Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California.
Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Am J Perinatol. 2024 May;41(S 01):e728-e738. doi: 10.1055/s-0042-1757354. Epub 2022 Oct 19.
Our objective is to examine severe maternal morbidity (SMM) and patterns of antihypertensive medication use before and during pregnancy among individuals with chronic hypertension.
We examined 11,759 pregnancies resulting in a live birth or stillbirth to individuals with chronic hypertension and one or more antihypertensive prescription 6 months before pregnancy (Optum, 2007-17). We examined whether study outcomes were associated with the use of medication as compared to no use during pregnancy. In addition, patterns of medication use based on the Food and Drug Administration guidance and literature were evaluated. Medication use was divided into prepregnancy and during pregnancy use and classified as pregnancy recommended (PR) or not pregnancy recommended (nPR) or no medication use. SMM was defined per the Centers for Disease Control and Prevention definition of 21 indicators. Risk ratios (RR) reflecting the association of SMM with the use of antihypertensive medications were computed using modified Poisson regression with robust standard errors and adjusted for maternal age, education, and birth year.
Overall, 83% of individuals filled an antihypertensive prescription during pregnancy and 6.3% experienced SMM. The majority of individuals with a prescription prior to pregnancy had a prescription for the same medication in pregnancy. Individuals with any versus no medication use in pregnancy had increased adjusted RR (aRR) of SMM (1.18, 95% confidence interval [CI]: 0.96-1.44). Compared to the use of PR medications before and during pregnancy, aRRs were 1.42 (95% CI: 1.18-1.69, 12.4% of sample) for nPR use before and during pregnancy, 1.52 (1.23-1.86; 12.4%) for nPR (before) and PR (during) use, and 2.67 (1.73-4.15) for PR and nPR use. Patterns with no medication use during pregnancy were not statistically significant.
Pattern of antihypertensive medication use before and during pregnancy may be associated with an elevated risk of SMM. Further research is required to elucidate whether this association is related to the severity of hypertension, medication effectiveness, or suboptimal quality of care.
· Individuals with any medication use compared to no medication use in pregnancy had an increased risk of SMM.. · Specific medication use patterns were associated with an elevated risk of SMM.. · Pattern of antihypertensive medication use before and during pregnancy may be associated with an increased risk of SMM..
本研究旨在探讨慢性高血压患者在妊娠前和妊娠期间严重孕产妇发病率（SMM）和降压药物使用模式。
我们对 11759 例妊娠（活产或死胎）进行了研究，这些妊娠来自于在妊娠前 6 个月有慢性高血压且至少有一种降压处方药的个体（Optum，2007-17 年）。我们研究了研究结果是否与妊娠期间药物使用有关。此外，还评估了基于食品和药物管理局指导和文献的药物使用模式。药物使用分为妊娠前和妊娠期间使用，并分为妊娠推荐（PR）或非妊娠推荐（nPR）或无药物使用。SMM 按照疾病预防控制中心 21 项指标的定义进行定义。使用校正后的 Poisson 回归和稳健标准误差，计算反映与降压药物使用相关的 SMM 风险比（RR），并根据产妇年龄、教育程度和出生年份进行调整。
总体而言，83%的个体在妊娠期间开了降压药处方，6.3%的个体发生了 SMM。大多数在妊娠前有处方的个体在妊娠期间开了相同的药物。与妊娠期间无药物使用相比，妊娠期间有任何药物使用的个体调整后的 SMM 风险比（aRR）更高（1.18，95%置信区间[CI]：0.96-1.44）。与妊娠前和妊娠期间使用 PR 药物相比，妊娠前和妊娠期间使用 nPR 药物的 aRR 为 1.42（95%CI：1.18-1.69，占样本的 12.4%），妊娠前使用 nPR 药物和妊娠期间使用 PR 药物的 aRR 为 1.52（1.23-1.86；占 12.4%），妊娠前和妊娠期间使用 PR 和 nPR 药物的 aRR 为 2.67（1.73-4.15）。妊娠期间无药物使用的模式没有统计学意义。
妊娠前和妊娠期间降压药物使用模式可能与 SMM 风险增加有关。需要进一步研究以阐明这种关联是否与高血压严重程度、药物有效性或护理质量欠佳有关。
·与妊娠期间无药物使用相比，妊娠期间有任何药物使用的个体 SMM 风险增加。
·特定的药物使用模式与 SMM 风险增加有关。
·妊娠前和妊娠期间降压药物使用模式可能与 SMM 风险增加有关。
