Comparative efficacy and safety of antihypertensive agents in preeclampsia and gestational hypertension uncontrolled and their long-term effects on offspring

Background: Hypertensive disorder of pregnancy (HDP), a common obstetric complication that seriously threatens maternal and infant health. The current clinical treatment drugs include methyldopa, calcium channel blockers, etc. In order to provide evidence-based medicine for the treatment and medication of gestational hypertension, this study compared the efficacy and safety of different drugs in the treatment of gestational hypertension through network meta-analysis. Methods: Search and select relevant articles in the published and unpublished available data from Controlled Trials, PsycINFO, CINAHL,, etc. To assess the efficacy and safety of HDP treatment, 4 primary outcomes [SBP, DBP, perinatal fetal deaths, and NICU cases] and 9 secondary outcomes were selected. Results: 50 articles with 8212 participants were included. Low molecular weight heparin (LMH), Labetalol + LMH and Labetalol + Methyldopa can reduce DBP, and Ambrisentan + Methyldopa can prevent the occurrence of severe hypertension. Methyldopa and Atenolol were associated with lower rates of preterm birth, and Nifedipine, Methyldopa as well as Labetalol reduced the incidence of placental abruption. Ambrisentan + Nifedipine, Methyldopa, Labetalol + Nimodipine, Labetalol + LMH, Labetalol and LMH significantly reduced the incidence of postpartum complications. Magnesium sulfate (SM) and SM+ LMH can prolong the mean gestational age, LMH and Kethyldopa can reduce perinatal fetal death. Conclusions: LMH, labetalol, Methyldopa, labetalol in combination with LMH, and labetalol in combination with Methyldopa have better efficacy and safety.