Published: 2017-09-23

A Study of drug utilization and clinical outcomes in indoor patients of hypertensive disorders of pregnancy

Smita L. Gaidhankar, Jaiprakash B. Ramanand, Parashram G. Kadam, Ajitkumar M. Zende, Rama R. Bhosale, Nitin N. Puram


Background: Hypertensive disorders of pregnancy are an important determinant of drug use during pregnancy. The aim of study was to assess the clinical outcome and evaluate drug utilization according to WHO core drug prescribing indicators in hypertensive disorders of pregnancy.

Methods: This prospective, observational study in a tertiary care hospital was conducted in 150 pregnant women with hypertensive disorders of pregnancy from January 2014 and December 2014 who fulfilled the inclusion criteria. Antepartum and intrapartum care and the maternal and perinatal outcome were noted. The data was analyzed to evaluate clinical outcome and drug utilization according to WHO core drug use indicators.

Results: Gestational hypertension was most common among hypertensive disorders of pregnancy seen in 62/150 (41.3%) women. The most common symptom was headache (48%) while sign noted was edema (69%). A total of 66% women had preterm delivery and 42% babies weighed less than 2.5 kg. Average number of drugs per encounter was 9.7. Percentage of drugs prescribed by generic name and from essential drug list was 64% and 79% respectively. The most commonly used drugs were vitamins and minerals prescribed in 100% patients followed by antihypertensive drugs (92%). The most common antihypertensive used were calcium channel blockers and anticonvulsant was magnesium sulphate.

Conclusions: There was increased maternal and perinatal morbidity and operative intervention among pregnant women with hypertensive disorders of pregnancy. Most of the drugs were used appropriately and were in accordance with standard guidelines. The important problems identified were inappropriate use of antimicrobials, use of sublingual nifedipine and use of brand names in 1/4th of prescriptions. 


Drug utilization study, Eclampsia, Hypertension, Magnesium sulphate, Preeclampsia, Pregnancy

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Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066-74.

Gupte S, Wagh G. Preeclampsia-Eclampsia. J Obstet Gynaecol India. 2014;64:4-13.

Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122:1122-31.

Dutta DC. Hypertensive Disorders in Pregnancy. In: Konar H, editors. DC Dutta’s Textbook of Obstetrics. 8th Ed. New Delhi: Jaypee Brothers Medical Publishers; 2015:256-278.

Magee LA, von Dadelszen P, Chan S, Gafni A, Gruslin A, Helewa M, et al. CHIPS Pilot Trial Collaborative Group. The control of hypertension in pregnancy study pilot trial. Br J Obstet Gynaecol. 2007;114:13-20.

WHO. How to investigate drug use in health facilities: selected drug use indicators. (WHO/DAP/93.1). Geneva: Action Programme on Essential Drugs, World Health Organization; 1993:1-87. Available at: Accessed 15 February 2015.

Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J, et al. Magpie Trial Collaboration Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: A randomised placebo-controlled trial. Lancet 2002;359:1877-90.

Collaboration Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: A randomised placebo-controlled trial. Lancet. 2002;359:1877-90.

Duley L. Magnesium sulphate regimens for women with eclampsia: Messages from the Collaborative Eclampsia Trial. Br J Obstet Gynaecol. 1996;103:103-5.

Patel KP. A study of morbidity and drug utilization pattern in indoor patients of high risk pregnancy at tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2013;2(3):372-78.

Good Clinical Practice Recommendations for Iron Deficiency Anemia in Pregnancy (IDA) in Pregnancy in India. J Obstet Gynaecol India. 2011;61:569-71.

Gawde SR, Bhide SS, Patel TC, Chauhan AR, Mayadeo NM, Sawardekar SB. Drug Prescription Pattern in Pregnant Women Attending Antenatal Out Patient Department of a Tertiary Care Hospital. Br J Pharm Res. 2013;3(1):1-12.

Haas JS, Phillips KA, Gerstenberger EP, Seger AC. Potential savings from substituting generic drugs for brand-name drugs: medical expenditure panel survey, 1997-2000. Ann Intern Med. 2005;142(11):891-7.

Bagratee JS, Moodley J, Kleinschmidt I, Zawilski W. A randomised controlled trial of antibiotic prophylaxis in elective caesarean delivery. BJOG. 2001;108:143-8.

Deb T, Ghosh A, Bhadra B. Drug utilization study in pregnancy induced hypertension in a tertiary care teaching hospital. JDDT. 2014;4:169-72.

Sibai BM, Ross MG. Hypertension in gestational diabetes mellitus: Pathophysiology and long-term consequences. J Matern Fetal Neonatal Med. 2010;23:229-33.

Bateman BT, Hernandez-Diaz S, Hybrecht KF. Patterns of outpatient antihypertensive medication use during pregnancy in a Medicaid population. Hypertension. 2012;60:913-20.

Kumar S, Bansal D, Hota D, Jain M, Singh P, Pandey BL. Assessment of clinical outcomes and prescribing behavior among in patients with severe preeclampsia and eclampsia: An Indian experience. Indian J Pharmacol. 2014;46(1):18-23.

Sibai BM. Imitators of severe pre-eclampsia/eclampsia. Clin Perinatol. 2004;31:835-52.

Chien PF, Khan KS, Arnott N. Magnesium sulphate in the treatment of eclampsia and pre-eclampsia: An overview of the evidence from randomised trials. Br J Obstet Gynaecol. 1996;103:1085-91.