Improvement in control of maternal blood pressure with use of beta-blockers would be worthwhile only if it were reflected in substantive benefits for mother and/or baby, and none have been clearly demonstrated. The effect of beta-blockers on perinatal outcome is uncertain; the worrying trend to an increase in SGA infants is partly dependent on one small outlying trial. Large randomised trials are needed to determine whether antihypertensive therapy in general (rather than beta-blocker therapy specifically) results in greater benefit than risk, for treatment of mild-moderate pregnancy hypertension. If so, then it would be appropriate to consider which antihypertensive is best, and beta-blockers should be evaluated.
[Note: the seventeen reports in the awaiting classification section of the review may alter the conclusions of the review once assessed.]
The fetal outcome in a randomized double-blind controlled trial of labetalol versus placebo in pregnancy-induced hypertension.
The effects of labetalol were compared with those of placebo in a multicentre randomized double-blind and prospective study of 152 patients with mild to moderate, non-proteinuric pregnancy-induced hypertension. Labetalol in a dose of 100 mg three times daily, increasing to 200 mg three times daily where required, significantly reduced maternal mean arterial pressure. There was some reduction in preterm delivery, neonatal respiratory distress syndrome and jaundice in the labetalol-treated group. Intrauterine growth retardation and neonatal hypoglycaemia occurred with the same frequency in both groups. There were no perinatal deaths. Labetalol appears to be an effective agent in the management of mild to moderate pregnancy-induced hypertension. The data from this study suggest possible advantages and no apparent disadvantages for the fetus during its use.