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

Marianne Vestgaard; Elaf Al-Saudi; Björg Ásbjörnsdóttir; Lone N Nørgaard; Berit Woetman Pedersen; Charlotte Kvist Ekelund; Lene Ringholm; Lise Lotte T Andersen; Dorte M Jensen; Ann Tabor; Peter Damm; Elisabeth R Mathiesen

doi:10.1111/dme.14722

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

Diabet Med. 2022 Apr;39(4):e14722. doi: 10.1111/dme.14722. Epub 2021 Oct 30.

Authors

Marianne Vestgaard^{1

2}, Elaf Al-Saudi¹, Björg Ásbjörnsdóttir¹, Lone N Nørgaard², Berit Woetman Pedersen², Charlotte Kvist Ekelund², Lene Ringholm¹, Lise Lotte T Andersen³, Dorte M Jensen^{3

4}, Ann Tabor^{2

5}, Peter Damm^{1

2

5}, Elisabeth R Mathiesen^{1

5}

Affiliations

¹ Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
² Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
³ Department of Obstetrics, Odense University Hospital, Odense, Denmark.
⁴ Steno Diabetes Center, Odense University Hospital, Odense, Denmark.
⁵ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

PMID: 34653280
DOI: 10.1111/dme.14722

Abstract

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.

Keywords: anti-hypertensive treatment; blood pressure control; doppler flow parameters; growth; hemodynamics; pre-existing diabetes; pregnancy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antihypertensive Agents / therapeutic use
Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / drug therapy
Female
Fetal Development
Hemodynamics
Humans
Hypertension, Pregnancy-Induced* / drug therapy
Hypertension, Pregnancy-Induced* / epidemiology
Pregnancy
Pregnancy Complications*
Pregnant Women
Prospective Studies

Substances

Antihypertensive Agents