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The following is a summary of “Oral antihypertensive treatment during pregnancy: a systematic review and network meta-analysis,” published in the April 2025 issue of American Journal of Obstetrics & Gynecology by Hup et al. 

Researchers conducted a retrospective study to examine the effects of antenatal treatment with methyldopa, labetalol, or nifedipine on maternal, fetal, and neonatal morbidity and mortality in hypertensive disorders of pregnancy.  

They performed an electronic search on August 25, 2023, in PubMed/Medline, Embase, and CENTRAL. Randomized controlled trials (RCTs) reporting perinatal outcomes in hypertensive pregnancies treated with oral antihypertensive agents (methyldopa, labetalol, or nifedipine) or placebo/no treatment were identified. Quality assessment was performed using the Cochrane Risk-of-Bias tool for RCTs, and trustworthiness was assessed using the Trustworthiness in Randomised Controlled Trials Checklist. Data on predefined outcomes were extracted, and relative risks were calculated in network estimates when feasible.  

The results showed that 23 trials (3,989 women) were analyzed, with overall evidence quality ranging from low to moderate. Compared to placebo/no treatment, labetalol and methyldopa significantly lowered severe hypertension risk (8 studies), with relative risks of 0.20 (95% CI 0.09–0.48) and 0.44 (0.20–0.99), respectively. In the network meta-analysis, labetalol versus nifedipine was linked to a reduced risk of 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 were observed for other outcomes.  

Investigators concluded that head-to-head comparisons of currently available oral antihypertensive agents did not reveal significant differences in severe hypertension or most secondary outcomes, although a modest preference for labetalol over nifedipine was noted for preeclampsia and preterm birth. 

Source: ajog.org/article/S0002-9378(25)00218-2/fulltext