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    Study: No association between prenatal ultrasound duration and autism


    More mothers receiving antihypertensives for preeclampsia; fewer having strokes

    Results of a retrospective cohort study show that use of antihypertensive medications for preeclampsia has increased in recent years and incidence of maternal stoke is decreasing. The trends suggest that ob/gyns are adopting the American College of Obstetricians and Gynecologists’ 2014 recommendations on benefits of this form of management for preeclampsia.

    More than 200,000 patients were included in the analysis, which spanned 2006 to the first quarter of 2015 and was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Data were taken from the Perspective database and included 126,595 women with mild, 31,628 women with superimposed, and 81,231 women with severe preeclampsia. Superimposed preeclampsia was more common in the south, in black women, those aged ≥ 35, and in teaching versus nonteaching hospitals.

    Overall, 105,409 women received a hypertensive agent. In all the patients with preeclampsia, use of antihypertensives increased from 2006 to 2014: from 20.3% to 31.4% for oral labetalol, 13.3% to 21.4% for intravenous (IV) labetalol, 12.8% to 16.9% for hydralazine, 15.0% to 18.2% for nifedipine, and 16.5% to 25.8% for more than one medication. From 2006 to 2015, the proportion of patients with preeclampsia who received any antihypertensive medication rose from 37.8% to 49.4%. Overall, the most commonly given antihypertensive medication was oral labetalol, followed by more than one medication, IV labetalol, nifedipine, and hydralazine. Overall, oral labetalol was the most common form of management for mild and severe preeclampsia whereas more than one medication was used for superimposed preeclampsia.

    Risk of stroke associated with severe preeclampsia decreased from 13.5 per 10,000 deliveries in 2006 to 2008 to 9.7 in 2009 to 2011 and 6.0 in 2012 to 2014 (P = .02). Overall, risk of stroke in patients with preeclampsia fell from 6.6 to 5.6 to 3.5 per 10,000 deliveries in 2006 to 2008, 2009 to 2011, and 2012 to 2014, respectively (P = .02).

    In discussing their findings, the authors noted several limitations of the study. They were not able to obtain detailed information on hospital factors such as protocols and guidelines, no information was available on patient vital signs and time to administration of hypertensive agents, and no causal relationship could be established between use or lack of use of antihypertensive agents and risk of stroke. The strengths of the research were the large patient population, long study period, geographically clinically diverse hospital settings, and ability to query use of specific antihypertensive drugs. 

    Ben Schwartz
    Ben Schwartz is Associate Editor, Contemporary OB/GYN.
    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is an editorial consultant for Contemporary OB/GYN.


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