Peripartum antihypertensive use and the risk of neonatal hypoglycemia and postpartum uterine atony: a retrospective cohort study.

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.