title: Hypertension and antihypertensive drugs in pregnancy and perinatal outcomes.
abstract: OBJECTIVE
  Despite high rates of hypertension in pregnancy, the effects of hypertension have not been separated appropriately from the effects of the medications that are used. We evaluated the safety of exposure to antihypertensive medications during pregnancy, while accounting for disease effects.
  
  
  METHODS
  A population-based retrospective cohort study was performed that compared all pregnancies of women with hypertension who were either exposed or unexposed to antihypertensive medications. A computerized database of the medications that were dispensed to pregnant women from 1998-2008 was linked with computerized databases that contained maternal and infant hospitalization records from the district hospital during the same period.
  
  
  RESULTS
  During the study period, 100,029 deliveries occurred; of those, 1964 pregnant women experienced chronic hypertension, and 620 neonates (0.6%) were exposed to at least 1 antihypertensive medication (methyldopa or atenolol) during pregnancy. A higher rate of intrauterine growth restriction (7.2% vs 2.1%, respectively; adjusted odds ratio [OR], 4.37; 95% confidence interval [CI], 3.00-6.36; P < .001), small for gestational age (3% vs 1.7%, respectively; adjusted OR, 2.23; 95% CI, 1.27-3.92; P = .005), and preterm deliveries (<37 weeks, 22.9% vs 8.0%, respectively; adjusted OR, 3.69; 95% CI, 2.90-4.69; P < .001) were noted among the pregnancies of women who were exposed to antihypertensive medications during the third trimester. Importantly, a similar association was detected when we compared women with chronic hypertension who were not treated during pregnancy (n = 1074) to women who had no chronic hypertension and who were unexposed to antihypertensive medications (n = 97,820).
  
  
  CONCLUSIONS
  Chronic hypertension with or without treatment during pregnancy is an independent and significant risk factor for adverse perinatal outcomes such as intrauterine growth restriction, small for gestational age, and preterm delivery.
authors.affiliation: Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Hagay
authors.initials: H
authors.lastname: Orbach
authors.forename: Ilan
authors.initials: I
authors.lastname: Matok
authors.forename: Rafael
authors.initials: R
authors.lastname: Gorodischer
authors.forename: Eyal
authors.initials: E
authors.lastname: Sheiner
authors.forename: Sharon
authors.initials: S
authors.lastname: Daniel
authors.forename: Arnon
authors.initials: A
authors.lastname: Wiznitzer
authors.forename: Gideon
authors.initials: G
authors.lastname: Koren
authors.forename: Amalia
authors.initials: A
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D007231:Infant, Newborn; D008875:Middle Aged; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy / Q000209:etiology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents