Outpatient calcium-channel blockers and the risk of postpartum haemorrhage: a cohort study

Authors

  • BT Bateman,

    Corresponding author
    1. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
    2. Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
    • Correspondence: Dr BT Bateman, Brigham & Women's Hospital, Department of Medicine, Division of Pharmacoepidemiology & Pharmacoeconomics, 1620 Tremont Street, Suite 3030, Boston, MA 02120, USA. Email bbateman@partners.org

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  • S Hernandez-Diaz,

    1. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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  • KF Huybrechts,

    1. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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  • K Palmsten,

    1. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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  • H Mogun,

    1. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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  • JL Ecker,

    1. Department of Obstetrics, Gynecology, and Reproductive Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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  • EW Seely,

    1. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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  • MA Fischer

    1. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Abstract

Objective

To determine whether outpatient exposure to calcium-channel blockers (CCBs) at the time of delivery is associated with an increased risk for postpartum haemorrhage (PPH).

Design

Cohort study.

Setting

United States of America.

Population or sample

Medicaid beneficiaries.

Methods

We identified a cohort of 9750 patients with outpatient prescriptions for CCBs, methyldopa, or labetalol for pre-existing or gestational hypertension whose days of supply overlapped with delivery; 1226 were exposed to CCBs. The risk of PPH was compared in those exposed to CCBs to those exposed to methyldopa or labetalol. Propensity score matching and stratification were used to address potential confounding.

Main outcome measures

The occurrence of PPH during the delivery hospitalisation.

Results

There were 27 patients exposed to CCBs (2.2%) and 232 patients exposed to methyldopa or labetalol (2.7%) who experienced PPH. After accounting for confounders, there was no meaningful association between CCB exposure and PPH in the propensity score matched (odds ratio 0.77, 95% CI 0.50–1.18) or stratified (odds ratio 0.79, 95% CI 0.53–1.19) analyses. Similar results were obtained across multiple sensitivity analyses.

Conclusions

The outpatient use of CCBs in late pregnancy for the treatment of hypertension does not increase the risk of PPH.

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