In-utero exposure to antihypertensive medication and neonatal and child health outcomes:A systematic review

Background: Although medication is generally avoided wherever possible during pregnancy, pharmacotherapy is required for the treatment of pregnancy associated hypertension, which remains a leading cause of maternal and fetal morbidity and mortality. The long-term effects to the child of in-utero exposure to antihypertensive agents remains largely unknown. Objective: The aim of this study was to systematically review published studies on adverse outcomes to the child associated with in-utero exposure to antihypertensive medications. Methods: OVID, Scopus, EBSCO Collections, the Cochrane Library, and Web of Science databases were searched for relevant publications published between January 1950 and October 2016 and a total of 688 potentially eligible studies were identified. Results: Following review, 47 primary studies were eligible for inclusion. The Critical Appraisal Skills Programme checklist was used to assess study quality. Five studies were of excellent quality; the remainder were either mediocre or poor. Increased risk of low birth weight, low size for gestational age, preterm birth, and congenital defects following in-utero exposure to all antihypertensive agents were identified. Two studies reported an increased risk of attention deficit hyperactivity disorder following exposure to labetalol, and an increased risk of sleep disorders following exposure to methyldopa and clonidine. Conclusion: The current systematic review demonstrates a paucity of relevant published high-quality studies. A small number of studies suggest possible increased risk of adverse child health outcomes; however, most published studies have methodological weaknesses and/or lacked statistical power thus preventing any firm conclusions being drawn

Adam of Dryburgh

Adam of Dryburgh,whose life and writings are here discussed,is one of the few religious writers of mediaeval Scotland to have commanded an audience outside his native land. The list of his extant writings has slowly grown,and may yet increase further. The writer of this thesis is particularly indebted to two predecessors in the same field Dr N.J.Weyns of Tongerloo,who has written on Adam's life as a White Canon,and Miss E. Margaret Thompson, who has written on his time as a Carthusian. This study was interrupted by an illness during which a numbers of references to sources were lost