Abstract Introduction Arterial hypertension affects about 5-10% of pregnancies and has detrimental effects on pregnancy outcomes in both the mother and fetus. The study aimed to analyse the outcomes antihypertensive treatment in different periods of pregnancy. Methodology Nationwide data on all births and abortions in the period 2012-2022 in the Czech Republic were obtained from the National Registry of Reproductive Health (NRRZ) and the National Registry of Reimbursable Health Services (NRHZS). Women who had the diagnosis I10 within one year before pregnancy and were prescribed any antihypertensive drug from selected ATC groups (C02, C03, C07, C08, C09) were classified as pre-existing hypertension. Women diagnosed with O13 or I10 during pregnancy were classified as pregnancy induced hypertension. Hypoxia in the new-born was defined as pH 7.1 or Apgar score 8 present after delivery. For all factors, univariate logistic regression was used to calculate the odds ratios (OR) of adverse outcomes. Results There were total of 1,154,648 deliveries in the 11-year period. 95,215 women had hypertension in pregnancy, out of these 21,094 (22.2%) were treated with antihypertensive drugs. Odds ratios for caesarean section, pre-term delivery, low birth weight, new-born hypoxia and pre-eclampsia in women using different antihypertensive classes and drugs in different periods of pregnancy are shown in the Table. Risk of all maternal and fetal complications was found to be higher with calcium channel blocker (CCB) amlodipine, particularly if used in the third trimester. Betablocker use (especially betaxolol) initiated before pregnancy was associated with higher risk of low birth weight. Although used in limited numbers, diuretics, verapamil, ACE-inhibitors (ACEI) and angiotensin receptor blockers (ARBs) appeared to have their safety profile comparable to methyldopa. Conclusion Amlodipine use in the later stages of pregnancy was associated with increased risk of all maternal and fetal adverse outcomes. Betablocker use before pregnancy was associated with higher risk of low birth weight.Table
Václavík et al. (Sat,) studied this question.