Comparative Maternal-Fetal Outcomes Associated with Different Antihypertensive Treatment Strategies in Preeclampsia: A Retrospective Cohort Study

Background Preeclampsia poses a significant threat to maternal and infant health. Antihypertensive therapy is a critical component in improving perinatal outcomes, but the comparative maternal-fetal effects of different oral antihypertensive agents require further clinical evidence. Objective To compare the differences in maternal-fetal outcomes between two antihypertensive strategies—oral labetalol and oral nifedipine—in patients with preeclampsia, providing a reference for individualized clinical treatment. Methods This retrospective cohort study enrolled consecutive preeclampsia patients admitted from January 2023 to December 2025, dividing them into two groups based on antihypertensive treatment: the Labetalol Group (154 patients) and the Nifedipine Group (136 patients). Both groups received magnesium sulfate for spasmolysis as needed based on their condition, and were also given adjunctive aspirin or low-molecular-weight heparin depending on platelet counts and coagulation function. Following 1:1 Propensity Score Matching (PSM), maternal and fetal outcomes were compared between groups. Primary outcomes were the occurrence of maternal complications and neonatal outcomes. Secondary outcomes included maternal uterine artery blood flow and hemodynamics, incidence of fetal growth restriction, and incidence of adverse drug reactions. Multivariate logistic regression identified independent predictors of adverse maternal-fetal outcomes. Results Following PSM, baseline characteristics were comparable between the two groups (P > 0.05). Both achieved similar improvements in blood pressure, uterine artery blood flow (S/D, PI, RI), and hemodynamic indicators (plasma and whole blood viscosity, hematocrit) (P > 0.05). The Labetalol Group, compared to the Nifedipine Group, had significantly lower rates of postpartum hemorrhage (8.8% vs. 17.0%, P = 0.043) and preterm birth (24.6% vs. 37.3%, P = 0.041), and higher neonatal birth weight (2933.95 ± 803.23 g vs. 2541.35 ± 631.41 g, P < 0.001). Conversely, the Nifedipine Group experienced higher incidences of headache (16.4% vs. 7.3%, P = 0.037) and facial flushing (13.6% vs. 4.6%, P = 0.019). Multivariate Logistic regression identified maternal age ≥ 35 years, pre-pregnancy overweight/obesity, preeclampsia onset at < 34 weeks, primiparity, multiple pregnancy, severe preeclampsia, and pre-gestational diabetes as independent risk factors for adverse maternal-fetal outcomes (all P < 0.05). Conclusion Both labetalol and nifedipine effectively control blood pressure and improve uteroplacental blood flow and most maternal-fetal outcomes in patients with preeclampsia. Adverse effects are more common with nifedipine, whereas labetalol offers the added benefits of reducing preterm birth and postpartum hemorrhage, indicating a better safety profile.