Postpartum management of the hypertensive disorders of pregnancy: a systematic review and meta-analysis
Bibliographic record
Abstract
OBJECTIVE: To assess the effectiveness and safety of management strategies for postpartum hypertension. DATA SOURCES: We searched the Cochrane Pregnancy and Childbirth's Trials Register in collaboration with their Information Specialist, on October 20, 2022. As the Pregnancy and Childbirth Review Group closed (2023), we updated our literature search on September 17, 2024 (topped up on September 25, 2025), using a strategy developed with an information specialist from the Royal College of Physicians, United Kingdom. STUDY ELIGIBILITY CRITERIA: We included randomized controlled trials assessing any intervention (pharmacological, surgical, or models of care) used to reduce maternal blood pressure in participants with postpartum hypertension. STUDY APPRAISAL AND SYNTHESIS METHODS: Search results were screened independently by 2 authors, with any disagreement resolved by consensus. Data were extracted independently, onto a Cochrane-based bespoke form which included Cochrane's Trustworthiness Screening Tool. Random-effects meta-analysis was performed in RevMan. RESULTS: Of the 944 studies identified, 40/44 included had informative data. Certainty of evidence was low or very low. There were no safety concerns. In 7 trials (n=1113 participants) of diuretics (primarily furosemide) vs placebo/no therapy, blood pressure control was better with diuretics when administered alongside antihypertensive. In 3 trials (n=96) of antihypertensive vs placebo, data were insufficient to inform effectiveness. In 9 trials (n=865) of antihypertensive (4 types) vs another (3 types) for nonsevere hypertension, additional antihypertensive need was similar in comparisons with either nifedipine or methyldopa, but greater when amlodipine or either enalapril or lisinopril/thiazide were compared with nifedipine. In 8 trials (n=403) of antihypertensive vs another for severe hypertension, blood pressure was lower with diltiazem (vs nifedipine). In 4 trials (n=668) of uterine curettage vs usual care, observed improvements in laboratory parameters were of unclear clinical significance. In 9 trials (n=1263) of models of postnatal care (usually blood pressure self-monitoring/management, N=6) vs usual care, blood pressure was lower 8 months postpartum following blood pressure self-monitoring/management or lifestyle change. CONCLUSION: While diuretics may aid in blood pressure control, they cannot be recommended as monotherapy. Evidence guiding the optimal choice of antihypertensive agents remains limited. Of greatest relevance to practice is the effectiveness of: enalapril or amlodipine (vs nifedipine) in controlling blood pressure; and blood pressure self-measurement/management or lifestyle change (vs usual care) in preventing longer-term cardiovascular outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.045 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.022 | 0.035 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".