Treatment for mild hypertension in pregnancy with different strategies: A systematic review and meta‐analysis

Abstract Objectives To synthesize the evidence from randomized controlled trials (RCTs) of antihypertensive treatment for mild pregnancy hypertension. Methods We searched various databases from inception to June 2022, using keywords including hypertension; pregnancy; therapy; treatment; pregnancy outcomes; maternal outcomes; and perinatal outcomes. Only RCTs of antihypertensive treatment for mild hypertension in pregnancy comparing placebo/no therapy were included. We used Review Manager version 5.3 for statistical analyses. Results In all, eight studies were eligible, with a total of 4211 participants. Compared with control, the active treatment significantly prevented preeclampsia (OR 0.55; 95%CI, 0.39–0.78), placental abruption (OR 0.39; 95%CI, 0.17–0.91), severe hypertension (OR 0.35; 95%CI, 0.17–0.71), end–organ dysfunction (OR 0.34; 95%CI, 0.19–0.62) and preterm birth (OR 0.69; 95%CI, 0.59–0.82), with no increased risk of small for gestational age (SGA) (OR 1.25; 95%CI, 0.78–2.00), or admission to the NICU (OR 0.83; 95%CI, 0.54–1.28). Subgroup analyses demonstrated that the tight control group did not show an advantage over the less‐tight control group in improving pregnancy outcomes. Conclusion In pregnant women with mild pregnancy‐induced hypertension or chronic hypertension, antihypertensive treatment still provided precise benefits of improving pregnancy outcomes without increased risk in fetal outcomes.