A new study published in the Hypertension journal discovered that a daily blood pressure medication taken after severe preeclampsia is detected and the choosing to proceed with delivery could also prevent problems in the mother and/or infant.

New research published today in Hypertension says that women with severe preeclampsia (severely high blood pressure) during pregnancy may be treated with extended-release nifedipine, a blood pressure-lowering

Women who took the medication were less likely to have dangerously high blood pressure, which would necessitate therapy with fast-acting treatments, such as intravenous (IV) medications.

The purpose of the study was to determine whether treatment with nifedipine, an extended-release blood pressure-lowering drug, prior to labor and delivery could prevent the development of severe blood pressure levels and, as a result, eliminate the requirement for the administration of fast-acting IV medications.

According to the American Heart Association, preeclampsia is often diagnosed after 20 weeks of pregnancy with symptoms including headaches, visual problems, and swelling of the hands, feet, face, and eyes.

Preeclampsia with severe features is usually identified by systolic blood pressure of 160 mm Hg or higher and/or diastolic blood pressure of 110 mm Hg or higher, as well as high protein levels in the urine.

It can impact up to 8% of pregnancies and raises the risk of preterm birth, stroke, and liver or kidney damage (delivery before 40 weeks).

Preeclampsia can only start to get better after the baby is born, and most of the symptoms go away within a few days. However, some women require blood pressure medication for up to six weeks following birth.

“We know that bringing down very high blood pressure to a safer range will help prevent maternal and fetal complications,” said  said lead study author Erin M. Cleary. “However, besides rapid-acting,” according to the author, “IV medicines for severe hypertension during pregnancy, optimal management for hypertension during the labor and delivery process, has not been studied.”

Severe high blood pressure also increases the risk of complications like placental abruption, which happens when the placenta, which gives the baby nutrients and oxygen from the mother while it is growing in the uterus, separates from the uterus before the baby is born. This could make things very hard for the mother and/or the baby.

The need for an emergency delivery, blood loss for the mother, and potential life-threatening situations for both the mother and the baby are just a few of the issues, according to Cleary. A rapid-IV medication for very high blood pressure may cause about 10% of patients to experience very low blood pressure very fast. 

“When blood pressure gets too low, too fast, that can lead to other serious complications.”

At least 110 pregnant women who were diagnosed with severe preeclampsia, had induction of labor, and were at least 22 weeks pregnant participated in the trial, which ran from June 2020 to April 2022 at The Ohio State University Wexner Medical Center in Columbus.

Half of the participants were given a 30 mg pill of nifedipine extended-release every day until they gave birth. The other half were given a placebo pill every day until they gave birth.

No one in the study, including the researchers, the clinical care team, or the women, knew if they were given nifedipine or a placebo. Participants were tracked through hospital discharge, and a chart review was done six weeks after delivery to keep track of any postpartum readmissions and the causes of those readmissions.

The researchers also looked at how taking nifedipine affected delivery, whether and for how long the baby might have needed care in the neonatal intensive care unit (NICU), and any other bad things that happened to the mother or baby.

The study revealed:

• Compared to 55.1% of the women in the placebo group, only 34% of the women in the nifedipine group required acute hypertension medication (immediate blood pressure reduction).
• Women who were given nifedipine were less likely to have cesarean sections than those who were given a placebo; 20.8% of women in the nifedipine group gave birth via C-section, whereas 34.7% of women in the placebo group did so.
• Newborns whose mothers took nifedipine were less likely to be admitted to a neonatal intensive care unit (29.1% versus 47.1% in the placebo group).
• Poor outcomes for the baby, like a lower Apgar score, low blood sugar, high bilirubin, or needing extra oxygen, did not differ much between the two treatment groups.

It’s important to note, though, that the number of people in this study was too small to tell if the differences in NICU and Cesarean rates are real or if they are just a result of chance or something else.

Researchers plan to do bigger studies with more people to learn more about whether or not these differences are real.

Source: 10.1161/HYPERTENSIONAHA.122.19751

Image Credit: Getty

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