Initiation or continuation of oral labetalol versus extended‐release nifedipine in expectant management of preeclampsia with severe features

Full abstract

Read the full abstract

Abstract Introduction Preeclampsia with severe features remains a major contributor to maternal and neonatal morbidity. In select patients <34 weeks, expectant management may safely prolong pregnancy and improve neonatal outcomes. Oral labetalol and extended‐release nifedipine are commonly used for blood pressure control in this setting; however, comparative data are limited. This study aimed to compare maternal and neonatal outcomes between these agents. Methods This is a retrospective cohort study of patients admitted for expectant management of preeclampsia with severe features <34 weeks and initiated or continued on oral labetalol or nifedipine. Exclusion criteria included patients already on both medications at the time of admission, and any contraindication to expectant management within 24 h. The primary outcome was pregnancy latency. Secondary outcomes included need for delivery <34 weeks, initial agent dose increase, addition of second agent, number of acute treatment episodes of severe hypertension, proportion reaching max dosing of initial agent, birth weight, and 1‐ and 5‐min APGARs. Results A total of 219 patients were included. Comparing labetalol versus nifedipine, there was no difference in median latency period (4 vs. 5 days, p = 0.28), need for delivery <34 weeks (87% vs. 79%, p = 0.09), initial agent dose increase (73% vs. 73%, p = 0.79), addition of second agent (39% vs. 30%, p = 0.13), median number of acute treatment episodes (3 vs. 3 p = 0.83), and proportion reaching max dosing of initial agent (20% vs. 18% p = 0.61). A higher proportion of patients in the nifedipine group required delivery <34 weeks for elevated liver enzymes (26% vs. 7% p = 0.001) and/or for elevated creatinine (15% vs. 5% p = 0.026). There were no differences in neonatal outcomes. In a subgroup analysis of patients not on any antihypertensive therapy at the time of admission ( N = 153), findings were consistent with the primary analysis. Outcomes were also overall similar when stratified by gestational age. Conclusion For patients admitted for expectant management of preeclampsia with severe features, the choice of oral labetalol versus nifedipine for blood pressure control was not associated with a significant difference in pregnancy latency. However, patients initiated or continued on nifedipine were more likely to experience elevated liver enzymes and/or elevated creatinine as an indication for delivery <34 weeks. These findings suggest potential differences in disease trajectory by antihypertensive choice and warrant further investigation.