| Pharmacodynamics of clonidine therapy in pregnancy: a heterogeneous maternal response impacts fetal growth. | |
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MedLine Citation:
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PMID: 20725050 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Clonidine, a centrally acting antihypertensive agent, has been used successfully in pregnancy. We sought to describe the pharmacodynamic effects of clonidine in pregnancy and the associated impact on fetal growth. METHODS: A retrospective cohort study was performed. Maternal hemodynamics were measured before and after treatment. Responses to clonidine were categorized by the predominant hemodynamic effect: decreased vascular resistance, decreased cardiac output (CO), or mixed. Multinomial logistic regression was used to evaluate predictors of hemodynamic response to clonidine and association between response group and birth weight. RESULTS: Sixty-six pregnant women were studied. Treatment was associated with a reduction of mean arterial pressure (MAP) (-9.2 mm Hg, P < 0.001), a reduction in total peripheral resistance (TPR) (-194 dyne·cm·sec⁻⁵, P < 0.001), and an increase in CO (+0.5 l/min, P < 0.001). The hemodynamic response was characterized by decreased resistance in 34 women; decreased CO in 22; and mixed effect in 10. No maternal demographic characteristics were associated with a reduction in CO. Mean birth weight percentile was lower in the group that experienced a reduction in CO compared to the group with a reduction in vascular resistance (26.1 vs. 43.6, P = 0.02). The rate of birth weight <10th percentile was also higher in the group experiencing decreased CO (41 vs. 8.8%, P = 0.008). CONCLUSIONS: The hemodynamic effect of clonidine in pregnancy is heterogeneous. The category of effect, reduction in vascular resistance vs. reduction in CO, significantly impacts fetal growth. A reduction in heart rate (HR) after therapy identifies pregnancies at risk for reduced fetal growth. |
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Authors:
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Sophia Rothberger; Darcy Carr; Debra Brateng; Mary Hebert; Thomas R Easterling |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2010-08-19 |
Journal Detail:
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Title: American journal of hypertension Volume: 23 ISSN: 1941-7225 ISO Abbreviation: Am. J. Hypertens. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-19 Completed Date: 2011-01-31 Revised Date: 2011-11-01 |
Medline Journal Info:
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Nlm Unique ID: 8803676 Medline TA: Am J Hypertens Country: United States |
Other Details:
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Languages: eng Pagination: 1234-40 Citation Subset: IM |
Affiliation:
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Department of Obstetrics and Gynecology, University of Washington, Seattle, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Antihypertensive Agents / administration & dosage* Birth Weight / drug effects Blood Pressure / drug effects Cardiac Output / drug effects Clonidine / administration & dosage* Cohort Studies Female Fetal Development / drug effects* Fetal Growth Retardation / drug therapy* Heart Rate / drug effects Humans Hypertension, Pregnancy-Induced / drug therapy* Infant, Newborn Pregnancy Pregnancy Outcome Retrospective Studies Risk Factors Vascular Resistance / drug effects Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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U10HD047892/HD/NICHD NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Antihypertensive Agents; 4205-90-7/Clonidine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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