In utero antihypertensive medication exposure and neonatal outcomes: A data linkage cohort study

Catherine Fitton, Michael Fleming, Markus F C Steiner, Lorna Aucott, Jill P. Pell, Daniel F Mackay, James McLay* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)
7 Downloads (Pure)


Hypertensive disorders during pregnancy are an important risk to mother and fetus, frequently necessitating antihypertensive treatment. Data describing the safety of in utero exposure to antihypertensive treatment is conflicting, with many studies suffering from significant methodological issues, such as inappropriate study design, small sample sizes, and no untreated control group. We conducted a retrospective cohort study using linked routinely collected healthcare records for 268 711 children born 2010–2014 in Scotland to assess outcomes following in utero exposure to antihypertensive medication. We identified a cohort of 265 488 eligible children born over the study period; of which, 2350 were exposed to in utero antihypertensive medication, 4391 exposed to treated late-onset hypertension, and 7971 exposed to untreated hypertension during pregnancy. Untreated hypertension was associated with increased risk of preterm birth (adjusted risk ratio [aRR], 1.15 [99% CI, 1.01–1.30]), low birth weight (aRR, 2.01 [99% CI, 1.72–2.36]) and being small for gestational age (aRR, 1.50 [99% CI, 1.35–1.66]), while in utero antihypertensive exposure was also associated with preterm birth (aRR, 3.12 [99% CI, 2.68–3.64]), low birth weight (aRR, 2.23 [99% CI, 1.79–2.78]), and being small for gestational age (aRR, 2.13 [99% CI, 1.81–2.52]). Late-onset hypertension was also associated with preterm birth (aRR, 2.21 [99% CI, 1.86–2.62]), low birth weight (aRR, 2.06 [99% CI, 1.74–2.43]), and being small for gestational age (aRR, 1.90 [99% CI, 1.68–2.16]). Our results suggest that hypertension is a key risk factor for low birth weight and preterm birth. Although preterm birth may be associated with antihypertensive medication exposure during pregnancy, these associations may reflect increasing hypertension severity necessitating treatment.
Original languageEnglish
Pages (from-to)628–633
Number of pages5
Issue number3
Early online date30 Dec 2019
Publication statusPublished - 1 Mar 2020

Bibliographical note

We acknowledge the support from the Farr Institute @ Scotland. The Farr Institute @ Scotland is supported by a 10-funder consortium:

Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the

Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute of Health Research, the

National Institute for Social Care and Health Research (Welsh Assembly Government), the Chief Scientist Office (Scottish

Government Health Directorates), the Wellcome Trust, (MRC grant number MR/K007017/1).


  • antihypertensive agents
  • child
  • gestational age
  • hypertension
  • pregnancy
  • RISK
  • AGE


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