Sibai B M, Mabie W C, Shamsa F, Villar M A, Anderson G D
Department of Obstetrics and Gynecology, University of Tennessee, Memphis.
Am J Obstet Gynecol. 1990 Apr;162(4):960-6; discussion 966-7. doi: 10.1016/0002-9378(90)91297-p.
Three hundred women with mild chronic hypertension at 6 to 13 weeks' gestation were randomly allocated to receive either methyldopa or labetalol or be in the control group. Thirty-seven women (12%) were excluded for various reasons. Of the remaining 263 patients, 90 received no drug, 87 received methyldopa, and 86 received labetalol. All 263 were followed throughout pregnancy with serial renal function tests and serial assessment of fetal status. There were no differences among the three groups in mean systolic or diastolic blood pressures, mean gestational age, or initial laboratory findings at time of entry. Patients treated with medications had significantly lower (p less than 0.0001) systolic and diastolic blood pressures throughout gestation compared with the no-medication group. Among the control group there was a spontaneously significant lowering (p less than 0.0001) of both systolic and diastolic blood pressures at 14 to 26 weeks' gestation. However, there were no differences among the three groups regarding the incidences of either superimposed preeclampsia (15.6%, 18.4%, and 16.3%, respectively), abruptio placentae (2.2%, 1.1%, and 2.3%, respectively), or preterm delivery (10%, 12.5%, and 11.6%, respectively). In addition, there were no differences among the groups regarding gestational age at delivery, birth weight, incidence of fetal growth retardation, or neonatal head circumference. There was one midtrimester loss in the methyldopa group and one stillbirth in each of the other groups. We conclude that treatment of maternal blood pressure in mild chronic hypertension during pregnancy did not improve perinatal outcome.
300名妊娠6至13周的轻度慢性高血压女性被随机分配接受甲基多巴或拉贝洛尔治疗或进入对照组。37名女性（12%）因各种原因被排除。在其余263名患者中，90名未接受药物治疗，87名接受甲基多巴治疗，86名接受拉贝洛尔治疗。对所有263名患者在整个孕期进行了系列肾功能检查和胎儿状况的系列评估。三组在平均收缩压或舒张压、平均孕周或入组时的初始实验室检查结果方面无差异。与未用药组相比，接受药物治疗的患者在整个孕期的收缩压和舒张压显著更低（p<0.0001）。在对照组中，妊娠14至26周时收缩压和舒张压均出现自发性显著下降（p<0.0001）。然而，三组在子痫前期（分别为15.6%、18.4%和16.3%）、胎盘早剥（分别为2.2%、1.1%和2.3%）或早产（分别为10%、12.5%和11.6%）的发生率方面无差异。此外，三组在分娩孕周、出生体重、胎儿生长受限发生率或新生儿头围方面也无差异。甲基多巴组有1例孕中期流产，其他组各有1例死产。我们得出结论，孕期轻度慢性高血压患者的母体血压治疗并未改善围产期结局。
