Prescribing patterns for hypertensive disorders of pregnancy in low- and middle-income countries: a systematic review

Hypertensive Disorders of Pregnancy (HDPs), encompassing gestational hypertension, pre-eclampsia, and eclampsia, affect approximately 18 million pregnancies globally. While international guidelines specify management for these disorders, their implementation in low-and middle-income countries (LMICs) is unassessed. Therefore, this systematic review aims to assess the prescribing patterns for HDPs to gauge suitable recommendations for practitioners in LMICs. A systematic review was conducted using PubMed, CINAHL, Scopus and Google Scholar using relevant terms for HDPs, prescribing patterns and LMICs. Observational studies published between January 2000 and November 2023 reporting management of HDPs in LMICs were included. The quality of the articles was screened using the National Heart Lung and Blood Institute (NHLBI) quality assessment tool. A total of 54 studies comprising 14,598 HDP cases from 17 LMICs were included. Of these studies, 18 reported prescriptions for gestational hypertension, in which, calcium channel blockers were reported to be prescribed in all, while the frequency of other prescribed medications included labetalol (89.0%) and methyldopa (66.7%). 41 studies reported medications for pre-eclampsia which included magnesium sulfate—MgSO4 (68.3%), nifedipine (61.0%), methyldopa (48.8%) and labetalol (43.9%) prescriptions. A majority of the 28 studies reporting on eclampsia mentioned the use of MgSO4, while 33% prescribed diazepam, and phenytoin was prescribed in 15% of the studies. Majority of LMICs tend to prescribe the established first line medications for HDPs. Slight differences are seen in combinations, likely due to use of different guidelines and medication availability. Standardization of institutional guidelines and strategies to increase adherence to guidelines across LMICs are crucial for improved outcomes and safer prescribing patterns among physicians. Several studies report an absence of institutional guidelines, while practices differ from international guidelines, necessitating the need for standardization of prescribing patterns across resource-limited settings.