Neonatal Outcomes of Premature Infants Who Were Delivered from Mother with Hypertensive Disorders of Pregnancy and Effects of Antihypertensive Drugs and MgSO4

Bong Sul Suh; Keun Hyeok Ko; Ji Seok Bang; Yeon Joung Oh; Yong Ju Lee; Jung Won Lee; Kon Hee Lee; Tae-Jung Sung

doi:10.14734/kjp.2015.26.3.190

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Suh, Ko, Bang, Oh, Lee, Lee, Lee, and Sung: Neonatal Outcomes of Premature Infants Who Were Delivered from Mother with Hypertensive Disorders of Pregnancy and Effects of Antihypertensive Drugs and MgSO4

Original Article

Korean J Perinatol 2015;26(3):190-199.

Published online: 20 September 2015

DOI: https://doi.org/10.14734/kjp.2015.26.3.190

Neonatal Outcomes of Premature Infants Who Were Delivered from Mother with Hypertensive Disorders of Pregnancy and Effects of Antihypertensive Drugs and MgSO₄

Bong Sul Suh, M.D., Keun Hyeok Ko, M.D., Ji Seok Bang, M.D., Yeon Joung Oh, M.D., Yong Ju Lee, M.D., Jung Won Lee, M.D., Ph.D., Kon Hee Lee, M.D., Ph.D., Tae-Jung Sung, M.D., Ph.D.

Department of Pediatrics, Hallym University Medical Center, Kangnam Sacred Heart, Seoul, Korea

Correspondence to: Tae-Jung Sung, M.D., Ph.D. Department of Pediatrics, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Korea Tel: +82-2-829-5142, Fax: +82-2-849-4469, E-mail: neosung@hallym.or.kr

Received 22 June 2015 Revised 1 September 2015 Accepted 2 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Hypertensive disorders of pregnancy increase morbidity and mortality of fetus and neonates. Recently some studies revealed that antihypertensive agents affected the neonatal outcomes. The aim of this study was to investigate the prognosis of preterm infants delivered from the mothers with hypertensive disorders who were treated with antihypertensive agents and magnesium sulfate.

Methods

This retrospective study was conducted on preterm infants who were delivered from normotensive mother (control, n=436) and antihypertensive drugs +/– magnesium sulfate treated mother (study, n=150) between January 2009 and December 2013. Study group were divided into two groups based on whether they received antihypertensive drugs only (n=110) and additional magnesium sulfate (n=40). We compared the characteristics of mothers and neonatal outcomes.

Results

Study group had shorter gestational age (32.2±3.5 weeks vs. 33.7±3.0 weeks, P=0.000) and lower birth weight (1,810.5 ± 689.2 g, 2,212.1 ± 604.9 g, P=0.000), and higher rate of small for gestational age infants (22% vs 11%, P=0.000). One minute and 5 minutes Apgar score were lower, but duration of hospital days, oxygen supplement and mechanical ventilation were longer in study group. Respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, retinopathy of prematurity, intraventricular hemorrhage occurred more in study group than control. The group treated with magnesium sulfate together with antihypertensive agent had lower 1 minute and 5 minutes Apgar score than the group taken antihypertensive agent only.

Conclusions

Mothers with hypertensive disorders have increased the risk of preterm delivery, low birth weight, and high neonatal morbidity rate. Therefore it is important to predict and manage possible complication. Moreover, if magnesium sulfate is taken, careful neonatal monitoring is needed because of possible low Apgar score.

Keywords: Antihypertensive agents, Magnesium sulfate, Premature infant

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Fig. 1.

Schematic view of study population. Abbreviation: anti-HT, antihy pertensive drugs.

Table 1.

The Demographics and Clinical Characteristics

	HT (n = 150)	Control (n = 436)	P value
Maternal characteristics
Male (%)	84 (56.0)	23 9(55.7)	0.951
Cesarean section (%)	125 (83.3)	279 (64.3)	0.000
Primipara (%)	54 (36.0)	142 (32.7)	0.463
Premature labor (%)	65 (43.3)	185 (42.8)	0.953
Antenatal steroid (%)	90 (62.9)	126 (29.0)	0.000
PROM (%)	25 (16.6)	167 (38.5)	0.000
Clinical chorioamnionitis (%)	38 (25.3)	73 (16.8)	0.023
Histological chorioamnionitis (%)	16 (12.8)	38 (11.6)	0.730
Neonatal demographics
Gestational age (wk)^∗	32.2±3.5	33.7±3.0	0.000
Birth weight (g)^∗	1,810.5±689.2	2,212.1±604.9	0.000
SGA (%)^∗	22 (14.7)	11 (2.5)	0.000
Apgar score at 1 minute^∗	5.5±2.6	6.6±2.5	0.000
Apgar score at 5 minute^∗	7.2±2.1	8.1±2.2	0.000
Length of stay (d)^∗	31.0±29.3	17.3±19.3	0.000
Duration of use of ventilation (d)^∗	4.9±12.7	1.6±6.2	0.000
Duration of oxygen supplement (d)^∗	11.4±24.7	4.1 ±13.7	0.000

^∗ Data presented as mean±SD Abbreviations: HT, hypertension; PROM, premature rupture of membrane; SGA, small for gestational age.

Table 2.

The Demographics and Clinical Characteristics between Treated Groups

	Anti-HT (n=40)	Anti-HT+Mg (n=110)	P value
Maternal characteristics
Male (%)	23 (57.5)	61 (55.5)	0.823
Cesarean section (%)	32 (80.0)	93 (84.5)	0.509
Primipara (%)	13 (32.5)	41 (37.3)	0.590
Premature labor (%)	16 (40.0)	49 (44.5)	0.619
Antenatal steroid (%)	16 (42.1)	74 (70.5)	0.002
PROM (%)	9 (22.5)	16 (14.5)	0.248
Clinical chorioamnionitis (%)	9 (22.5)	29 (26.4)	0.630
Histological chorioamnionitis (%)	3 (8.8)	13 (14.3)	0.416
Neonatal demographics
Gestational age (week)^∗	33.2±3.6	31.9±3.8	0.051
Birth weight (g)^∗	1,982.8±695.4	1,747.8±679.3	0.065
SGA (%)^∗	6 (15.0)	16 (15.0)	0.945
Apgar score at 1 minute^∗	6.3±2.6	5.3±2.5	0.031
Apgar score at 5 minute^∗	7.9±2.1	7.0±2.1	0.032
Length of stay(d)^∗	26.7±25.1	33.0±30.5	0.181
Duration of use of ventilation (d)^∗	2.7±6.5 (0–35, 0.625)	5.7±14.2 (0–81, 0.682)	0.078
Duration of oxygen supplement (d)^∗	7.9 ±18.4 (0–75, 0.414)	12.9±26.8 (0–135, 1.375)	0.205

^∗ Data presented as mean±SD Abbreviations: Anti-HT, antihypertension drugs; PROM, premature rupture of membrane; SGA, small for gestational age

Table 3.

Comparison of Neonatal Morbidities between Two Groups

	HT (n = 150)	Control (n = 436)	P value
RDS (%)	46 (30.7)	61 (14.1)	0.000
BPD (%)	21 (14.7)	19 (4.5)	0.000
Moderate to severe BPD (%)	13 (9.1)	11 (2.6)	0.001
PDA treated (medication±operation)(%)	16 (11.0)	17 (4.0)	0.002
ROP treated with laser (%)	13 (9.0)	10 (2.4)	0.000
NEC (%)	2 (1.4)	10 (2.3)	0.473
IVH (≥ Grade 2) (%)	11 (7.4)	5 (1.2)	0.000
PVL (%)	9 (6.3)	12 (2.8)	0.141
Mortality (%)	8 (5.3)	16 (3.7)	0.381

Abbreviations: HT, hypertension; RDS, respiratory distress syndrome; BPD, bronchopulmonary dysplasia; PDA, patent ductus arteriosus; ROP, retinopathy of prematurity; IVH, intraventricular hemorrhage; PVL, periventricular leukomalacia

Table 4.

Comparison of Neonatal Morbidities between Treated Groups

	Anti-HT (n=40)	Anti-HT+Mg (n=110)	P value
RDS (%)	10 (25.0)	36 (32.7)	0.242
BPD (%)	4 (10.3)	17 (16.3)	0.264
Moderate to severe BPD (%)	3 (7.7)	10 (9.6)	0.576
PDA treated (medication±operation) (%)	4 (10.0)	12 (11.4)	0.534
ROP treated with laser (%)	1 (2.6)	12 (11.4)	0.086
NEC (%)	0 (0.0)	2 (1.9)	0.528
IVH (≥ Grade 2) (%)	1 (2.5)	10 (9.2)	0.151
PVL (%)	0 (0.0)	9 (8.6)	0.053
Mortality (%)	1 (2.5)	7 (6.4)	0.320

Abbreviations: Anti-HT, antihypertension drugs; RDS, respiratory distress syndrome; BPD, bronchopulmonary dysplasia; PDA, patent ductus arteriosus; ROP, retinopathy of prematurity; PVL, periventricular leukomalacia; IVH, intraventricular hemorrhage

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