Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
BJOG. 2013 Dec;120(13):1668-76; dicussion 1676-7. doi: 10.1111/1471-0528.12428. Epub 2013 Sep 11.
To determine whether outpatient exposure to calcium-channel blockers (CCBs) at the time of delivery is associated with an increased risk for postpartum haemorrhage (PPH).
Cohort study.
United States of America.
Medicaid beneficiaries.
We identified a cohort of 9750 patients with outpatient prescriptions for CCBs, methyldopa, or labetalol for pre-existing or gestational hypertension whose days of supply overlapped with delivery; 1226 were exposed to CCBs. The risk of PPH was compared in those exposed to CCBs to those exposed to methyldopa or labetalol. Propensity score matching and stratification were used to address potential confounding.
The occurrence of PPH during the delivery hospitalisation.
There were 27 patients exposed to CCBs (2.2%) and 232 patients exposed to methyldopa or labetalol (2.7%) who experienced PPH. After accounting for confounders, there was no meaningful association between CCB exposure and PPH in the propensity score matched (odds ratio 0.77, 95% CI 0.50-1.18) or stratified (odds ratio 0.79, 95% CI 0.53-1.19) analyses. Similar results were obtained across multiple sensitivity analyses.
The outpatient use of CCBs in late pregnancy for the treatment of hypertension does not increase the risk of PPH.
确定分娩时门诊使用钙通道阻滞剂（CCB）是否与产后出血（PPH）风险增加有关。
队列研究。
美利坚合众国。
医疗补助受益人群。
我们确定了一个队列，其中包括 9750 名患有门诊处方 CCB、甲基多巴或拉贝洛尔的患者，这些患者患有先前存在的或妊娠高血压，其供应天数与分娩重叠；1226 名患者暴露于 CCB 中。将暴露于 CCB 的患者与暴露于甲基多巴或拉贝洛尔的患者的 PPH 风险进行比较。使用倾向评分匹配和分层来解决潜在的混杂因素。
分娩住院期间发生 PPH 的情况。
有 27 名暴露于 CCB 的患者（2.2%）和 232 名暴露于甲基多巴或拉贝洛尔的患者（2.7%）发生 PPH。在考虑混杂因素后，在倾向评分匹配（比值比 0.77，95%置信区间 0.50-1.18）或分层（比值比 0.79，95%置信区间 0.53-1.19）分析中，CCB 暴露与 PPH 之间没有明显的关联。在多次敏感性分析中也得到了类似的结果。
妊娠晚期门诊使用 CCB 治疗高血压不会增加 PPH 的风险。
