Clonidine versus Captopril for Severe Postpartum Hypertension: A Randomized Controlled Trial.

BACKGROUND: Changes during the puerperium are still unclear, particularly in women with hypertension. The choice of antihypertensives, both to control very high blood pressure episodes and to keep blood pressure stable, also requires further elucidation. Currently, there are no clear data to guide the decision for the choice of postpartum antihypertensives. Captopril plays an important role in the treatment of very high blood pressure episodes and may be used postpartum. Clonidine has been used as an alternative in pregnant or postpartum women with contraindications to captopril, with satisfactory effect. The objective of the present study was to evaluate the effectiveness and safety of clonidine compared to captopril for treating severe postpartum hypertension. METHODS AND FINDINGS: A randomized, drug-controlled, triple-blind clinical trial evaluating postpartum women receiving captopril or clonidine. Inclusion criteria consisted of: women with hypertensive disorders of pregnancy systolic blood pressure (SBP) ≥180 mmHg and/or diastolic blood pressure (DBP) ≥110 mmHg], requiring magnesium sulfate. Exclusion criteria were: heart disease, smoking, illicit drug use, contraindications to captopril, clonidine or oral medication, and having used captopril/clonidine previously. The primary outcome was the frequency of very high blood pressure episodes while in the obstetric intensive care unit. A total of 90 postpartum women met the study inclusion criteria, with 45 randomized to each group. There were fewer very high blood pressure episodes during hospitalization (2.1 ± 2.1 vs. 3.5 ± 4.7, p = 0.08), greater percentage reduction in SBP (14.0% ± 8.6% vs. 10.8% ± 8.8%, p = 0.08) and fewer women requiring sodium nitroprusside (2.3% vs. 13.3%; RR: 0.17; 95%CI: 0.02-1.39; p = 0.06) in the clonidine group compared to the captopril group; however, these differences were not significant. The groups were similar regarding daily mean SBP or DBP; however, on the third postpartum day, mean SBP was lower in the clonidine compared to the captopril group (151.9 ± 11.8 mmHg vs. 158.1 ± 13.6 mmHg, p = 0.02). Although not statistically significant, adverse reactions were more common in the captopril group (28.8%) compared to the clonidine group (18.6%). CONCLUSION: Clonidine and captopril represent safe, effective treatments for severe postpartum hypertension. TRIAL REGISTRATION: clinicaltrials.gov: www.clinicaltrial.gov, NCT01761916.

Visceral adiposity in the first half of pregnancy predicts newborn weight among adolescent mothers.

OBJECTIVE: Maternal obesity is a strong risk factor for gestational diabetes mellitus and fetal macrosomia. We assessed the association between maternal visceral adiposity tissue (VAT) depth in the first half of pregnancy and both glucose tolerance in late pregnancy and newborn weight in pregnant adolescents. METHODS: We completed a prospective cohort study of 73 pregnant adolescents aged 10 to 19 years, without pre-pregnancy diabetes. VAT depth was measured by ultrasound at 12 to 20 weeks' gestation, followed by a two-hour 75-g oral glucose tolerance test at 36 to 39 weeks' gestation, to determine the glucose area under the curve (AUC glucose0-120). The association between VAT depth and newborn weight was evaluated by multiple linear regression analysis, controlling for maternal age, parity, smoking, gestational age at delivery, infant sex, pre-pregnancy BMI, weight gain in pregnancy, and fasting serum glucose at 36 to 39 weeks' gestation. The relation between VAT depth and AUC glucose0-120 was assessed by linear regression analysis, adjusting for maternal age, parity, smoking, pre-pregnancy BMI, and weight gain in pregnancy. RESULTS: A 1 cm increase in VAT depth was associated with a 206 g (95% CI 101 to 311) adjusted increase in mean birth weight. VAT depth and the other model covariates together explained more of the variance in birth weight (r(2) = 0.282; P < 0.001) than pre-pregnancy BMI with the other covariates in the same model (r(2) = 0.081; P = 0.076). All three glucose tolerance test measures were performed at 36 to 39 weeks' gestation in 51 of the 73 participants. The relationship between VAT depth and AUC glucose0-120 was not significant (P = 0.43). CONCLUSION: VAT depth in the first half of pregnancy predicts newborn weight better than BMI, but is not associated with glucose tolerance in late pregnancy.

Objectif : L'obésité maternelle constitue un solide facteur de risque en ce qui concerne le diabète sucré gestationnel et la macrosomie fœtale. Nous avons évalué, chez des adolescentes enceintes, l'association entre, d'une part, la profondeur du tissu adipeux viscéral (TAV) maternel au cours de la première moitié de la grossesse et, d'autre part, la tolérance au glucose aux derniers moments de la grossesse et le poids du nouveau-né. Méthodes : Nous avons mené une étude de cohorte prospective auprès de 73 adolescentes enceintes âgées de 10 à 19 ans qui ne présentaient pas un diabète prégrossesse. La profondeur du TAV a été mesurée par échographie à 12 - 20 semaines de gestation; par la suite, nous avons mené une épreuve d'hyperglycémie provoquée par voie orale (deux heures, 75 g) à 36 - 39 semaines de gestation, en vue de déterminer la surface sous la courbe du glucose (SSC glucose0­120). L'association entre la profondeur du TAV et le poids du nouveau-né a été évaluée au moyen d'une analyse de régression linéaire multiple, en neutralisant l'effet de l'âge maternel, de la parité, du tabagisme, de l'âge gestationnel au moment de l'accouchement, du sexe du nouveau-né, de l'IMC prégrossesse, du gain pondéral pendant la grossesse et de la glycémie à jeun à 36 - 39 semaines de gestation. La relation entre la profondeur du TAV et la SSC glucose0­120 a été évaluée au moyen d'une analyse de régression linéaire, en neutralisant l'effet de l'âge maternel, de la parité, du tabagisme, de l'IMC prégrossesse et du gain pondéral pendant la grossesse. Résultats : L'augmentation de la profondeur du TAV d'un centimètre a été associée à une hausse corrigée du poids moyen de naissance de 206 g (IC à 95 %, 101 - 311). La profondeur du TAV (prise en considération conjointement avec les autres covariables du modèle) a mieux permis d'expliquer la variance du poids de naissance (r2 = 0,282; P < 0,001) que l'IMC prégrossesse (prise en considération conjointement avec les autres covariables du même modèle) (r2 = 0,081; P = 0,076). Les trois épreuves d'hyperglycémie ont été menées à 36 - 39 semaines de gestation chez 51 des 73 participantes. La relation entre la profondeur du TAV et la SSC glucose0­120 ne s'est pas révélée être significative (P = 0,43). Conclusion : Bien que la profondeur du TAV au cours de la première moitié de la grossesse permette de mieux prédire le poids du nouveau-né que l'IMC, elle n'est pas associée à la tolérance au glucose aux derniers moments de la grossesse.

[Antihypertensive treatment in pregnancy]. / Tratamento anti-hipertensivo na gravidez.

Pregnancy hypertensive disorders represent a frequent gestational pathology. It is one of the most important causes of maternal demise and perinatal morbidity/mortality in the world. Antihypertensive treatment is part of a vast therapeutic arsenal used for prevention of severe complications. However, data from literature research have been controversial about benefits of antihypertensive treatment. We performed a literature review about antihypertensive treatment in severe pre-eclampsia, describing drugs' pharmacological particularities and scientific evidences about their efficacy and safety. It is not controversial that treatment of hypertensive emergency must be instituted. The ideal medication used in those cases is not defined, therefore the real benefits of maintenance antihypertensive treatment in pre-eclampsia remains unclear.

[Nifedipine antihypertensive treatment effects in pre-eclampsia]. / Efeitos da nifedipina no tratamento anti-hipertensivo da pré-eclâmpsia.

Literature analysis has been controversial about pre-eclampsia. It is known that not pregnant patients should be treated due cardiovascular benefits. However, the real benefits of antihypertensive treatment in pre-eclampsia were not demonstrated. Yet, there are many drugs that can be used for antihypertensive treatment in pregnancy. Calcium cannel blockers, particularly nifedipine, are used as a second line treatment. There are just a few evidences about nifedipine treatment in hypertension during pregnancy. Recently, researches were performed to evaluate the effects of nifedipine on maternal-fetal binomial, more safety, efficacy, and effectiveness were found using it. This literature review concludes that hypertension treatment only must be done in severe cases and emergency hypertensive. Therefore nifedipine can be used in antihypertensive treatment during pregnancy without serious complications.