Comparative evaluation of efficacy and safety of methyldopa and labetalol in pregnancy-induced hypertension: A meta-analysis

Abstract

Introduction: Methyldopa and labetalol are the drugs that frequently used for the management of pregnancy-induced hypertension. But fewer data available for the efficacy and safety of their use. So, here we are doing a systemic review for the safety and efficacy of methyldopa in comparison to labetalol. Objectives: Assessment of efficacy and safety of methyldopa versus labetalol in pregnancy-induced hypertension. Method: A total of 10 randomized controlled trials (RCTs) following PRISMA guidelines (2015) and have included pregnant women who developed hypertension after the 20th week of gestation and receiving methyldopa (100–400 mg/day) or labetalol (250–1000 mg/day). All RCTs with changes in mean arterial pressure (MAP) before and after drug administration was collected. The adverse effects of the respective drugs were also noted. RevMan 5.3 software was used for the calculation of standardized mean difference (SMD). P value less than 0.05 will be considered significant. Result: Data of 1,200 patients were included in our study. Both the drug decreases MAP statistically significantly. In the labetalol group, P value was statistically significant (random effect model P < 0.005 and in the fixed-effect model <0.001). In methyldopa group, P < 0.001, significant in fixed effect. In the majority of the studies, the difference in the reduction of MAP was higher in labetalol than methyldopa. In labetalol vs methyldopa study using random-effect model SMD was 1.568 (95% CI, 0.735 to 2.401, P < 0.001). Drowsiness, headache, nausea, vomiting, weakness, and myalgia were associated with drugs. Out of the six adverse effects, there was a significant difference found in drowsiness (P = 0.023) which was seen more in patients receiving methyldopa. There was no significant difference in the prevalence of the other maternal side effects. Conclusions: Labetalol is more efficacious and safer as compared to methyldopa.