Chronic hypertension in pregnancy and the risk of congenital malformations: a cohort study - 31/10/14

Doi : 10.1016/j.ajog.2014.09.031

Brian T. Bateman, MD, MSc ^a,^c,^⁎ , Krista F. Huybrechts, MS, PhD ^a, Michael A. Fischer, MD, MS ^a, Ellen W. Seely, MD ^b, Jeffrey L. Ecker, MD ^d, Anna S. Oberg, MD, PhD ^e, Jessica M. Franklin, PhD ^a, Helen Mogun, MS ^a, Sonia Hernandez-Diaz, MD, DrPH ^e
^a Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
^b Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
^c Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
^d Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
^e Department of Epidemiology, Harvard School of Public Health, Boston, MA

^∗Corresponding author: Brian T. Bateman, MD, MSc.

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Abstract

Objective

Chronic hypertension is a common medical condition in pregnancy. The purpose of the study was to examine the association between maternal chronic hypertension and the risk of congenital malformations in the offspring.

Study Design

We defined a cohort of 878,126 completed pregnancies linked to infant medical records using the Medicaid Analytic Extract. The risk of congenital malformations was compared between normotensive controls and those with treated and untreated chronic hypertension. Confounding was addressed using propensity score matching.

Results

After matching, compared with normotensive controls, pregnancies complicated by treated chronic hypertension were at increased risk of congenital malformations (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.2–1.5), as were pregnancies with untreated chronic hypertension (OR 1.2; 95% CI, 1.1–1.3). In our analysis of organ-specific malformations, both treated and untreated chronic hypertension was associated with a significant increase in the risk of cardiac malformations (OR, 1.6; 95% CI, 1.4–1.9 and OR, 1.5; 95% CI, 1.3–1.7, respectively). These associations persisted across a range of sensitivity analyses.

Conclusion

There is a similar increase in the risk of congenital malformations (particularly cardiac malformations) associated with treated and untreated chronic hypertension that is independent of measured confounders. Studies evaluating the teratogenic potential of antihypertensive medications must control for confounding by indication. Fetuses and neonates of mothers with chronic hypertension should be carefully evaluated for potential malformations, particularly cardiac defects.

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Key words : birth defect, drug, epidemiology, hypertension, pregnancy

Plan

Materials and Methods

Sensitivity and exploratory analyses

Results

Comment

	The views expressed herein are those of the authors and do not necessarily represent the official views of the National Institutes of Health.
	This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, under grant no. K08HD075831 (B.T.B.) and K24 from the National Heart Lung and Blood Institute at the National Institutes of Health under grant no. K24HL096141 (E.W.S.). The Medicaid Analytic eXtract pregnancy cohort was supported by grant R01HS018533 from the Agency for Healthcare Research and Quality (S.H.-D.).
	S.H.-D. has consulted for Novartis, GlaxoSmithKline-Biologics (Middlesex, England, UK), and AstraZeneca (London, England, UK) for unrelated projects. The remaining authors report no conflict of interest.
	Cite this article as: Bateman BT, Huybrechts KF, Fischer MA, et al. Chronic hypertension in pregnancy and the risk of congenital malformations: a cohort study. Am J Obstet Gynecol 2014;211:xx-xx.