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Poster Session 4

Category: Hypertension

Poster Session 4

(1236) Initiation or continuation of oral labetalol versus extended-release nifedipine in expectant management of severe preeclampsia

Thursday, February 12, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Ryan D. Farias, MD

University of Virginia School of Medicine
Charlottesville, Virginia, United States

Coauthor(s)

CE

Christopher S. Ennen, MD

Assistant Professor
University of Virginia School of Medicine
Charlottesville, Virginia, United States
Adam J. Schettler, MD

MFM Fellow
University of Virginia School of Medicine
Charlottesville, Virginia, United States
EF

Ella Frazier

University of Virginia School of Medicine
University of Virginia School of Medicine, Virginia, United States

Objective:
To compare maternal and neonatal outcomes among patients with preeclampsia with severe features managed expectantly with oral labetalol or extended-release nifedipine.

Study Design:
This is a retrospective cohort study of patients admitted for expectant management of preeclampsia with severe features < 34 weeks and initiated or continued on oral labetalol or extended-release nifedipine. Exclusion criteria included patients already on both medications at time of admission, and any contraindication to expectant management within 24 hours. The primary outcome was pregnancy latency. Secondary outcomes included need for early delivery, initial agent dose increase, addition of second agent, number of acute treatment episodes of severe hypertension, indications for early delivery, birth weight, and one- and five-minute APGARs.

Results:
Baseline characteristics are shown in Table 1. Overall, comparing labetalol vs nifedipine, there was no difference in median latency period [4 (5) vs 5 (6.25)] days p=0.28), need for early delivery (87% vs 79% p=.09), initial agent dose increase (73% vs 73% p=0.79), addition of second agent (39% vs 30% p=0.13), and median number of acute treatment episodes [3 (3) vs 3 (3.5) p=0.83]. A higher proportion of patients in the nifedipine group required early delivery for elevated liver enzymes (26% vs 7% p=.001) and/or for elevated creatinine (15% vs 5% p=.026). There was also a trend towards a higher proportion of patients in the labetalol group requiring early delivery for pulmonary edema (10% vs 3% p=.078). Results are summarized in Table 2.

Conclusion:
Initiation or continuation of oral labetalol vs nifedipine did not significantly impact maternal or neonatal outcomes. However, patients initially on nifedipine were more likely to experience elevated liver enzymes and/or elevated creatinine as an indication for delivery. There was a trend towards the development of pulmonary edema with labetalol. These findings suggest potential differences in disease trajectory by antihypertensive choice and warrant further prospective investigation.