Analysis of prescribing pattern of antihypertensive drugs during pregnancy and neonatal outcome in a tertiary care centre

Abstract

INTRODUCTION Hypertensive disorders are the most common medical complications of pregnancy with an incidence of 2 to 8 %. 1,2 It is one of the major causes of maternal and perinatal morbidity and mortality worldwide. There are several major categories of hypertensive disorders in pregnancy ranging from mild to moderate rise in blood pressure without proteinuria usually called pregnancy induced hypertension (PIH), preeclampsia (hypertension with proteinuria), severe preeclampsia and eclampsia. 2 Maternal hypertension, even of the mild to moderate category, can lead to adverse perinatal outcomes like low birth weight, prematurity, stillbirth and intrauterine growth retardation. 3 Though hypertension occurs in 2 to 8% of pregnancies, yet information on the safety of antihypertensive medication use during pregnancy is limited. For severe hypertension, anti-hypertensive medication is used to prevent serious maternal and foetal complications; however, there is no consensus on when to treat mild-to-moderate hypertension. According to ACOG (American college of gynaecology) technical bulletin recommends that drugs not to be administered in pregnancy associated with hypertension, if systolic BP is less than 160 and diastolic BP less than 110. 4 Hypertensive pregnant mothers are at increased risks for premature delivery, intrauterine foetal death, growth retardation and abruptio placentae; they also have an increased risk of vascular injury with thrombotic micro-angioplasty, coagulopathy, cerebral haemorrhage, and multi organ injury especially of kidney and liver. So as to avoid all such complications, it is better to start the treatment with antihypertensive after assessing correct stage and class of hypertension and always prescribe the safe drug to avoid adverse effects over the foetus and ABSTRACT Background: Hypertensive disorders are the most common medical complications of pregnancy with an incidence of 2-8%. Maternal hypertension, even of the mild to moderate category, can lead to adverse perinatal outcomes like low birth weight, prematurity, stillbirth and intrauterine growth retardation. Though hypertension occurs up to 8% of pregnancies, yet information on the safety of antihypertensive medication use during pregnancy is limited. The objective of this study was to analyse the prescription pattern of antihypertensive drugs in pregnant woman and also to assess the neonatal outcome in pregnant woman on antihypertensive drugs. Methods: The retrospective study includes analysis of all the prescriptions from case records of hypertensive pregnant women till the delivery for one year. Results: Total number of 122 hypertensive pregnant patients was included in the study. Mean age of the patients was 25.8 years. 51.6% were primigravida. Most of them were diagnosed after 28±2 weeks of pregnancy. 54% were on monotherapy. Most commonly used drug was alpha methyl dopa followed by nifedipine. Out of 86.9% (n=106) live birth delivered; 29.2% were of low birth weight. Conclusions: All the prescriptions were prescribed rationally. Most of the prescriptions contain monotherapy with alpha methyl dopa which is considered to be safest antihypertensives in pregnancy.