|Title||Do labetalol and methyldopa have different effects on pregnancy outcome? Analysis of data from the Control of Hypertension In Pregnancy Study (CHIPS) trial.|
|Publication Type||Journal Article|
|Year of Publication||2016|
|Authors||Magee, 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 Authors||CHIPS Study Group|
|Date Published||2016 Jun|
|Keywords||Adult, 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|
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.