The impact of anti‐hypertensive treatment on foetal growth and haemodynamics in pregnant women with pre‐existing diabetes – An explorative study

• Published in: Diabetic medicine Vol. 39; no. 4; pp. e14722 - n/a
• Main Authors: Vestgaard, Marianne, Al‐Saudi, Elaf, Ásbjörnsdóttir, Björg, Nørgaard, Lone N., Pedersen, Berit Woetman, Ekelund, Charlotte Kvist, Ringholm, Lene, Andersen, Lise Lotte T., Jensen, Dorte M., Tabor, Ann, Damm, Peter, Mathiesen, Elisabeth R.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-04-2022
• Subjects: Antihypertensive Agents - therapeutic use; Antihypertensives; anti‐hypertensive treatment; Birth weight; Blood pressure; blood pressure control; Diabetes; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Doppler effect; doppler flow parameters; Female; Fetal Development; growth; Hemodynamics; Humans; Hypertension; Hypertension, Pregnancy-Induced - drug therapy; Hypertension, Pregnancy-Induced - epidemiology; Methyldopa; Pregnancy; Pregnancy Complications; Pregnant Women; pre‐existing diabetes; Prospective Studies; Small-for-gestational age; Ultrasonic imaging; Ultrasound; Womens health; pre-existing diabetes; pregnancy; growth; blood pressure control; anti-hypertensive treatment; doppler flow parameters; hemodynamics
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.14722

Objectives
To explore the impact of anti‐hypertensive treatment of pregnancy‐induced hypertension on foetal growth and hemodynamics in women with pre‐existing diabetes.
Methods
A prospective cohort study of 247 consecutive pregnant women with pre‐existing diabetes (152 type 1 diabetes; 95 type 2 diabetes), where tight anti‐hypertensive treatment was initiated and intensified (mainly with methyldopa) when office blood pressure (BP) ≥135/85 mmHg and home BP ≥130/80 mmHg. Foetal growth was assessed by ultrasound at 27, 33 and 36 weeks and foetal hemodynamics were assessed by ultrasound Doppler before and 1–2 weeks after initiation of anti‐hypertensive treatment.
Results
In 215 initially normotensive women, anti‐hypertensive treatment for pregnancy‐induced hypertensive disorders was initiated in 42 (20%), whilst 173 were left untreated. Chronic hypertension was present in 32 (13%). Anti‐hypertensive treatment for pregnancy‐induced hypertensive disorders was not associated with foetal growth deviation (linear mixed model, p = 0.681). At 27 weeks, mainly before initiation of anti‐hypertensive treatment, the prevalence of small foetuses with an estimated foetal weight <10th percentile was 12% in women initiating anti‐hypertensive treatment compared with 4% in untreated women (p = 0.054). These numbers were close to the prevalence of birth weight ≤10th percentile (small for gestational age (SGA)) (17% vs. 4%, p = 0.003). Pulsatility index in the umbilical and middle cerebral artery remained stable after the onset of anti‐hypertensive treatment in a representative subgroup (n = 12, p = 0.941 and p = 0.799, respectively).
Conclusion
There is no clear indication that antihypertensive treatment causes harm in this particular at‐high‐risk group of pregnant women with diabetes, such that a larger well‐designed study to determine the value of tight antihypertensive control would be worthwhile.