A comparative study of efficacy of antihypertensive drugs and feto-maternal outcome in the treatment of pregnancy induced hypertension


  • Kavita Babbar Department of Obstetrics & Gynaecology, Chhattisgarh institute of medical sciences, Bilaspur, Chhattisgarh, India
  • Meena Armo Department of Obstetrics & Gynaecology, Chhattisgarh institute of medical sciences, Bilaspur, Chhattisgarh, India
  • Rajib Lochan Bhanja Department of Cardiology, Apollo Hospital, Bilaspur, Chhattisgarh, India




Pregnancy, Hypertension, Methyldopa, Nifedipine, Labetalol, Efficacy


Background: Hypertensive disorders are the most common medical disorders in pregnancy contributing significantly to maternal and perinatal mortality and morbidity worldwide. The incidence is around 3-10% of all pregnancies. The aim of antihypertensives is to reduce, stabilize the blood pressure and thus minimize the risks such as placental abruption, maternal cardiac failure, cerebral hemorrhage; but they should not have any adverse effects on the utero-placental circulation and the fetus. Antihypertensive drugs are often used to lower blood pressure to prevent this progression to adverse outcomes for the mother and the fetus. The risk of developing severe hypertension is reduced to half by using antihypertensive medications. The aim and objectives of the study was a comparative study of the efficacy of methyldopa, nifedipine versus labetalol and the feto- maternal outcome in gestational hypertension in a tertiary care referral centre.

Methods: A prospective study on 240 outpatients as well as inpatients of the antenatal ward of Obstetrics and Gynaecology department of Chhattisgarh Institute of Medical Sciences, Bilaspur which is a tertiary care referral hospital. The patients randomly divided in three groups. The first group received alpha-methyl dopa 250mg tds, second 20 mg bd nifedipine and the third one labetalol 100mg bd. Mean arterial pressure calculated by systolic BP +2 DBP/3.The fall in BP calculated along with time required, dose of drug required, spontaneous/ induced labour or caesarean section, adverse maternal and the fetal outcome was observed.

Results: Maximum number of patients that is 145(60.42%) patients belonged to the age group of 19 to 24 years and were primigravida (70.42%) presenting at 33-37 weeks of gestation. Significant fall in MAP was seen in patients receiving nifedipine and labetalol. Mean time to control blood pressure is 46.32 hrs in methyldopa group, 30.44hrs in nifedipine group and 37.24 hrs in labetalol group. 103 (42.9%) patients had normal delivery whereas 137 (57.1%) required a caesarian section, higher rate of spontaneous labour in nifedipine and labetalol group. Most common side-effect observed was headache; the other side effects included drowsiness, more in patients treated with methyldopa, weakness, more in patients treated with labetalol. The fetal outcome was better with labetalol and nifedipine than methyl-dopa group.

Conclusions: The decreased association from maternal and fetal side-effects, the comparatively better hypotensive action indicates that labetalol and nifedipine is suitable for use during pregnancy. Labetalol is safer, quicker in achieving adequate control of blood pressure with considerable prolongation of the duration of pregnancy with fewer side effects on the mother as well as the neonate when used in the management hypertensive disorders of pregnancy.


Davey DA, MacGillivray I. The classification and definition of the hypertensive disorders of pregnancy. Am J Obstet Gynecol. 1988;158(4):892-8.

Magee LA, Von Dadelszen P. Treatment of hypertension in pregnancy. Can J Clin Pharmacol. 2004;11(2):e199-e201.

Abalos E, Duley L, Steyn DW, Henderson-Smart DJ. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. 2007;(1):CD002252.

Magee LA, Ornstein MP. Management of hypertension in pregnancy. BMJ. 1999;318(7194):1332-6.

Giannubilo SR, Bezzeccheri V, Cecchi S, Landi B, Battistoni GI. Nifedipine versus labetalol in the treatment of hypertensive disorders of pregnancy. Arch Gynecol Obstet. 2012;286:637-42.

El-Qarmalawi AM, Morsy AH, al-Fadly A, Obeid A, Hashem M. Labetalol vs. methyldopa in the treatment of pregnancy-induced hypertension. Int J Gynaecol Obstet. 1995;49:125-30.

Khedun SM, Moodley J, Naicker T, Maharaj B .Drug management of hypertensive disorders of pregnancy. Pharmacol Ther. 1997;74: 221-58.

Guzick DS, Klein VR, Tyson JE, Lasky RE, Gant NF, Rosenfeld CR. Risk factors for the occurrence of pregnancy induced hypertension. Informa healthcare – Hypertension in pregnancy. 1987;b6(2):281-97 .

Zibaeenazhad MJ, M Ghodsi P Arab, Gholzom N. the prevalence of hypertensive disorders of pregnancy in Shiraz, Southern Iran; Iranian Cardiovascular Research Journal. 2010;4:169-72.

Redman CWG, Gallery ED, Mitchell MD. Fall in BP in response to volume expansion in pregnancy associated hypertension (PE): Why does it occur? BMJ. 1984;2(2):177-82.

Plouin PF, Breart G, Maillard F, Papiernik E, Relier JP. Comparison of antihypertensive efficacy and perinatal safety of labetalol and methyldopa in the treatment of hypertension in pregnancy: a randomized controlled trial. Br J Obstet Gynaecol. 1988;95:868-76 .

Sajith M. Incidence of pregnancy induced hypertension and prescription pattern of antihypertensive drugs in pregnancy International Journal of Pharma Sciences and Research. 2014;(4):168-72.

Lardoux H, Blazquez G, Leperlier E, Gérard J. Randomized, comparative study on the treatment of moderate arterial hypertension during pregnancy: methyldopa, acebutolol, labetalol. Arch Mal Coeur Vaiss. 1988;81:137-40.

Sibai BM. Diagnosis and management of gestational hypertension and pre-eclampsia. Obstet Gynecol. 2003;102(1):181-92.

Zhang J, Zeisler J, Hatch MC, Berkowitz G. Epidemiology of pregnancy-induced hypertension. Epidemiology Revised. 1997;19:218-32.

Pickles CJ, Broughton Pipkin F, Symonds EM. A randomised placebo controlled trial of labetalol in the treatment of mild to moderate pregnancy induced hypertension. Br J Obstet Gynaecol. 1992;99(12):964-8 .

Sibai BM, Mabie WC, Shamsa F, Villar MA, Anderson GD. A comparison of no medicationversus methyldopa or labetalol in chronic hypertension during pregnancy. Pharmacology J Obstet Gynecol. 1990;162(4):960-6.

Lamming GD. Symonds SM. Use of labetalol and methyldopa in pregnancy-induced hypertension .Br. J. clin. Pharmac. 1979;8:217S-22S.

Verma R, Lahon K, Tonpay SD, Joshi Kale V, Jain DK. A comparative randomized controlled parallel group study of efficacy and tolerability of labetalol versus methyldopa in the treatment of new onset hypertension during pregnancy. Pharmacology. 2012;2:23-31.

Magee LA, Ornstein MP, von Dadelszen P. Management of hypertension in pregnancy. BMJ. 1999;318:1332-6.

Ray JG, Elizabeth AB. Use of antihypertensive medications in pregnancy and the risk of adverse perinatal outcomes. BMC Pregnancy Childbirth. 2001;1:1-6.






Original Research Articles