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Antihypertensive drug use during pregnancy: a population based study
Carmen D'Amore1, Francesco Trotta2, Roberto Da Cas1
1Reparto di Farmacoepidemiologia, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy.
Annali Dell'Istituto Superiore Di Sanita
|October 3, 2015
Summary
European guidelines for antihypertensive drug use in pregnancy are not consistently followed. A significant proportion of women received non-recommended medications, particularly those with multiple comorbidities.
Area of Science:
- Obstetrics and Gynecology
- Pharmacology
- Public Health
Background:
- Adherence to European guidelines for antihypertensive drug (AD) use during pregnancy is crucial for maternal and fetal health.
- Previous studies indicate variability in clinical practice regarding AD prescription in pregnant populations.
Purpose of the Study:
- To assess adherence to European guidelines for antihypertensive drug use in clinical practice.
- To evaluate the association between non-recommended drug use and patient characteristics.
Main Methods:
- A retrospective cohort study of 86,171 singleton deliveries in Lombardy, Italy (2009-2010).
- Incident users were defined as women with their first AD prescription during pregnancy.
- Recommended drugs included methyldopa, labetalol, and nifedipine; others were classified as non-recommended.
Main Results:
- 1.2% (1009) of deliveries involved AD exposure, with 66.9% being incident users.
- 31% of incident users received non-recommended AD; this decreased to 18% for those starting treatment in the third trimester.
- Women with ≥4 comorbidities had a significantly higher risk of receiving non-recommended AD (OR 2.68; 95% CI 1.10-6.73).
Conclusions:
- While exposure to recommended antihypertensives increased, a notable fraction of pregnant women still received non-recommended medications.
- Clinical practice adherence to guidelines for antihypertensive drug use in pregnancy requires improvement.
- Comorbidities are associated with the use of non-recommended antihypertensives during pregnancy.
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