Throughout her career as a physician in Canada and the U.K., Laura Magee has taken a restrained approach to use of blood pressure-lowering medication in her pregnant patients, fearing that lowering pressure could reduce the flow of blood and vital nutrients to their babies.
But Dr. Magee, a Clinical Professor in the Department of Medicine and the Department of Obstetrics & Gynaecology, has up-ended her own beliefs with an international study being published today in the New England Journal of Medicine.
The 15-country study shows that treating a woman’s elevated blood pressure during pregnancy is safer for her, and safe for her baby. As a result of these findings, Magee and her collaborators recommend normalizing blood pressure in pregnant women.
“Before this study, I was a ‘less tight’ controller,” says Dr. Magee, a specialist in women’s and maternal health. “I was hoping that this approach would be better for the baby, without increasing risks for the mother. However, I was wrong. ‘Less tight’ control, which means allowing blood pressure to be mildly to moderately elevated in pregnancy, is not better for the baby. It’s actually harmful to the mother, who will more often experience levels of blood pressure that increase the risk of stroke. As a responsible maternity care provider, I can no longer justify a ‘less tight’ approach to blood pressure control.”
The study, which tracked the health of 987 women and their newborns at 94 sites around the world, addresses an age-old belief that reducing elevated blood pressure during pregnancy might lead to reduced growth in the womb and worse health at birth.
But normalizing a pregnant women’s elevated blood pressure did not result in poorer outcomes for babies before or after birth. At the same time, allowing the mother’s blood pressure to be mildly to moderately elevated in pregnancy led to more episodes of dangerously elevated blood pressure that increase the risk of stroke and death for the mother during pregnancy.
“Our trial showed that you should treat a mother’s high blood pressure in pregnancy,” said Dr. Magee, a physician at BC Women’s Hospital and Health Centre and a scientist at the Child & Family Research Institute. “This reduces her risk without increasing the risks for her baby.”
L-R: Laura Magee and collaborator Peter von Dadelszen.
The Control of Hypertension in Pregnancy Study, or CHIPS, was designed to study the impact of either ‘less tight’ or ‘tight’ control of high blood pressure during pregnancy on outcomes for the baby and for the mother. The study involved nearly 1,000 women in 15 countries, who were between 14 and 33 weeks pregnant.
The women were randomly assigned to one of two groups. A group of 497 women had ‘less tight’ control with a target diastolic blood pressure of 100 mmHg, while the second group of 490 women had ‘tight’ control with a target diastolic blood pressure of 85 mmHg.
Most of the women in both groups received blood pressure medication at some point in the trial — 77 per cent in the ‘less tight’ group and 94 per cent in the ‘tight’ control group.
The researchers found that the number of babies who died or were admitted for prolonged newborn intensive care was similar between the two blood pressure control groups. Fetal growth was also similar.
“For almost 50 years, there has been major controversy over whether it is safe or dangerous to use blood pressure lowering medications during pregnancy,” said Mark Brown, President of the International Society for the Study of Hypertension in Pregnancy and a Professor at the University of New South Wales. “Following this well conducted CHIPS study, which is one of a very small number of landmark studies in this field, we now have an answer: A lower level of blood pressure lessens the risk of stroke for hypertensive pregnant women without causing any new risk for baby. This will have a direct impact on the health of pregnant women worldwide.”
Quick facts:
- Up to 10 per cent of pregnant women worldwide suffer from hypertension.
- All women with hypertension in pregnancy are at increased risk of poor outcomes for themselves and for their babies. These risks are further increased when women have hypertension before 34 weeks of pregnancy.
- Dr. Magee and study co-author (and husband) Peter von Dadelszen, a Professor in the Department of Obstetrics and Gynaecology, received the prestigious Chesley Award at the 2014 World Congress of the International Society for Study of Hypertension in Pregnancy.