Prevention of preeclampsia: A randomized trial of atenolol in hyperdynamic patients before onset of hypertension
Prevention of preeclampsia: A randomized trial of atenolol in hyperdynamic patients before onset of hypertension
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DOI：
10.1016/s0029-7844(98)00522-5
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发表时间：
1999-05-01
影响因子：
7.2
通讯作者：
Millard, SP
中科院分区：
文献类型：
--
作者：
Easterling, TR;Brateng, D;Millard, SP
目的：为了确定是否评估产妇血流动力学可以预测妇女的发展先兆子痫的风险，如果治疗针对血流动力学异常的高血压发病前可以防止先兆子痫，如果母亲可以治疗的方式，保护胎儿growth.Methods：一个双盲，随机对照试验进行。如果受试者在妊娠24周前心输出量大于7.4 L/min，则认为受试者有先兆子痫的风险。未生育和糖尿病高危受试者接受100 mg阿替洛尔或安慰剂治疗。多普勒技术测定心输出量。结果：阿替洛尔治疗使先兆子痫的发病率从5/28（18%）降低到1/28（3.8%）（P = 0.04）。未生育的妇女被确定为先兆子痫的风险是类似的糖尿病妇女的风险。每一个都明显比对照组重，菊糖和对氨基马尿酸盐的清除率大于对照组。阿替洛尔治疗组婴儿体重比未经产安慰剂组婴儿轻440 g（P = 0.02）。在糖尿病患者中未观察到对出生体重的影响。母亲的最小的婴儿谁是阿替洛尔治疗，可以确定意想不到的大减少，心输出量。结论：在孕中期的心输出量的测量确定妇女在先兆子痫的风险。阿替洛尔治疗可降低先兆子痫的发生率。在母体血流动力学、母体体重和肾功能方面，处于先兆子痫风险的未产妇和糖尿病妇女相似。阿替洛尔治疗与婴儿出生体重降低有关。(C)1999年由美国妇产科医师学会。
Objective: To determine if assessment of maternal hemodynamics could predict women at risk for the development of preeclampsia, if treatment directed at hemodynamic abnormalities before the onset of hypertension could prevent preeclampsia, and if mothers could be treated in a way that protects fetal growth.Methods: A double-blinded, randomized controlled trial was conducted. Subjects were considered to be at risk for preeclampsia if their cardiac output was greater than 7.4 L/min before 24 weeks' gestation. Nulliparous and diabetic subjects at risk were treated with 100 mg of atenolol or placebo. Cardiac output was measured by Doppler technique. Inulin and para-aminohippurate clearances were performed.Results: Treatment with atenolol reduced the incidence of preeclampsia from 5 of 28 (18%) to I of 28 (3.8%), (P = .04). Nulliparous women determined to be at risk for preeclampsia were similar to diabetic women at risk. Each was significantly heavier and had inulin and para-aminohippurate clearances greater than the control group. Treatment with atenolol was associated with infants weighing 440 g less than infants in the nulliparous placebo group, (P = .02). No effect on birth weight was seen in the diabetic patients. Mothers of the smallest infants who were treated with atenolol could be identified by unexpectedly large reductions in cardiac output.Conclusion: Measurement of cardiac output in the second trimester identified women at risk for preeclampsia. Treatment with atenolol decreased the incidence of preeclampsia. Nulliparous and diabetic women at risk for preeclampsia were similar with regard to maternal hemodynamics, maternal weight, and renal function. Treatment with atenolol was associated with reduced infant birth weight. (C) 1999 by The American College of Obstetricians and Gynecologists.