TY - JOUR
T1 - Antenatal exposure to nonsteroidal anti-inflammatory drugs and risk of neonatal hypertension
AU - Habli, Mounira
AU - Clifford, Corey C.
AU - Brady, Tammy M.
AU - Rodriguez, Zahidee
AU - Eschenbacher, Michaela
AU - Wu, Malcolm
AU - DeFranco, Emily
AU - Gresh, James
AU - Kamath-Rayne, Beena D.
N1 - Funding Information:
Funding information Dr. Tammy Brady was supported by the NIH/NHLBI (1K23 HL119622-01). Authority has been granted to the corresponding author by all authors to commit to all requirements for copyright transfer, when applicable. Dr. Corey Clifford and Dr. Mounira Habli wrote the first draft of the manuscript and no one received any payment to work on the manuscript. Both authors contributed equally to project: Mounira Habli, MD; Corey Clifford, DO, MBA. We acknowledge the University of Cincinnati Center for Clinical and Translational Science and Training grant support (UL1-RR026314) for the support of Dr. Eric Hall and Mr. Matthew Leonard, who assisted in the design of our RedCAP database. We acknowledge Dr. Kathy Wedig of Cincinnati Children's Hospital Medical Center/Good Samaritan Neonatal Intensive Care Unit and Follow-up for her assistance in providing detail on medical management of infants with neonatal hypertension. We also thank Sherri Sterwerf and John Vidas of Good Samaritan Medical Records for their assistance in obtaining the charts for our review. We thank Ganga Devaiah and the Hatton Research Institute at Good Samaritan for their support and efforts with statistical analysis.
Funding Information:
We acknowledge the University of Cincinnati Center for Clinical and Translational Science and Training grant support (UL1‐RR026314) for the support of Dr. Eric Hall and Mr. Matthew Leonard, who as‐ sisted in the design of our RedCAP database. We acknowledge Dr. Kathy Wedig of Cincinnati Children’s Hospital Medical Center/Good Samaritan Neonatal Intensive Care Unit and Follow‐up for her assis‐ tance in providing detail on medical management of infants with ne‐ onatal hypertension. We also thank Sherri Sterwerf and John Vidas of Good Samaritan Medical Records for their assistance in obtaining the charts for our review. We thank Ganga Devaiah and the Hatton Research Institute at Good Samaritan for their support and efforts with statistical analysis.
Funding Information:
Dr. Tammy Brady was supported by the NIH/ NHLBI (1K23 HL119622‐01). Authority has been granted to the corresponding author by all authors to commit to all requirements for copyright transfer, when applicable. Dr. Corey Clifford and Dr. Mounira Habli wrote the first draft of the manuscript and no one received any payment to work on the manuscript. Both authors contributed equally to project: Mounira Habli, MD; Corey Clifford, DO, MBA.
Publisher Copyright:
©2018 Wiley Periodicals, Inc.
PY - 2018/9
Y1 - 2018/9
N2 - Nonsteroidal anti-inflammatory drugs (NSAIDs) are used as tocolytics, which are medications that suppress uterine contractions for preterm birth prevention. Their effect on cerebral/systemic vascular beds poses the question of whether antenatal NSAID exposure is associated with neonatal hypertension. We performed a retrospective case-control study in a tertiary neonatal intensive care unit, including 40 hypertension cases (hospitalized neonates ≥ 35 weeks with systolic BP > 100 mm Hg on three consecutive days) compared to 134 controls matched by gestational age at delivery, plurality, and delivery date. Cases and controls were compared by antenatal NSAID exposure, other common tocolytics, and maternal/neonatal characteristics and complications. Multivariable logistic regression was used to estimate the odds of hypertension among those with prenatal exposure to NSAIDs versus those without exposure. Newborns with hypertension had a lower gestational age at delivery and increased incidence of neonatal complications, including respiratory distress syndrome, bronchopulmonary dysplasia, surfactant administration, longer duration of ventilation, and history of umbilical artery catheterization. Days of indomethacin exposure were positively associated with greater odds of neonatal hypertension (OR 1.17 [1.00 to 1.38], P = 0.055), even after adjustment for other factors associated with neonatal hypertension. Newborns with hypertension were less likely to have been exposed to calcium channel blockers as a tocolytic. The results of our study suggest an association between prenatal exposure to nonsteroidal anti-inflammatory drugs and neonatal hypertension. Furthermore, our data suggest that prenatal calcium channel blocker exposure may protect against the development of neonatal hypertension. Future multicenter studies are needed to understand the risks of tocolytics and subsequent consequences in preterm infants.
AB - Nonsteroidal anti-inflammatory drugs (NSAIDs) are used as tocolytics, which are medications that suppress uterine contractions for preterm birth prevention. Their effect on cerebral/systemic vascular beds poses the question of whether antenatal NSAID exposure is associated with neonatal hypertension. We performed a retrospective case-control study in a tertiary neonatal intensive care unit, including 40 hypertension cases (hospitalized neonates ≥ 35 weeks with systolic BP > 100 mm Hg on three consecutive days) compared to 134 controls matched by gestational age at delivery, plurality, and delivery date. Cases and controls were compared by antenatal NSAID exposure, other common tocolytics, and maternal/neonatal characteristics and complications. Multivariable logistic regression was used to estimate the odds of hypertension among those with prenatal exposure to NSAIDs versus those without exposure. Newborns with hypertension had a lower gestational age at delivery and increased incidence of neonatal complications, including respiratory distress syndrome, bronchopulmonary dysplasia, surfactant administration, longer duration of ventilation, and history of umbilical artery catheterization. Days of indomethacin exposure were positively associated with greater odds of neonatal hypertension (OR 1.17 [1.00 to 1.38], P = 0.055), even after adjustment for other factors associated with neonatal hypertension. Newborns with hypertension were less likely to have been exposed to calcium channel blockers as a tocolytic. The results of our study suggest an association between prenatal exposure to nonsteroidal anti-inflammatory drugs and neonatal hypertension. Furthermore, our data suggest that prenatal calcium channel blocker exposure may protect against the development of neonatal hypertension. Future multicenter studies are needed to understand the risks of tocolytics and subsequent consequences in preterm infants.
KW - NSAIDs
KW - neonatal hypertension
KW - prematurity
KW - tocolytic
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U2 - 10.1111/jch.13354
DO - 10.1111/jch.13354
M3 - Article
C2 - 30051971
AN - SCOPUS:85051228364
SN - 1524-6175
VL - 20
SP - 1334
EP - 1341
JO - Journal of Clinical Hypertension
JF - Journal of Clinical Hypertension
IS - 9
ER -