Hypertension
Poster Session 4
Ann Nguyen Pham, MD
University of California, Irvine
Orange, CA, United States
Oluwatoni Okuyemi, MD
University of California, Irvine
Orange, CA, United States
Gina F. Milone, MD (she/her/hers)
Fellow Physician
University of California Irvine
Irvine, CA, United States
Jenny Chang, MPH
University of California Irvine School of Medicine
Irvine, CA, United States
Argyrios Ziogas, PhD
University of California Irvine
Irvine, CA, United States
Pranathi Rao, BS
University of California Irvine
Irvine, CA, United States
Kenneth Chan, MD
Long Beach Memorial Medical Center Women's Hospital
Long Beach, CA, United States
To determine whether initiation of long-acting antihypertensives achieves pregnancy prolongation in preeclamptic patients with severe features and, if so, whether there is significant neonatal benefit gained and maternal risk incurred by this prolongation.
This was a retrospective cohort study conducted at a single site between 2015-2022. The charts of preeclamptic patients diagnosed with severe features (de novo or superimposed) between 23w0d-33w6d were reviewed and separated into two cohorts: those diagnosed between 23-28 weeks gestation (extremely preterm, or EP) and those diagnosed between 28-34 weeks gestation (preterm, or P). Each cohort was then divided into a traditional subcohort who received only urgent short-acting antihypertensives and a novel subcohort who received both short-acting and long-acting antihypertensives. The primary outcome was pregnancy prolongation, defined as days elapsed between diagnosis of preeclampsia with severe features and delivery. The secondary outcomes were maternal composite outcome and neonatal composite outcome (Table 1). Two sample t-tests and Chi squared analyses with multivariate analysis were utilized.
A total of 288 patients were included. Demographics did not differ significantly. Long-acting antihypertensives prolonged pregnancy by 7 days in the EP cohort (9 days vs 2 days, p < 0.0001) and by 3 days in the P cohort (6 days vs 3 days, p < 0.0001). Further, use of long-acting antihypertensives provided clinical and statistical benefits in neonatal composite outcomes for the EP neonates (Table 1). Such was not seen in the P neonates, and no changes in maternal composite outcomes were noted in either cohort.
The initiation of oral long-acting antihypertensives for preeclamptic patients with severe features prolonged pregnancy sufficiently to improve newborn outcomes in the 23-28-week cohort but not in the 28-34 week cohort. Doing so did not result in maternal harm. Randomized-controlled-trial results are needed to confirm these findings and to potentially adopt this clinical approach.