Discussion Questions

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  What was the study’s main objective?

  
  
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  What was the study design?

  
  
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  What were the outcomes of interest?

  
  
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  What were the key results?

  
  
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  What were the study’s strengths and weaknesses?

  
  
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  What is confounding by indication?

Chronic hypertension in pregnancy boosts the risk for an array of adverse events, including maternal and fetal mortality. An estimated 1-5% of pregnancies are complicated by this disorder, but Orbach and colleagues note that its incidence can be expected to increase as rates of maternal obesity climb and as women postpone childbearing. The researchers, authors of a new study discussed by Journal Club members, have attempted to determine whether adverse perinatal outcomes occurring in this patient group are the result of the disease or of the drugs used to treat it. Data like these could help resolve which women are the best candidates for medication.

Plentiful data

Might treatment worsen perinatal outcomes? Participants felt that this was a good question, especially in light of the controversy concerning drug treatment of mild hypertension in pregnancy. To assess this question, the authors performed a retrospective cohort design, using a combination of datasets from Southern Israel. One focused on drug prescribing information, while the others focused on demographics, medical conditions during pregnancy and delivery, delivery information, and discharge diagnoses. While the datasets seemed to be robust and include a large number of deliveries, further description would have been helpful; perhaps through references to methodologically-focused papers.

The principle results were as follows. First, untreated hypertension was significantly associated with a host of adverse perinatal outcomes, including preeclampsia, small size for gestational age (SGA), intrauterine growth restriction (IUGR) and preterm birth. Women treated for their hypertension with atenolol or methyldopa in the third trimester of pregnancy also had increased risks for all of these outcomes, and in general, the adjusted odds ratios were higher than those seen for women with untreated hypertension.