Antihypertensive treatment during pregnancy and functional development at primary school age in a historical cohort study.
OBJECTIVE
To determine the functional development of children born after treatment of mild-to-moderate gestational hypertension with labetalol versus methyldopa, and no antihypertensive treatment.


METHODS
Historical cohort study.


METHODS
Twelve Dutch hospital departments of obstetrics.


METHODS
Live-born children born in these hospitals and prenatally exposed to labetalol, methyldopa, or bed rest because of mild-to-moderate gestational hypertension.


METHODS
Central nervous system development was measured with standard tests at 4-10 years of age. Linear regression techniques and Pearson's chi-square tests were used to compare the groups with regard to the outcome measures.


METHODS
Intelligence quotient (IQ), concentration, motor development, and behaviour at primary school age.


RESULTS
A total of 202 children were included in the analyses. More children exposed to labetalol had attention deficit hyperactivity disorder (ADHD) than those exposed to methyldopa (OR 2.3; 95% CI 0.7-7.3), or those born to women who had been admitted for bed rest (OR 4.1; 95% CI 1.2-13.9). Sleeping problems seemed to be reported more frequently after prenatal methyldopa exposure than after exposure to labetalol (OR 3.2; 95% CI 0.6-16.7) or bed rest (OR 4.5; 95% CI 0.9-23.2), although the differences were not statistically significant. Test scores on other aspects of functional development did not differ between the three groups.


CONCLUSIONS
In this hypothesis-generating study, labetalol exposure in utero seemed to increase the risk of ADHD among children of primary school age, whereas prenatal methyldopa exposure might influence sleep. Further studies with appropriate sample sizes are warranted to determine the long-term effects of antihypertensive medications.
Pasker-de Jong
P C M
PC
Department of Epidemiology, Biostatistics, and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Zielhuis
G A
GA
van Gelder
M M H J
MM
Pellegrino
A
A
Gabreëls
F J M
FJ
Eskes
T K A B
TK
D000959:Antihypertensive Agents / Q000009:adverse effects*; D001288:Attention / Q000187:drug effects; D001289:Attention Deficit Disorder with Hyperactivity / Q000139:chemically induced; D001510:Bed Rest; D002648:Child; D002657:Child Development / Q000187:drug effects*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000188:drug therapy*; D007360:Intelligence / Q000187:drug effects; D007741:Labetalol / Q000009:adverse effects*; D008750:Methyldopa / Q000009:adverse effects*; D009426:Netherlands; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced*; D011597:Psychomotor Performance / Q000187:drug effects; D012574:Schools
D000959:Antihypertensive Agents; D008750:Methyldopa; D007741:Labetalol