(1209) Hypertensive Control and Delivery Outcomes with Use of Oral Antihypertensives in Pregnancy for Non-severe Hypertension.

Friday, January 31, 2025

4:00 PM - 6:00 PM

Submitting Author and Presenting Author(s)

Tiffany Yang, MD

Maternal Fetal Medicine Fellow
Stony Brook University Hospital
Stony Brook, New York, United States

Coauthor(s)

HA

Hannah K. Agoglia, BS

Medical Student
Renaissance School of Medicine at Stony Brook University
Stonybrook, New York, United States
David Garry, DO

Maternal Fetal Medicine
Stony Brook University Hospital
Stony Brook, New York, United States
CH

Cassandra Heiselman, DO, MPH

Clinical Assistant Professor of Obstetrics, Gynecology, and Reproductive Medicine
Stony Brook University Hospital
Stony Brook, New York, United States

Objective: This study aims to determine if there are differences in pregnancy outcomes and hypertension control for patients on single versus multiple antihypertensive maintenance drug regimens.

Study Design: Retrospective chart review of adult pregnant patients who received prenatal care and delivered at a single academic institution with a diagnosed hypertensive disorder requiring antenatal antihypertensive maintenance medications started by 34 weeks GA or for a minimum of 2 weeks. Exclusion criteria were pregnancies of known anomalous fetus and multifetal gestations.  Patients were then stratified by type and number of medications prescribed. Chi-squared, Fischer’s exact, and student’s t-test analysis were performed.

Results: 112 patients met inclusion criteria. 96 (85.7%) were prescribed a single drug regimen: labetalol 71(63.4%), metoprolol 2(1.8%), nifedipine 11 (9.8%), other 12 (10.7%); 16 (14.3%) were taking a combination of medications. There were no differences in age, obesity, race/ethnicity, insurance status, hypertensive diagnosis, maternal co-morbidities, aspirin or tobacco use. More women requiring polytherapy had more history of preeclampsia versus those on monotherapy (89% vs 28%, p</span> < 0.001), along with higher diastolic BP and MAP at first prenatal visit. Patients on multidrug regimens had higher rates of change in hypertensive diagnosis (i.e. chronic to preeclampsia) (p=0.01), inpatient admission for blood pressure control (p=0.002), higher BP and MAP at delivery (p < 0.001), earlier gestational age at delivery (p < 0.001), rates of medically indicated PTD (p < 0.001), cesarean delivery (p < 0.001), and longer maternal hospitalization (p=0.02), as compared to the monotherapy group (Table 1).

Conclusion: Requiring multidrug antihypertensive regimens may be a proxy for pregnancies with poor hypertensive control, and furthermore a marker for poor maternal outcomes. Close supervision and attention to these patient populations may be warranted to optimize their pregnancy outcomes.