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• W2062948723 abstract "P von Dadelszen and colleagues1von Dadelszen P Ornstein MP Bull SB Logan AG Koren G Magee LA Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis.Lancet. 2000; 355: 87-92Summary Full Text Full Text PDF PubMed Scopus (399) Google Scholar excluded a study group2Jannet D Carbonne B Sebban E Milliez J Nicardipine versus metoprolol in the treatment of hypertension during pregnancy. A randomized comparative trial.Obstet Gynecol. 1994; 84: 354-359PubMed Google Scholar from their analysis because of disparity with results of other studies, although no obvious methodological flaw is outlined by the investigators. Before accepting the flattering position of “extreme outlier” offered by the investigators, we would like to add a few comments on the results of this meta-analysis and on our own study.Omitting data from statistically outlying trials is not widely accepted. We are surprised that the investigators did not make this choice a priori, but alternatively presented the results including and then excluding our data after showing that the association of fetal growth restriction with fall in mean arterial pressure (MAP) was dependent on omitting this trial.The investigators state that the association of fall in MAP with fetal growth restriction cannot be explained by the type of antihypertensive agent used. However, the deleterious effects of antihypertensive drugs are not limited to their effect on fetal growth. Severe complications—eg, fetal distress and even fetal death—have been observed with some drugs. We believe that such a statement may lead to all treatments being taken as equally harmful or useless.In our study2Jannet D Carbonne B Sebban E Milliez J Nicardipine versus metoprolol in the treatment of hypertension during pregnancy. A randomized comparative trial.Obstet Gynecol. 1994; 84: 354-359PubMed Google Scholar we compared the use of the calcium-channel blocker nicardipine, to β-blocker metoprolol. Nicardipine was chosen for its potent vasodilator effect, potentially beneficial to utero-placental perfusion. Despite a more important decrease in blood pressure, a trend towards higher mean birthweight was observed with nicardipine. We believe that this observation is probably not due to chance alone. In patients on nicardipine, placental resistance as assessed by feto-placental doppler decreased throughout pregnancy in a similar manner to normal pregnancies, whereas doppler remained unchanged in patients on metoprolol. Vascular resistance at 36 weeks gestation was higher in the metoprolol group when compared with the nicardipine group. This difference could account for the lack of decrease in birthweight with nicardipine, despite better blood-pressure control. Moreover, other preliminary reports described a beneficial effect of calcium-channel blockers on fetal growth, though not in patients with hypertension.3Gulmezoglu AM Hofmeyr GJ Calcium channel blockers for potential impaired fetal growth.The Cochrane Library, issue 4. Update Software, Oxford1999Google ScholarAlthough we also believe that an important decrease in maternal blood pressure may be deleterious to the fetus, we think that von Dadelszen and colleagues should be more cautious when suggesting that all treatments are similarly harmful. P von Dadelszen and colleagues1von Dadelszen P Ornstein MP Bull SB Logan AG Koren G Magee LA Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis.Lancet. 2000; 355: 87-92Summary Full Text Full Text PDF PubMed Scopus (399) Google Scholar excluded a study group2Jannet D Carbonne B Sebban E Milliez J Nicardipine versus metoprolol in the treatment of hypertension during pregnancy. A randomized comparative trial.Obstet Gynecol. 1994; 84: 354-359PubMed Google Scholar from their analysis because of disparity with results of other studies, although no obvious methodological flaw is outlined by the investigators. Before accepting the flattering position of “extreme outlier” offered by the investigators, we would like to add a few comments on the results of this meta-analysis and on our own study. Omitting data from statistically outlying trials is not widely accepted. We are surprised that the investigators did not make this choice a priori, but alternatively presented the results including and then excluding our data after showing that the association of fetal growth restriction with fall in mean arterial pressure (MAP) was dependent on omitting this trial. The investigators state that the association of fall in MAP with fetal growth restriction cannot be explained by the type of antihypertensive agent used. However, the deleterious effects of antihypertensive drugs are not limited to their effect on fetal growth. Severe complications—eg, fetal distress and even fetal death—have been observed with some drugs. We believe that such a statement may lead to all treatments being taken as equally harmful or useless. In our study2Jannet D Carbonne B Sebban E Milliez J Nicardipine versus metoprolol in the treatment of hypertension during pregnancy. A randomized comparative trial.Obstet Gynecol. 1994; 84: 354-359PubMed Google Scholar we compared the use of the calcium-channel blocker nicardipine, to β-blocker metoprolol. Nicardipine was chosen for its potent vasodilator effect, potentially beneficial to utero-placental perfusion. Despite a more important decrease in blood pressure, a trend towards higher mean birthweight was observed with nicardipine. We believe that this observation is probably not due to chance alone. In patients on nicardipine, placental resistance as assessed by feto-placental doppler decreased throughout pregnancy in a similar manner to normal pregnancies, whereas doppler remained unchanged in patients on metoprolol. Vascular resistance at 36 weeks gestation was higher in the metoprolol group when compared with the nicardipine group. This difference could account for the lack of decrease in birthweight with nicardipine, despite better blood-pressure control. Moreover, other preliminary reports described a beneficial effect of calcium-channel blockers on fetal growth, though not in patients with hypertension.3Gulmezoglu AM Hofmeyr GJ Calcium channel blockers for potential impaired fetal growth.The Cochrane Library, issue 4. Update Software, Oxford1999Google Scholar Although we also believe that an important decrease in maternal blood pressure may be deleterious to the fetus, we think that von Dadelszen and colleagues should be more cautious when suggesting that all treatments are similarly harmful." @default.
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• W2062948723 title "Fetal growth restriction" @default.
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