Pregnancy Hypertens. 2025 Jun 25;41:101232. doi: 10.1016/j.preghy.2025.101232. Online ahead of print.
ABSTRACT
OBJECTIVES: Determine whether peripartum antihypertensive use increases secondary uterotonic use, neonatal hypoglycemia, bradycardia, or NICU admission. Hypertensive disorders of pregnancy are common and increasing. Treatment includes beta- and calcium channel- blocking medications. Outpatient beta-blockers were associated with increases in neonatal bradycardia, hypoglycemia, and NICU admissions. Calcium channel blockers are weak tocolytics and may precipitate uterine atony and hemorrhage.
STUDY DESIGN: Retrospective, single-center study at a tertiary academic hospital. Records of 26,058 parturients over 5 years were reviewed. We compared exposure to labetalol and nifedipine in separate analyses. We calculated univariate odds ratio and binomial generalized models to account for covariates. P < 0.05 was considered significant.
MAIN OUTCOME MEASURES: Primary outcomes were incidence of 1-hour neonatal hypoglycemia and maternal secondary uterotonic or antifibrinolytic use. Additional maternal outcomes were change in hemoglobin concentration and estimated blood loss; neonatal outcomes included hypoglycemia at 24-hours, bradycardia, and NICU admissions.
RESULTS: We analyzed 24,845 records. Labetalol exposure occurred in 605 (2.4 %) deliveries and nifedipine in 426 (1.7 %). In multivariate analyses in the full cohort and matched cohorts, labetalol administration was significantly associated with 1-hour hypoglycemia (p < 0.001, OR 1.72, 95 %CI 1.33-2.23), but not 24-hour hypoglycemia (p = 0.12), bradycardia (p = 0.65), or NICU admissions (p = 0.86). Labetalol and nifedipine were associated with uterine atony (p = 0.006 and p = 0.027). Confounders and sensitivity analyses accounted for magnesium exposure, general anesthesia, and hypertensive diagnoses.
CONCLUSION: Labetalol exposure was significantly and independently associated with neonatal hypoglycemia. Any hypertensive use associated with uterine atony. Clinicians should consider 1-hour assessment of glucose in neonates born to labetalol-treated mothers.
PMID:40570616 | DOI:10.1016/j.preghy.2025.101232
