Labetalol therapy in pregnancy induced hypertension: the effects on fetoplacental circulation and fetal outcome

Modulatory effect of ginger on skeletal malformations, cell cycle, apoptosis and structural changes in the liver of rat fetuses prenatally exposed to labetalol

Background

Drug-induced liver damage with clinical symptoms has been related to labetalol in a number of instances. In addition to having a wide range of anti-inflammatory and antioxidant qualities, ginger also includes biotrace that are crucial in the fight against disease and skeletal deformity. In this study, we hypothesized that prenatal supplementation of ginger (200 mg/kg) attenuates skeletal malformation and hepatotoxicity mediated by labetalol during the organogenesis period. The tested dams were divided into four groups: control, ginger (200 mg/kg), labetalol (300 mg/kg) and combined group (labetalol and ginger at the same doses).

Results

The labetalol group showed various skeletal abnormalities represented by mandibular hypoplasia, costal separation and retardation in the ossification. Histological and ultrastructural examination of the fetal liver tissue revealed multiple pathological changes. DNA damage, G0/G1 cell cycle arrest and a high percentage of apoptosis were also detected in the fetal hepatocytes from labetalol groups through gel electrophoresis and flow cytometry using PI and annexin V/PI methods, respectively. Administration of ginger after labetalol caused an evident decrease in these skeletal malformations, structural changes, DNA damage, apoptosis and G0/G1 cell cycle arrest.

Conclusions

It can be concluded that ginger has great potential in attenuating the skeletal malformation, structural changes and cyto-genotoxicity of fetal hepatocytes upon prenatal exposure to labetalol.

Ginger extract attenuates labetalol induced apoptosis, DNA damage, histological and ultrastructural changes in the heart of rat fetuses

Labetalol is a medication used to treat maternal hypertension during pregnancy. However, it is often associated with many side effects. Recently, several studies have been focused on the protective effect of medicinal plant extracts, such as ginger, against drugs inducing toxicity. Therefore, it has been hypothesized that ginger aqueous extraction can ameliorate labetalol-induced histological, ultrastructural changes, DNA damage, and apoptosis in fetal heart tissue. To achieve the aim of this study, sixty pregnant female albino rats were divided into 4 groups (15 each). Group I (Control). Group II received ginger (200 mg/kg). Group III received labetalol (300 mg/kg). Group IV received labetalol first followed by ginger. All groups were orally injected daily during the organogenesis phase of gestation i.e., from the 6th to the 15th day, and sacrificed at the 20th day of gestation. Results showed that labetalol-induced marked histological and ultrastructural alterations. Also, there was severe DNA damage and an increase in the apoptotic rates determined by Annexin-V/PI dual staining assay. Injection of the ginger aqueous extract caused evident improvement in cardiac tissue, DNA damage, and apoptotic rates. In conclusion, the results suggest that ginger extract could be a potential candidate agent for reducing labetalol-induced cardiotoxicity in the fetal heart of albino rats.

Oral nifedipine versus intravenous labetalol in hypertensive urgencies and emergencies of pregnancy: a randomized clinical trial

BACKGROUND

Hypertensive crisis is an important cause of maternal and perinatal morbidity and mortality.

AIM

To compare the efficacy of oral nifedipine and intravenous labetalol.

MATERIALS AND METHODS

One hundred women with hypertensive crisis were randomized to receive either oral nifedipine 10 mg or intravenous labetalol 20 mg. Oral nifedipine was given 10 mg stat followed by 10 mg every 30 minutes up to a maximum of 50 mg. Intravenous labetalol was given 20 mg stat followed by 40 mg 30 minutes later then two more doses of 80 mg every 30 minutes up to a maximum of 220 mg. The primary outcome was the number of doses required to achieve target blood pressure (BP) and time required to reduce the mean arterial pressure by 25%. Secondary outcomes analysed included additional drugs required, resurgence of hypertensive crisis. Data were analysed using repeated measures analysis of variance (ANOVA), mixed ANOVA, unpaired t-test and chi square test and P value ≤0.05 was considered significant.

RESULTS

Systolic (SBP), diastolic (DBP) and mean arterial blood pressure (MAP) were lower than baseline at all time points of follow-up in both nifedipine and labetalol groups (P < 0.01). P < 0.05 by repeated measures ANOVA for overall trend of changes in SBP, DBP and MAP for within-group effects in both nifedipine and labetalol groups and P < 0.05 by mixed ANOVA for between-group effects during entire observation period. The magnitude of fall in SBP, DBP and MAP was greater in the labetalol group compared with the nifedipine group (P < 0.05). Target BP was achieved in 90% in the nifedipine group and 92% in the labetalol group. Maternal and fetal adverse effects were infrequent.

CONCLUSION

Both oral nifedipine and intravenous labetalol are effective in the treatment of hypertensive crisis. Intravenous labetalol may have benefits because it is more effective in reducing the SBP, DBP and MAP to target levels with a lower number of doses.

Antihypertensive treatment during pregnancy and functional development at primary school age in a historical cohort study

OBJECTIVE

To determine the functional development of children born after treatment of mild-to-moderate gestational hypertension with labetalol versus methyldopa, and no antihypertensive treatment.

DESIGN

Historical cohort study.

SETTING

Twelve Dutch hospital departments of obstetrics.

POPULATION

Live-born children born in these hospitals and prenatally exposed to labetalol, methyldopa, or bed rest because of mild-to-moderate gestational hypertension.

METHODS

Central nervous system development was measured with standard tests at 4-10 years of age. Linear regression techniques and Pearson's chi-square tests were used to compare the groups with regard to the outcome measures.

MAIN OUTCOME MEASURES

Intelligence quotient (IQ), concentration, motor development, and behaviour at primary school age.

RESULTS

A total of 202 children were included in the analyses. More children exposed to labetalol had attention deficit hyperactivity disorder (ADHD) than those exposed to methyldopa (OR 2.3; 95% CI 0.7-7.3), or those born to women who had been admitted for bed rest (OR 4.1; 95% CI 1.2-13.9). Sleeping problems seemed to be reported more frequently after prenatal methyldopa exposure than after exposure to labetalol (OR 3.2; 95% CI 0.6-16.7) or bed rest (OR 4.5; 95% CI 0.9-23.2), although the differences were not statistically significant. Test scores on other aspects of functional development did not differ between the three groups.

CONCLUSIONS

In this hypothesis-generating study, labetalol exposure in utero seemed to increase the risk of ADHD among children of primary school age, whereas prenatal methyldopa exposure might influence sleep. Further studies with appropriate sample sizes are warranted to determine the long-term effects of antihypertensive medications.

Cerebral Hemodynamics in Preeclampsia: Cerebral Perfusion and the Rationale for an Alternative to Magnesium Sulfate

Preeclampsia and eclampsia continue to be major causes of maternal death. Currently, approximately 18% of U.S. maternal deaths are attributed to hypertensive disorders and eclampsia, and several hundred women die from eclampsia and its complications every year. In the United States, preeclamptic women have received magnesium sulfate as a seizure prophylaxis agent for 3 decades, and this practice is becoming more widely accepted internationally. In addition to a recognized failure rate, there are financial, logistic, and safety concerns associated with the universal administration of magnesium sulfate. Many institutions in the developing world lack the necessary equipment and expertise to administer the medication, and many preeclamptic patients thus do not receive magnesium sulfate before their first seizure. As effective as it has been in reducing mortality from eclampsia, magnesium sulfate is also associated with appreciable morbidity and mortality from administration errors and magnesium toxicity. The availability of an easily administered, cheap, safe, and orally administered alternative to magnesium sulfate would be welcomed in the developing world and would provide an extremely useful alternative therapy to the current standard of care. Recent advances in the understanding of the pathophysiology of preeclampsia and eclampsia, primarily related to cerebral perfusion and blood flow, could allow us to reduce the seizure rate in treated preeclamptic women even further than what is currently reported. This article deals with the rationale behind the use of labetalol as an alternative to magnesium sulfate for the prevention of eclampsia.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader should be able to recall that hypertensive diseases of pregnancy contribute a significant portion of today's maternal mortality, explain that methods of preventing eclampsia are not applicable worldwide, and state that understanding of the pathophysiology of preeclampsia/eclampsia may assist in developing safe and effective medications that can be used universally.