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Do labetalol and methyldopa have different effects on pregnancy outcome? Analysis of data from the Control of Hypertension In Pregnancy Study (CHIPS) trial.

TitleDo labetalol and methyldopa have different effects on pregnancy outcome? Analysis of data from the Control of Hypertension In Pregnancy Study (CHIPS) trial.
Publication TypeJournal Article
Year of Publication2016
AuthorsMagee, LA, von Dadelszen, P, Singer, J, Lee, T, Rey, E, Ross, S, Asztalos, E, Murphy, KE, Menzies, J, J Sanchez, J, Gafni, A, Gruslin, A, Helewa, M, Hutton, E, Koren, G, Lee, SK, Logan, AG, Ganzevoort, J, Welch, R, Thornton, JG, Moutquin, J-M
Corporate AuthorsCHIPS Study Group
JournalBJOG
Volume123
Issue7
Pagination1143-51
Date Published2016 Jun
ISSN1471-0528
KeywordsAdult, Antihypertensive Agents, Blood Pressure, CLIP, Female, Humans, Hypertension, Hypertension, Pregnancy-Induced, Infant, Low Birth Weight, Labetalol, Methyldopa, Pre-Eclampsia, Pregnancy, Pregnancy Complications, Cardiovascular, Pregnancy Outcome
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.

DOI10.1111/1471-0528.13569
Alternate JournalBJOG
Citation Key549
PubMed ID26265372