The impact of anti-hypertensive treatment on foetal growth and haemodynamics in pregnant women with pre-existing diabetes - An explorative study.
anti-hypertensive treatment
blood pressure control
doppler flow parameters
growth
hemodynamics
pre-existing diabetes
pregnancy
Journal
Diabetic medicine : a journal of the British Diabetic Association
ISSN: 1464-5491
Titre abrégé: Diabet Med
Pays: England
ID NLM: 8500858
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
received:
09
02
2020
accepted:
13
10
2021
pubmed:
16
10
2021
medline:
4
5
2022
entrez:
15
10
2021
Statut:
ppublish
Résumé
To explore the impact of anti-hypertensive treatment of pregnancy-induced hypertension on foetal growth and hemodynamics in women with pre-existing diabetes. A prospective cohort study of 247 consecutive pregnant women with pre-existing diabetes (152 type 1 diabetes; 95 type 2 diabetes), where tight anti-hypertensive treatment was initiated and intensified (mainly with methyldopa) when office blood pressure (BP) ≥135/85 mmHg and home BP ≥130/80 mmHg. Foetal growth was assessed by ultrasound at 27, 33 and 36 weeks and foetal hemodynamics were assessed by ultrasound Doppler before and 1-2 weeks after initiation of anti-hypertensive treatment. In 215 initially normotensive women, anti-hypertensive treatment for pregnancy-induced hypertensive disorders was initiated in 42 (20%), whilst 173 were left untreated. Chronic hypertension was present in 32 (13%). Anti-hypertensive treatment for pregnancy-induced hypertensive disorders was not associated with foetal growth deviation (linear mixed model, p = 0.681). At 27 weeks, mainly before initiation of anti-hypertensive treatment, the prevalence of small foetuses with an estimated foetal weight <10th percentile was 12% in women initiating anti-hypertensive treatment compared with 4% in untreated women (p = 0.054). These numbers were close to the prevalence of birth weight ≤10th percentile (small for gestational age (SGA)) (17% vs. 4%, p = 0.003). Pulsatility index in the umbilical and middle cerebral artery remained stable after the onset of anti-hypertensive treatment in a representative subgroup (n = 12, p = 0.941 and p = 0.799, respectively). There is no clear indication that antihypertensive treatment causes harm in this particular at-high-risk group of pregnant women with diabetes, such that a larger well-designed study to determine the value of tight antihypertensive control would be worthwhile.
Substances chimiques
Antihypertensive Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14722Informations de copyright
© 2021 Diabetes UK.
Références
Mathiesen ER, Ringholm L, Feldt-Rasmussen B, Clausen P, Damm P. Obstetric nephrology: pregnancy in women with diabetic nephropathy-the role of antihypertensive treatment. Clin J Am Soc Nephrol. 2012;7(12):2081-2088.
Weissgerber TL, Mudd LM. Preeclampsia and diabetes. Curr Diab Rep. 2015;15(3):9.
Magee LA, Singer J, von Dadelszen P, Group CS. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med. 2015;372(24):2367-2368.
Mathiesen ER, Ringholm L, Damm P. Pregnancy management of women with pregestational diabetes. Endocrinol Metab Clin North Am. 2011;40(4):727-738.
Cundy T, Slee F, Gamble G, Neale L. Hypertensive disorders of pregnancy in women with Type 1 and Type 2 diabetes. Diabet Med. 2002;19(6):482-489.
Nielsen LR, Damm P, Mathiesen ER. Improved pregnancy outcome in type 1 diabetic women with microalbuminuria or diabetic nephropathy: effect of intensified antihypertensive therapy? Diabetes Care. 2009;32(1):38-44.
Nørgaard SK, Vestgaard MJ, Jørgensen IL, et al. Diastolic blood pressure is a potentially modifiable risk factor for preeclampsia in women with pre-existing diabetes. Diabetes Res Clin Pract. 2018;138:229-237.
von Dadelszen P, Magee LA. Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: an updated metaregression analysis. J Obstet Gynaecol Can. 2002;24(12):941-945.
von Dadelszen P, Ornstein MP, Bull SB, Logan AG, Koren G, Magee LA. Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis. Lancet. 2000;355(9198):87-92.
Pels A, Mol BWJ, Singer J, et al. Influence of gestational age at initiation of antihypertensive therapy: secondary analysis of CHIPS trial data (control of hypertension in pregnancy study). Hypertension. 2018;71(6):1170-1177.
Kuc S, Wortelboer EJ, Koster MP, de Valk HW, Schielen PC, Visser GH. Prediction of macrosomia at birth in type-1 and 2 diabetic pregnancies with biomarkers of early placentation. BJOG. 2011;118(6):748-754.
Khalil A, Harrington K, Muttukrishna S, Jauniaux E. Effect of antihypertensive therapy with alpha-methyldopa on uterine artery Doppler in pregnancies with hypertensive disorders. Ultrasound Obstet Gynecol. 2010;35(6):688-694.
Folic MM, Jankovic SM, Varjacic MR, Folic MD. Effects of methyldopa and nifedipine on uteroplacental and fetal hemodynamics in gestational hypertension. Hypertens Pregnancy. 2012;31(1):31-39.
Montan S, Anandakumar C, Arulkumaran S, Ingemarsson I, Ratnam S. Randomised controlled trial of methyldopa and isradipine in preeclampsia-effects on uteroplacental and fetal hemodynamics. J Perinat Med. 1996;24(2):177-184.
Gunenc O, Cicek N, Gorkemli H, Celik C, Acar A, Akyurek C. The effect of methyldopa treatment on uterine, umblical and fetal middle cerebral artery blood flows in preeclamptic patients. Arch Gynecol Obstet. 2002;266(3):141-144.
Pedersen BW, Ringholm L, Damm P, et al. Stable fetal hemodynamics measured by Doppler flow after initiation of anti-hypertensive treatment with methyldopa in pregnant women with diabetes. J Maternal-Fetal & Neonatal Med. 2016;29(4):550-553.
Dansk Endokrinologisk Selskab. NBV: Diabetes og graviditet. 2019. http://endocrinology.dk/index.php/1-diabetes-mellitus/8-diabetes-og-graviditet
Secher AL, Ringholm L, Andersen HU, Damm P, Mathiesen ER. The effect of real-time continuous glucose monitoring in pregnant women with diabetes: a randomized controlled trial. Diabetes Care. 2013;36(7):1877-1883.
Vestgaard M, Ringholm L, Andersen LTA, Jensen DM, Damm P, Mathiesen ER. White coat hypertension in early pregnancy in women with pre-existing diabetes-prevalence and pregnancy outcome. Diabetologia. 2019; in press.
American College of Obstetricians and Gynecologists. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122-1131.
Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology. 1991;181(1):129-133.
Verburg BO, Steegers EAP, De Ridder M, et al. New charts for ultrasound dating of pregnancy and assessment of fetal growth: longitudinal data from a population-based cohort study. Ultrasound Obstet Gynecol. 2008;31(4):388-396.
Parra-Cordero M, Lees C, Missfelder-Lobos H, Seed P, Harris C. Fetal arterial and venous Doppler pulsatility index and time averaged velocity ranges. Prenat Diagn. 2007;27(13):1251-1257.
Ebbing C, Rasmussen S, Kiserud T. Middle cerebral artery blood flow velocities and pulsatility index and the cerebroplacental pulsatility ratio: longitudinal reference ranges and terms for serial measurements. Ultrasound Obstet Gynecol. 2007;30(3):287-296.
Marsal K, Persson PH, Larsen T, Lilja H, Selbing A, Sultan B. Intrauterine growth curves based on ultrasonically estimated foetal weights. Acta Paediatr. 1996;85(7):843-848.
Magee LA, Dadelszen P, Singer J, et al. Do labetalol and methyldopa have different effects on pregnancy outcome? Analysis of data from the Control of Hypertension In Pregnancy Study (CHIPS) trial. BJOG. 2016;123(7):1143-1151.
Redman CW, Beilin LJ, Bonnar J. Treatment of hypertension in pregnancy with methyldopa: blood pressure control and side effects. Br J Obstet Gynaecol. 1977;84(6):419-426.
Brown MA, Magee LA, Kenny LC, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension. 2018;72(1):24-43.
Ekbom P, Damm P, Feldt-Rasmussen B, Feldt-Rasmussen U, Molvig J, Mathiesen ER. Pregnancy outcome in type 1 diabetic women with microalbuminuria. Diabetes Care. 2001;24(10):1739-1744.
Easterling T, Mundle S, Bracken H, et al. Oral antihypertensive regimens (nifedipine retard, labetalol, and methyldopa) for management of severe hypertension in pregnancy: an open-label, randomised controlled trial. Lancet. 2019;394(10203):1011-1021.