Category: Hypertension
Poster Session I
There is often debate on the optimal management of hypertension in postpartum patients with preeclampsia. It has been suggested that diuretics may aid in achieving blood pressure control. We aimed to conduct a systematic review and meta-analysis of randomized control trials evaluating the use of loop diuretics in the management of postpartum preeclampsia.
Study Design:
A systematic review was conducted using PubMed and EMBASE from inception through 2021 using relevant search terms. Inclusion criteria were randomized control trials (RCT) that studied postpartum patients with preeclampsia and use of oral loop diuretics. We excluded non-RCTs, studies during the antepartum period, and those using non-loop diuretics or non-oral routes of diuretics. A meta-analysis was then performed on loop diuretic vs. control/placebo in patients with postpartum preeclampsia. Clinical characteristics and outcome measures were extracted. Primary outcomes were antihypertensive use postpartum and at discharge. Secondary outcomes were length of stay and maternal morbidity. Meta-analysis was conducted using a random effects model to pool relative risks (RR) and calculate 95% confidence intervals. Heterogeneity was assessed using the I2 value.
Results:
Six randomized control trials met inclusion criteria, for a total of 974 women (treatment n = 488, control n = 486). There were no statistically significant differences found between treatment and control groups in the need for antihypertensive use postpartum (5 studies, n = 590, RR = 0.79, 95% CI 0.57-1.09, I2 = 0%) or at discharge (6 studies, n = 974, RR = 1.02, 95% CI 0.78-1.32, I2 = 58.1%). Additionally, in all studies, there was no statistically significant difference in length of stay between groups (p >0.05) and the rate of maternal morbidity was low (0-6%).
Conclusion:
Loop diuretics do not appear beneficial in the management of postpartum preeclampsia in reducing antihypertensive requirements postpartum or at time of discharge.
Kristyn Esteves, MD (she/her/hers)
MFM Fellow
University of Maryland Medical Center
Laurel, Maryland, United States
Emad Elsamadicy, MD, MS
Assistant Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Karl E. Seif, MD
Maternal Fetal Medicine Fellow
University of Maryland Medical Center
Baltimore, Maryland, United States
Katherine Goetzinger, MD
Director, Perinatal Outcomes
University of Maryland Medical Center
Baltimore, Maryland, United States
Ozhan M. Turan, MD, PhD
University of Maryland Medical Center
Baltimore, Maryland, United States