], r2 = 0.48, p = 0.006, 14 trials) and lower mean birthweight significant after exclusion of data from another paper regarded as an extreme statistical outliner (slope: -14.49 [6.98] r2 = 0.16, p = 0.049, 27). No relation with mean placental weight was seen (slope -2.01 [1.62], r2 = 0.15, p = 0.25, 11 trials). Interpretation. Treatment-induced falls in maternal blood pressure may adversely affect fetal growth. Given the small maternal benefits that are likely to be derived from therapy, new data are urgently needed to elucidate the relative maternal and fetal benefits and risks of oral antihypertensive drug treatment of mild-to-moderate pregnancy hypertension.
AB - Background. We investigated the relation between fetoplacental growth and the use of oral antihypertensive medication to treat mild-to-moderate pregnancy hypertension. Methods. The study design was a metaregression analysis of published data from randomised controlled trials. Data from a paper that was regarded as an extreme statistical outliner were excluded from primary analyses. The change in (group) mean arterial pressure (MAP) from enrolment to delivery was compared with indicators of fetoplacental growth. Findings. Greater mean difference in MAP with antihypertensive therapy was associated with the birth of a higher proportion of small-for-gestational-age (SGA) infants (slope: 0.09 [SD 0.03], r2 = 0.48, p = 0.006, 14 trials) and lower mean birthweight significant after exclusion of data from another paper regarded as an extreme statistical outliner (slope: -14.49 [6.98] r2 = 0.16, p = 0.049, 27). No relation with mean placental weight was seen (slope -2.01 [1.62], r2 = 0.15, p = 0.25, 11 trials). Interpretation. Treatment-induced falls in maternal blood pressure may adversely affect fetal growth. Given the small maternal benefits that are likely to be derived from therapy, new data are urgently needed to elucidate the relative maternal and fetal benefits and risks of oral antihypertensive drug treatment of mild-to-moderate pregnancy hypertension.
UR - http://www.scopus.com/inward/record.url?scp=0034620112&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(98)08049-0
DO - 10.1016/S0140-6736(98)08049-0
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C2 - 10675164
AN - SCOPUS:0034620112
SN - 0140-6736
VL - 355
SP - 87
EP - 92
JO - The Lancet
JF - The Lancet
IS - 9198
ER -