医薬品相互作用研究

Vol.36, No. 1（2012）29（29）

医薬品相互作用研究
一
般論
文
36（1） 29-37 （2012）

Evaluation of pharmacotherapy for pregnancy-induced hypertension
Kazuko UEMATSU1,4）, Eiko KOBAYASHI1）, Emi KATSUMOTO1）
Mitsuhiro SUGIMOTO2）, Tadashi KAWAKAMI3）
Tomoko TERAJIMA4）, Kayoko MAEZAWA4）, Junko KIZU4）1）

Department of Pharmacy Japanese Red Cross Medical Center,
Department of Obstetrics and Gynecology Japanese Red Cross Medical Center3）
Department of Neonatology Japanese Red Cross Medical Center
4）
Department of Practical Pharmacy, Keio University Faculty of Pharmacy

2）(Received April 5, 2012；Accepted June 7, 2012)

Purpose：The purpose of this study was to survey the use of hypotensive agents, for the treatmentof pregnancy-induced hypertension (PIH), and to examine the neonatal and neonatal patient characteristics and prognoses.
Methods：A retrospective investigation was conducted by the use of medical records for all deliveries between 2006 and 2010 at the Japanese Red Cross Medical Center .
Results：The maternal age, Cesarean section rate, and proportion of underweight neonates weregreater in women with PIH than that in the overall study population. Labetalol hydrochloride and anifedipine sustained-release preparation were administered as the hypotensive agents of choice before
and after delivery. The overall incidence of PIH during the study period was approximately 4%, and thisdid not change markedly from year-to-year. However, there were increases in the maternal age andproportion of patients receiving hypotensive agents. The birth weight of the infants also increasedslightly, and there was a decrease in the neonatal admission rate during the study period.
Conclusions： Administration of hypotensive agents such as labetalol hydrochloride and a nifedipine
sustained-release preparation for PIH during pregnancies may improve neonatal prognoses.

Key Words: Perinatal statistics, Pregnancy-induced hypertension, Hypotensive agents, Labetalol hydrochloride, Nifedipine

Introduction

super-perinatal center) in March 2009. Since then,In August 2000, the Japanese Red Cross Medical

pregnant women requiring critical care have also

Center was authorized as a “Baby Friendly Hospitalbeen admitted for care under the direction of critical(BFH),” by the United Nations Children Fundcare staﬀ.

(UNICEF) and the World Health Organization (WHO).

Statistical reports published by the Japanese

In November 2001, the hospital was also authorized

Ministry of Health, Labour and Welfare1) haveas a perinatal medical center by the Tokyo

indicated that the birth and perinatal mortality rates

Metropolitan Government; the same agency

are decreasing every year in Japan. At the same time

subsequently designated the hospital as a perinatal

decreases in the numbers of obstetricians andmedical center for maternal critical care (aobstetric clinics/hospitals, coupled with older

Department of Pharmacy Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
Department of Obstetrics and Gynecology Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
3）
Department of Neonatology Japanese Red Cross Medical Center，4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
4）
Department of Practical Pharmacy, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan.
*E-mail: kizu-jn@pha.keio.ac.jp1）2）

30（30）

医薬品相互作用研究

Vol.36, No. 1（2012）

mothers giving birth, have markedly increased the

additional hospital care), based on medical records.

number of high-risk patients. As a result, the number

Furthermore, the mothers were also classiﬁed withof pregnant women requiring drug therapy has

respect to the underlying disease resulting in theincreased in the major hospitals. In response to this

hypertension, the severity of their hypotension, andtrend, “Guidelines for the Management of

the timing of onset, according to the Guidelines forPregnancy-Induced Hypertension (PIH)” 2 ) were

the Management of Pregnancy-Induced

established by the Japan Society for the Study ofHypertension. Pregnant women with DownʼsHypertension in Pregnancy in 2009.

Syndrome and those delivering multiple children

In this study, we aimed to survey the use of

were excluded from the study.

hypotensive agents, for the treatment of PIH, and to
examine the neonatal and neonatal patientcharacteristics and prognoses.

Results
１. Total delivery count and PIH patients
There were a total of 12,140 deliveries between
2006 and 2010. The number of deliveries increased

Methods

every year, as did the number of patients with PIH.

Maternal characteristics (age, primipara/multipara,

However, the overall incidence of PIH wasand delivery type (normal or Cesarean section) anda p p r o x i m a t e l y 4 % i n e a c h y e a r. A d v a n c e d a g ebirth weights of the babies were extracted from the(deﬁned as women ≧ 35 years old) was more

hospital records of women who delivered a baby incommon in PIH patients (50%‒60%) than in the total

the hospital between 2006 and 2010. In addition, for

population of women delivering children within themothers diagnosed with PIH and their neonates, thestudy perio d. The primiparity rate was similars t u d y e x a m i n e d t h e u s e o f h y p o t e n s i ve a g e n t s

between women experiencing PIH and those who did

administered to mothers (before, during, and afternot. However, the numbers of Cesarean sections anddelivery) and the subsequent neonatal observations

underweight neonates were higher in PIH patients(Apgar score, umbilical cord venous blood pH, and(Table 1, 2 ).

Table 1. Total deliveries and pregnancy-induced hypertension statistics (PIH)*

Total number of deliveries

2006 2007
2129 2331

2008
2478

2009 2010
2477 2725

Proportion of advanced-age mothers (%)

35.2

37.4

35.3

36.5

40.2

Proportion of primiparas (%)

63.4

62.5

59.5

60.5

63.3

Cesarean section rate (%)

19.2

19.9

20.6

18

19.1

Proportion of low-birth-weight neonates (%)

13.6

13.9

13

12.1

12.7

Number of patients with PIH

78

82

94

106

105

Incidence of PIH (%)

3.7

3.5

3.8

4.3

3.9

Proportion of advanced-age mothers (%)

60.3

48.8

53.2

56.6

62.9

Proportion of primiparas (%)

62.8

63.4

64.9

63.2

71.4

Cesarean section rate (%)

38.5

51.2

48.9

34.9

54.3

Proportion of low-birth-weight neonates (%)

42.3

42.7

38.3

26.4

35.2

* These statistics exclude women who delivered multiple children
1 Advanced age defined as those mothers 35 years old
2 Low-birth-weight neonate defined as a birth-weight < 2,500 g

医薬品相互作用研究

Vol.36, No. 1（2012）

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Table 2. Comparison of women diagnosed with and without pregnancy-induced hypertension (PIH)

Number of patients

P value

PIH

non-PIH

Advanced-age at time of delivery

263

4493

<0.05

Proportion of primiparas

303

7501

NS

Cesarean sections

212

2346

<0.05

Proportion of low-birth-weight neonates

169

1580

<0.05
2

２. Use of hypotensive agents in PIH patients-test

therapeutic drug administration was also examined.

Of the 465 patients diagnosed with PIH,

The proportion of patients who received these agentsh y p o t e n s i ve a g e n t s w e r e a d m i n i s t e r e d t o 3 4 8

before, during, and after delivery was the highest(74.8%), with the annual percentage rate increasing(28%), followed by patients who received them only

over the 5-year study period (Table 3). In patients

before and after delivery (24%) (Figure 1).

treated w ith hypotensive agents, the t iming of
Table 3. Use of hypotensive agents in patients with pregnancy-induced hypertension (PIH)

Year

2006

2007

2008

2009

2010

Total

PIH patients (n)

78

82

94

106

195

465

Treatment with hypotensive agents (n)

50

63

66

82

87

348

Proportion of patients receiving hypotensive agents (%)

64.1

76.8

70.2

80.2

82.9

74.8

Figure 1. Timing of treatment with hypotensive agents (2006‒2010)(n = 348)

32（32）

医薬品相互作用研究

Vol.36, No. 1（2012）individuals. Marked proteinuria was noted in 50 of

３. Type of hypotensive agents and maternal side
eﬀectsthese individuals, and protein was absent from the

Combination therapy with labetalol hydrochloride

urine of 115 patients. The severity of hypertension

and a nifedipine sustained-release preparat ion

was evaluated as mild in 247 patients. In these(Adalat® L) was the most commonly administeredpatients, marked proteinuria was noted in only 6

therapy. However, the number of labetalol

individuals, and protein was absent from the urine ofhydro chloride ( Trandate®) doses administered

186 individuals. PIH occurred during the early phase

before delivery increased each year. During delivery,of pregnancy in most patients with severe

nicardipine hydrochloride injection (Perdipine®) was

preeclampsia. However, in the other patients, it

the most commonly administered therapeutic,

occurred most often during late phase . There wasfollowed by magnesium sulfate injection (Magnesol®,no speciﬁc annual tendency (Table 5).

Magsent®), which was employed to prevent
eclampsia. In a few patients, a combination therapy

５. Patients with eclampsia

was administered. After delivery, the number ofEclampsia was observed in only 4 individuals withadministered doses was similar between labetalol

PIH, whereas pregnancy-related eclampsia was nothydrochloride and the nifedipine sustained-releaseobserved in any patient. Eclampsia during labor was

preparation (Table 4).

noted in 3 patients, and puerperal eclampsia in 1; all

There were no serious maternal side eﬀects

4 patients were having their ﬁrst pregnancy (Table

associated with the use of the hypotensive agents

6). Two of the 3 patients experiencing eclampsia

described in the patient records. However, the mostduring labor did not receive a hypotensivie agent.

commonly observed mild side eﬀects consisted of

These 2 patients experienced a rise in blood pressurelabetalol hydrochloride-related dizziness (3during Phase I of delivery, leading to a convulsive

episodes), increase in the hepatic enzyme level (1attack, and resulting in emergency Cesarean sections

episodes), malaise (1 episodes), nifedipineb e i n g p e r f o r m e d . T h e t h i r d p a t i e n t r e c e i ve d asustained-release preparation-related headaches (16hypotensive agent before and during delivery. In

episodes), dull headaches (4 episodes), dizziness (4spite of this treatment, a convulsive attack occurred

episodes), facial discomfort (1 episodes), ﬂare of theduring Phase II of delivery, and vacuum extraction

face (1 episodes), hot ﬂushes/sweating (1 episodes),delivery was conducted. In the patient with puerperal

palpitation increase in the hepatic enzyme level (1eclampsia, an emergency Cesarean sect ion for

episodes).

placental abruption was performed at Week 27 ofpregnancy and a convulsive attack occurred 8 hours
after surgery. In all patients with eclampsia, the

４. Disease type and severity
Of the 465 patients diagnosed with PIH, thematernal and neonatal prognoses were favorable.

hypertension severity was recorded as severe in 206
Table 4. Type of hypotensive agent, timing, and number of doses administered to patients with pregnancy-induced hypertension
TimingBefore delivery

Hypotensive agent
Monotherapy

Labetalol hydrochloride
Nifedipine sustained-release preparation-Methyldopa
Hydralazine

Combination therapy

Labetalol hydrochloride + nifedipine sustained-release preparation

Monotherapy

Nicardipine injection

Combination therapy

Magnesium sulfate injection + nicardipine injection

OthersDuring delivery

Magnesium sulfate injection
After delivery

Monotherapy

Labetalol hydrochloride
Nifedipine sustained-release preparation
Nifedipine once-a-day sustained-release preparation

Combination therapy

Labetalol hydrochloride + nifedipine sustained-release preparation ,OthersYear

2006 2007 2008 2009 2010
15
22
24
35
35
4
0
3
0
2
1
1
1
0
1
0
0
1
0
1
9
8
8
10
22
0
1
1
1
0
18
19
6
16
16
6
13
10
15
10
2
4
6
8
4
18
27
31
19
15
10
9
14
32
46
0
1
0
2
6
5
15
10
9
7
2
4
0
1
1

Total

131
9
4
2
57
3
75
54
24
110
111
9
46
8

医薬品相互作用研究

Vol.36, No. 1（2012）

33（33）

Table 5. Disease type, severity, and timing of onset in patients with pregnancy-induced hypertension
Severity
Disease type

Preeclampsia

Bloodpressure

Proteinuria

SevereSevereNumber of
episodesTiming of
onset

50

Early

2006

2007

2008

2009

2010

Total

Late

6
2
3
5
0
1
3
7

6
5
1
4
1
1
3
10

3
10
0
4
0
2
1
15

1
2
5
5
0
1
0
5

11
4
0
14
0
0
1
10

27
23
9
32
1
5
8
47

Late
Severe

Mild

41

Early

Mild

Severe

6

Early

Mild

Mild

55

Early

Late
Late

Hypertension inpregnancy

SevereAbsent

115

Early

3

4

8

7

2

24

Late
Mild

Absent

186

Early

16
2
29

13
4
27

14
1
34

34
4
40

14
3
42

91
14
172

Late
Superimposed preeclampsia

8

1

2

2

1

2

8

Eclampsia (Refer to Table 6.)

4

0

1

0

1

2

4

1
Patients with superimposed preeclampsia: 1 patient with IgA nephropathy, 1 with nephrotic syndrome, 1 with glomerular nephritis, and 5 with essential
hypertension

Table 6. Patients with eclampsia (2006‒2010)

Drug therapy

1

Gestational age
on delivery

Primipara/multipara

Diagnosis

Admission
management

39 w 0 d

Primipara

Eclampsia
during delivery

0day(Transport)

Before delivery

During delivery

After delivery

None

Magnesium sulfate
injection

Labetalol tablets
Nifedipine sustained-releasetablets

2

40 w 6 dPrimipara

Eclampsia
during delivery

3

27 w 6 dPrimipara

Puerperal
0day (Transport
eclampsia (afteras an emergency)
8 hours of delivery)

10 days

Labetalolhydrochloride
tablets
Labetalolhydrochloride
tablets

Nicardipine injection

Nifedipine sustained-releasetablets

Magnesium sulfate
injection

Nifedipine sustained-releasetablets
At the onset of eclampsia
attacks: Magnesium sulfate
injection

4

41 w 4 d

Primipara

Eclampsia
during delivery

4 daysNone

Emergency Cesarean
section for eclampsia
attacks
Diltiazem
Propofol
Fentanyl
Midazolamw = weeks; d = days

Nifedipine sustained-releasetablets (systolic bloodpressure: 120 mmHg or more)34（34）

医薬品相互作用研究

Vol.36, No. 1（2012）section rate was also the highest in preeclampsia

６. Neonatal ﬁndings in PIH patients
Annual changes were not observed in the average

pat ients w ith severe hypertension and marked

neonatal Apg ar scores or in the umbilical cord

proteinuria. The neonates also did not demonstratevenous blood pH levels. However, the maternal age

any marked diﬀerences in the umbilical cord venous

and neonatal birth weights increased slightly. The

blood pH. However, the Apgar score was lower inpost-delivery admission rate of the neonates

i n f a n t s d e l i ve r e d t o m o t h e r s w h o e x p e r i e n c e ddecreased over the time period of the study (Table

preeclampsia with severe hypertension and marked

7). When comparing the neonatal observations inproteinuria. Additionally, the neonatal birth weight in2006 with those in 2010, there were no signiﬁcant

this group was less than 2,000 g, and these neonatesdiﬀerences in any of the parameters. However,

had the highest hospital admission rate. The

despite a 1-year rise in the average maternal age, theproportion of patients receiving hypotensive agents

average pregnancy period increased by 0.5 weeks,

before, during, and after delivery was higher in theand the birth weight increased by 100 g or moremothers with severe hypertension. However, in(Table 8).

mothers experiencing mild hypertension,
approximately 30% of the patients also received
hypotensive agents before delivery, and 40%‒60%

７. Type/severity of PIH and neonatal ﬁndings
The maternal and neonatal characteristics areafter delivery. In spite of the perinatal administration

shown in conjunction with the use of hypotensiveof hypotensive agents to their mothers, none ofagents in each patient group (Table 9). There were

neonates demonstrated a related adverse event.

no marked diﬀerences in maternal age; however, the(Table 9 and 10).

gestational age on delivery was less in preeclampsia
patients with severe hypertension. The Cesarean

Table 7. Neonatal characteristics (single pregnancy) in patients with pregnancy-induced hypertension
Maternal age(years)Gestational age(weeks)

77

34.4

3.6

36.8

3.2

2426.7

715.0

8.2

1.2

8.4

1.8

7.30

0.06

34.6

82

34.4

4.1

36.8

2.9

2499.2

720.3

8.4

1.0

8.7

1.2

7.28

0.05

34.1

2008

94

35.1

3.4

37.3

2.5

2530.0

583.4

8.4

0.9

9.2

0.8

7.31

0.04

23.4

2009

104

34.8

3.8

37.6

2.3

2673.0

572.9

8.3

1.0

9.0

1.1

7.31

0.05

22.6

2010

104

35.4

3.8

37.3

2.8

2562.6

615.4

8.1

1.0

9.1

0.9

7.30

0.05

Year

Number ofpatients

2006
2007

1

AP1: Apgar score at 1 minute2

AP5: Apgar score at 5 minutes

Birth weight(g)Umbilical cord
venous blood pH

AP5

AP1

Neonatal admission rate
(%)

21.9

Mean

Table 8. Comparison of neonatal characteristics in 2006 with those in 2010Maternal age (years)
Gestational age (weeks)
Birth weight (g)AP1AP5Umbilical cord venous blood pH
1

AP1: Apgar score at 1 minute2

AP5: Apgar score at 5 minutes

2006 (n=77)
34.4
3.6
36.8
3.2
2426.7
715.0
8.2
1.2
8.4
1.8
7.30
0.06

2010 (n=104)
35.4 3.8
37.3 2.8
2562.6 615.4
8.1 1.0
9.1 0.9
7.30 0.05
Mean

S.D.

P value

0.15
0.41
0.27
0.92
0.04
0.82
Student’s t-test

p<0.05S.D.

医薬品相互作用研究

Vol.36, No. 1（2012）

35（35）

Discussion

selected hypotensive agents. This is in spite of αThis study served as survey of PIH, as a-methyldopa and hydralazine being the recommended

pregnancy-related disorder, between 2006 and 2010 atﬁrst-choice agents in the 2009 PIH managementa major Japanese hospital. The PIH management

guidelines, which were based on the results of aguidelines indicate that “the continuation of pregnancy

large-scale study 3) and meta-analysis 4) . The dose ofwith drug administration prolongs the pregnancy

labetalol hydrochloride was 150‒300 mg/day, and that

period, and promotes fetal growth compared to positiveof the nifedipine preparation was 20‒40 mg/day.

2)

delivery induction” . The incidence of PIH in the total

Before delivery, monotherapy with labetalol

number of pregnancies during the 5-year study periodhydrochloride was administered in the highest

was approximately 4%, and did not show any marked

proportion of patients, followed by combination

changes over time. However, the proportion of patients

therapy with labetalol hydrochloride and a nifedipine

receiving hypotensive agents increased. This may

sustained-release preparation. After delivery, thereﬂect an increase in the number of severe PIH

number of patients receiving monotherapy withpatients, as drug therapy is primarily selected for thesesustained-release nifedipine was larger. In patientspatients. Despite an increase in the average maternalrequiring long-term control, a once daily nifedipine

age over the study period, a prolongation of thesustained-release preparation (Adalat® CR) was

pregnancy period, an increase in the birth weight, and aselected for an increasing number of patients. In

decrease in the neonatal admission rates were noted,

addition, a long-lasting calcium antagonist, amlodipine

suggesting that PIH control, including drug therapy,

besilate, and the angiotensin II receptor blockers

improved neonatal outcomes.

(ARBs), candesartan and valsartan, were also employed.

The results showed that labetalol hydrochloride and

The increasing use of once daily calcium antagonists

sustained-release nifedipine were the most commonly

may have been the result of the publication of

Table 9. Severity of pregnancy-induced hypertension and neonatal characteristics (2006‒2010)
Severity
Disease type

Preeclampsia

Hypertension
in pregnancy

NumberofepisodesMaternal age(years)Gestationalage (weeks)

Cesareansectionrate (%)

Proportion of patients receiving
hypotensive agents (%)
BeforedeliveryDuringdeliveryAfterdelivery

Birth weight (g)AP1Umbilical cord
venous blood pH

AP5Neonatal
admission
rate (%)

Bloodpressure

Urinary
protein

SevereSevere

50

34.3

5.3

33.6

4.3

80.0

74.0

52.0

88.0

1765.2

828.1

7.6

1.7

9.0

0.6

7.30

0.06

64.0

SevereMild

Mild
Severe

41
6

34.9
32.8

4.2
2.9

35.6
37.7

4.2
1.4

46.3
50.0

48.8
33.3

58.5
16.7

78.0
66.7

2232.32662.5

875.4
579.0

8.1
8.8

1.8
0.4

9.4
9.3

0.9
0.5

7.29
7.34

0.07
0.06

31.7
16.7

Mild

Mild

55

34.6

4.6

37.1

3.7

45.5

27.3

23.6

45.5

2481.9

864.1

8.5

1.2

8.8

2.6

7.29

0.05

30.9

SevereAbsent

115

35.7

4.4

37.6

3.0

45.2

49.6

53.9

75.7

2626.2

691.8

8.4

1.3

9.4

0.7

7.30

0.08

25.2

Mild

Absent

186

34.6

5.1

38.5

2.5

30.1

36.6

21.0

43.5

2849.1

605.6

8.6

1.2

9.4

1.3

7.30

0.08

14.5

1

AP1: Apgar score at 1 minute2

AP5: Apgar score at 5 minutes

Mean

S.D.

Table 10. Comparison of neonatal characteristics from the severe blood pressure patients in 2006 with those in 2010Maternal age (years)
Gestational age (weeks)
Birth weight (g)AP1AP5Umbilical cord venous blood pH
12

AP1: Apgar score at 1 minuteAP5: Apgar score at 5 minutes

2006 ( n=36 )
34.4
5.1
35.3
4.5
2126.8
878.2
7.8
2.2
7.7
3.6
7.271
0.125
Mean

S.D.

2010 ( n=49 )
36.0
4.3
35.9
4.2
2250.7
859.8
8.2
1.2
9.3
0.9
7.308
0.050

P value

0.16
0.56
0.51
0.41
0.03
0.16

Student’s t-test *p<0.05

36（36）

医薬品相互作用研究

Guidelines for Hypertension Treatment5). The relatively

Vol.36, No. 1（2012）

should also be emphasized.

low-level use of ARBs may be the result of their being

In some patients with PIH, kidney hypofunction has

contraindicated due to fetal toxicity caused by abeen observed7); caution is needed when administering

decrease in the amniotic ﬂuid volume in the second toagents where the primary route of clearance is throughthird pregnancy trimesters.

the kidney. When urinary protein is present, the blood

The hypotensive agents used in this study did notalbumin level decreases slightly. Therefore, the plasma

have any serious side eﬀects in the mothers, and nolevel of an agent that is highly protein bound may

side eﬀects were reported in the neonates. However,increase, resulting in an increased level of thethe primary maternal side eﬀects included labetalol

compound being bio-available. The protein binding ratehydrochloride-related dizziness and nifedipine-relatedof labetalol hydrochloride is 50%, and this agent isheadaches and dizziness; the headaches were diﬃcult

excreted in the kidney; therefore, monitoring kidney

to distinguish from those related to blood-pressurefunction is important. Furthermore, the protein binding

increases.

rate of nifedipine ranges from 92%‒98%, alsoThis survey revealed that, over the 5-year period, thesuggesting that caution is needed when there is a

gestational period in mothers with preeclampsia wasdecrease in the blood albumin level. Nifedipine,less in those with severe hypertension in pregnancy,

however, is almost completely metabolized in the liver;and the rate of Cesarean sections was also higher than

only a trace of the original compound is excreted in thethat in the overall study population. The birth weight ofkidney. Both agents may deteriorate kidney function

neonates delivered to mothers with preeclampsia wasvia a decrease in the renal reﬂux pressure related to aalso lower. These results were similar to those of afall in blood pressure. Liver dysfunction must be

previous study 6 ) that found that the prognoses forconsidered8) 9).

women and neonates were less favorable when the

During the survey period, the package inserts of bothmother exhibited hypertension with proteinuria thanlabetalol hydrochloride and the nifedipine preparations

when hypertension, alone, was observed. Similarly, theindicated that these agents were contraindicated for

current study demonstrated that the neonatal

use in pregnant women. However, this contraindication

admission rate was the highest in preeclampsia

was removed in June 2011, after the conclusion of thispatients with severe hypertension. The major reasonsstudy. As a result, the 2 agents will likely be

for neonatal admission included low birth weight (mostadministered to an increasing number of patients. As

neonates), meconium aspiration syndrome, apparent

the 2 agents were previously contraindicated forneonatal death, and heart disease. The proportions ofpregnant women, information on their use in pregnant

patients receiving hypotensive agents before, during,and lactating women has been minimal. Therefore, toand after delivery were also higher in the severe

ensure the safety of these drugs during pregnancy andhypertension group. However, in the mild hypertension

lactation, additional data should be collected. The

group, a substantial proportion of patients also

current 5-year survey involved only a single hospital.

received hypotensive agents. It was shown that, even

However, the results suggest that the control of PIH,

when hypertension was mild, hypotensive agents were

including its management using drug therapy, is useful.

administered to prevent blood pressure changes andDisclosure

eclampsia during pregnancy, during delivery, and after
delivery.
During the survey period, there were 4 episodes ofThis study was an unsponsored epidemiologicalinvestigation.

eclampsia. In addition to blood pressure rises during
pregnancy, an increase in the cerebral pressure, related

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