Methyldopa 50mg/5ml oral solution

ObjectiveConsidering safety and effectiveness of oral antihypertensive agents when treating hypertensive disorders of pregnancy, no preference can be stated between the 3 agents currently available. Therefore, this systematic review and network meta-analysis aims to determine the effects of antenatal treatment with methyldopa, labetalol, or nifedipine for hypertensive disorders of pregnancy regarding maternal or fetal/neonatal morbidity and mortality.Data sourcesOn August 25, 2023, an electronic search in PubMed/Medline, Embase, and CENTRAL was performed.Study eligibility criteriaRandomized controlled trials reporting on perinatal outcomes in hypertensive pregnancies treated with oral antihypertensive agents of interest (methyldopa, labetalol, or nifedipine) or placebo/no treatment were identified.Study appraisal and synthesis methodsQuality assessment was performed using the Cochrane Risk of Bias tool for randomized controlled trials and trustworthiness was assessed with the Trustworthiness in RAndomised Controlled Trials Checklist. Data on our predefined outcomes were extracted and relative risks were calculated in network estimates if possible.ResultsTwenty three trials (3989 women) were included in our network meta-analysis with an overall low-to-moderate quality. Compared to placebo/no treatment, labetalol and methyldopa significantly reduced the incidence of severe hypertension (including 8 studies, relative risk 0.20 [95% confidence interval 0.09-0.48] and 0.44 [0.20-0.99], respectively). In the network meta-analysis, labetalol vs nifedipine was associated with a reduction in preeclampsia (relative risk, 0.50 [0.28-0.87]; 15 studies) and preterm birth (relative risk, 0.68 [0.52-0.90]; 14 studies). No significant differences could be detected for any of the other outcomes of interest.ConclusionWhen comparing the oral antihypertensive agents currently available head-to-head, no significant differences in the primary outcome, severe hypertension, could be detected as well as on most of the secondary outcomes of interest. Considering the preference of labetalol over nifedipine regarding the outcomes preeclampsia and preterm birth, a modest favor for labetalol could be stated. Included studies however were of low overall quality warranting caution when interpreting results.

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ObjectiveTo assess the effectiveness and safety of management strategies for postpartum hypertension.Data sourcesWe searched the Cochrane Pregnancy and Childbirth's Trials Register in collaboration with their Information Specialist, on October 20, 2022. As the Pregnancy and Childbirth Review Group closed (2023), we updated our literature search on September 17, 2024 (topped up on September 25, 2025), using a strategy developed with an information specialist from the Royal College of Physicians, United Kingdom.Study eligibility criteriaWe included randomized controlled trials assessing any intervention (pharmacological, surgical, or models of care) used to reduce maternal blood pressure in participants with postpartum hypertension.Study appraisal and synthesis methodsSearch results were screened independently by 2 authors, with any disagreement resolved by consensus. Data were extracted independently, onto a Cochrane-based bespoke form which included Cochrane's Trustworthiness Screening Tool. Random-effects meta-analysis was performed in RevMan.ResultsOf the 944 studies identified, 40/44 included had informative data. Certainty of evidence was low or very low. There were no safety concerns. In 7 trials (n=1113 participants) of diuretics (primarily furosemide) vs placebo/no therapy, blood pressure control was better with diuretics when administered alongside antihypertensive. In 3 trials (n=96) of antihypertensive vs placebo, data were insufficient to inform effectiveness. In 9 trials (n=865) of antihypertensive (4 types) vs another (3 types) for nonsevere hypertension, additional antihypertensive need was similar in comparisons with either nifedipine or methyldopa, but greater when amlodipine or either enalapril or lisinopril/thiazide were compared with nifedipine. In 8 trials (n=403) of antihypertensive vs another for severe hypertension, blood pressure was lower with diltiazem (vs nifedipine). In 4 trials (n=668) of uterine curettage vs usual care, observed improvements in laboratory parameters were of unclear clinical significance. In 9 trials (n=1263) of models of postnatal care (usually blood pressure self-monitoring/management, N=6) vs usual care, blood pressure was lower 8 months postpartum following blood pressure self-monitoring/management or lifestyle change.ConclusionWhile diuretics may aid in blood pressure control, they cannot be recommended as monotherapy. Evidence guiding the optimal choice of antihypertensive agents remains limited. Of greatest relevance to practice is the effectiveness of: enalapril or amlodipine (vs nifedipine) in controlling blood pressure; and blood pressure self-measurement/management or lifestyle change (vs usual care) in preventing longer-term cardiovascular outcomes.

Abstract licence: CC BY