The use of loop diuretics in the context of hypertensive disorders of pregnancy: a systematic review and meta-analysis

J Hypertens. 2023 Jan 1;41(1):17-26. doi: 10.1097/HJH.0000000000003310. Epub 2022 Nov 2.


Aims: Addressing volume expansion may improve the management of hypertension across the pregnancy continuum. We conducted a systematic review to summarize the evidence on the use of loop diuretics in the context of hypertensive disorders during pregnancy and the postpartum period.

Methods and results: Medline, Embase, Cochrane library,, and Google Scholar were searched for original research articles published up to 29 June 2021. Of the 2801 results screened, 15 studies were included: eight randomized controlled trials, six before-after studies, and one cohort study. Based on random effects meta-analysis of before-after studies, antepartum use of loop diuretics was associated with lower DBP [mean difference -17.73 mmHg, (95% confidence intervals -34.50 to -0.96); I2 = 94%] and lower cardiac output [mean difference -0.75 l/min, (-1.11 to -0.39); I2 = 0%], with no difference in SBP, mean arterial pressure, heart rate, or total peripheral resistance. Meta-analysis of randomized controlled trials revealed that postpartum use of loop diuretics was associated with decreased need for additional antihypertensive patients [relative risk 0.69, (0.50-0.97); I2 = 14%], and an increased duration of hospitalization [mean difference 8.80 h, (4.46-13.14); I2 = 83%], with no difference in the need for antihypertensive therapy at hospital discharge, or persistent postpartum hypertension.

Conclusion: Antepartum use of loop diuretics lowered DBP and cardiac output, while their postpartum use reduced the need for additional antihypertensive medications. There was insufficient evidence to suggest a clear benefit. Future studies focusing on women with hypertensive pregnancy disorders who may most likely benefit from loop diuretics are required.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Antihypertensive Agents
  • Cohort Studies
  • Female
  • Humans
  • Hypertension, Pregnancy-Induced* / drug therapy
  • Pregnancy
  • Sodium Potassium Chloride Symporter Inhibitors*
  • Vascular Resistance


  • Sodium Potassium Chloride Symporter Inhibitors
  • Antihypertensive Agents