Relation Between Labetalol and Methyldopa in Treatment of Pregnancy Induced Hypertension

Abstract

Background: Hypertensive disorder is the most common medical problem encountered in pregnancy with a high perinatal and maternal mortality & morbidity. Worldwide about 76,000 pregnant women die each year from preeclampsia and related hypertensive disorders. Objective: To assess the relation between labetalol and methyldopa in treatment of pregnancy induced hypertension. Methods: This study was hospital based comparative prospective study was conducted at Dept. of Obstetrics & Gynaecology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January to June 2021. The study consisted of 100 patients with pregnancy induced hypertension attending outpatient department and admitted in ANW, or who directly came to labour room. These patients were randomly selected on lottery basis after they fulfilled the inclusion criteria. Total patients were taken for the study and divided into 2 groups of 50 patients in each group. Results: A total 100 patients were included. The mean age in Group I was 24.4±4.55 years and in Group-II, 23.95±4.28 years. Maximum number of patients was between 19- 24 years in both the groups. In Group-I, 26 (52%) patients and in Group-II, 25 (50%) patients were in this age group. The maximum age in the Group I was 34 years and 35 years in the Group-II. The minimum age was 17 years in both the groups. The inter group difference was not statistically significant (p>0.05) thus the two groups were comparable by age. At baseline no significant difference was seen in SBP in both treatment groups. However after 8 days post testament SBP of women was significantly lower in Group-I patients as that of Group-II patients. i.e. Group-I: 123.41 vs. Group-II: 126.62, p- value=0.009. At baseline no significant difference was seen in DBP in both treatment groups. However at 8th day post treatment DBP of patients was significantly lower in Group-I patients. i.e. 77.18 vs. Group-II 79.64, p-value=0.005. For SBP more effective control was seen in women whose parity was 3-4 and for DBP notable difference was seen in women whose parity was 1-2. The control of systolic blood pressure was more effective in patients with normal body mass index and for Diastolic blood pressure (DBP) more effective control was seen in patients who were obese. On comparison methyldopa significantly causes more drowsiness, headache and nasal congestion and the incidence of Postural hypotension and dysponea in both groups were not significantly different. The patient who required additional drugs to control the uncontrolled hypertension. In Group I, 2 (4%) patients and in Group II, 3 (6%) patients did not respond with starting drug. The inter group difference was not statistically significant (p>0.05). Conclusion: Labetalol had less maternal adverse effect compared to methyldopa but fetal outcome was not observed in this study. Labetalol and methyldopa are equally efficacious in controlling blood pressure in new onset hypertension in pregnancy. This study is just a step in this long way. Therefore, labetalol can be considered positively in the treatment of pregnancy induced hypertension.