Nifedipine may prevent adverse pregnancy outcomes in women with severe preeclampsia
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Women with severe preeclampsia who took nifedipine once daily during labor and delivery were less likely to need fast-acting medicine to control their blood pressure during labor, according to a study published in Hypertension.
This, in turn, may reduce the odds of maternal and neonatal complications.
“When I started training at The Ohio State University in 2019, I noticed some providers started their patients on long-acting antihypertensive medications during induction of labor, for individuals who had been diagnosed with preeclampsia with severe features,” Erin M. Cleary, MD, who was a maternal-fetal medicine fellow at The Ohio State University in Columbus at the time of the study, told Healio. “With a goal in mind to keep blood pressure values in a safe range during labor, this decision makes sense; however, there was no research or data to support it. My team decided to design a high-quality study (a triple-blind, placebo-controlled randomized trial) to further investigate this question.”
Participant selection, randomization
Between June 2020 and April 2022, Cleary and colleagues screened 365 women with singleton or twin pregnancies who had severe preeclampsia and who underwent induced labor between 22 weeks 0 days’ gestation and 41 weeks 6 days’ gestation. Of these, 55 patients were randomly assigned oral nifedipine 30 mg every 24 hours and 55 patients were randomly assigned placebo every 24 hours.
The researchers noted which participants were administered at least one dose of acute hypertension therapy for BP of at least 160/110 mm Hg that was sustained at least 10 minutes. They also calculated the risk for adverse maternal and neonatal outcomes and reviewed patients’ charts through 6 weeks postpartum.
Pregnancy outcomes
Patients who took nifedipine were significantly less likely to need acute hypertension therapy compared with those who took placebo (34% vs. 55.1%; RR = 0.62; 95% CI, 0.39-0.97).
Analyses of maternal outcomes revealed that the nifedipine group had lower rates of cesarean delivery compared with the placebo group, although the difference was not significant (20.8% vs. 34.7%; RR = 0.6; 95% CI, 0.31-1.15). The rate of hypotensive episodes did not differ between groups.
Neonates born to patients taking nifedipine had lower rates of NICU admission compared with those born to patients taking placebo (29.1% vs. 47.1%; RR = 0.62; 95% CI, 0.37-1.02). There were no differences in birth weight or small for gestational age status between groups. The neonatal composite outcome — which included 5-minute Apgar score, hyperbilirubinemia requiring phototherapy, hypoglycemia requiring IV therapy and supplemental oxygen therapy beyond the first 24 hours of life — did not differ between groups.
“We recommend obstetric providers consider initiating long-acting Procardia (nifedipine, Pfizer) every 24 hours for individuals with preeclampsia with severe features who are undergoing induction of labor, with other demographic information similar to those enrolled in our patients: Individuals in our study had singleton or twin pregnancies, were not already receiving this medication and had blood pressures greater than 120/70 mm Hg,” Cleary said. “There is no need to wait until patients require one or more doses of acute therapy before starting long-acting Procardia, as long as they otherwise meet criteria for preeclampsia with severe features.”
Moving forward, Cleary expressed interest in determining “the optimal medication, dose and frequency to achieve the best outcomes for individuals with different types of hypertensive disorders undergoing induction of labor, as well as in the postpartum period.”