Comparative maternal-fetal outcomes associated with different antihypertensive treatment strategies in preeclampsia: a retrospective cohort study.
Source: PubMed, NCBI / U.S. National Library of Medicine
Preeclampsia seriously threatens maternal and infant health. Antihypertensive therapy is key to improving perinatal outcomes, yet comparative maternal-fetal evidence for oral agents remains limited. To compare maternal-fetal outcomes of oral labetalol versus oral nifedipine in preeclampsia, informing individualized clinical treatment. This retrospective cohort study included consecutive preeclampsia patients admitted from January 2023 to December 2025, divided into Labetalol (n = 154) and nifedipine (n = 136) groups. Both received magnesium sulfate as needed, plus aspirin or low-molecular-weight heparin based on platelet count and coagulation function. After 1:1 propensity score matching (PSM), maternal and fetal outcomes were compared. Primary outcomes were maternal complications and neonatal outcomes. Secondary outcomes included uterine artery blood flow, hemodynamics, fetal growth restriction, and adverse drug reactions. Following PSM, baseline characteristics were comparable between the two groups (P > 0.05). Both achieved similar improvements in blood pressure, uterine artery blood flow (S/D, PI, RI), and hemodynamic indicators (plasma and whole blood viscosity, hematocrit) (P > 0.05). The Labetalol Group, compared to the nifedipine Group, had significantly lower rates of postpartum hemorrhage (8.8% vs. 17.0%, P = 0.043) and preterm birth (24.6% vs. 37.3%, P = 0.041), and higher neonatal birth weight (2933.95 ± 803.23 g vs. 2541.35 ± 631.41 g, P < 0.0
Abstract
Preeclampsia seriously threatens maternal and infant health. Antihypertensive therapy is key to improving perinatal outcomes, yet comparative maternal-fetal evidence for oral agents remains limited. To compare maternal-fetal outcomes of oral labetalol versus oral nifedipine in preeclampsia, informing individualized clinical treatment. This retrospective cohort study included consecutive preeclampsia patients admitted from January 2023 to December 2025, divided into Labetalol (n = 154) and nifedipine (n = 136) groups. Both received magnesium sulfate as needed, plus aspirin or low-molecular-weight heparin based on platelet count and coagulation function. After 1:1 propensity score matching (PSM), maternal and fetal outcomes were compared. Primary outcomes were maternal complications and neonatal outcomes. Secondary outcomes included uterine artery blood flow, hemodynamics, fetal growth restriction, and adverse drug reactions. Following PSM, baseline characteristics were comparable between the two groups (P > 0.05). Both achieved similar improvements in blood pressure, uterine artery blood flow (S/D, PI, RI), and hemodynamic indicators (plasma and whole blood viscosity, hematocrit) (P > 0.05). The Labetalol Group, compared to the nifedipine Group, had significantly lower rates of postpartum hemorrhage (8.8% vs. 17.0%, P = 0.043) and preterm birth (24.6% vs. 37.3%, P = 0.041), and higher neonatal birth weight (2933.95 ± 803.23 g vs. 2541.35 ± 631.41 g, P < 0.001). Conversely, the nifedipine Group experienced higher incidences of headache (16.4% vs. 7.3%, P = 0.037) and facial flushing (13.6% vs. 4.6%, P = 0.019). Multivariate Logistic regression identified maternal age ≥35 years, pre-pregnancy overweight/obesity, preeclampsia onset at <34 weeks, primiparity, multiple pregnancy, severe preeclampsia, and pre-gestational diabetes as independent risk factors for adverse maternal-fetal outcomes (all P < 0.05). Both labetalol and nifedipine effectively control blood pressure and improve uteroplacental blood flow and most maternal-fetal outcomes in patients with preeclampsia. Adverse effects (headache and facial flushing) were more commonly observed with nifedipine, whereas labetalol was associated with a lower incidence of preterm birth and postpartum hemorrhage. These findings suggest potential advantages of labetalol in specific outcomes, but causal inferences are limited by the observational study design.