Thesis in a nutshell
Hypertensive disorders in pregnancy are common complications affecting about one in seven hospital deliveries and contributing to 7% of pregnancy-related deaths in the United States. Chronic hypertension in pregnancy, defined as hypertension that predates pregnancy or is diagnosed before 20 weeks of gestation, is a particular concern. This condition is associated with increased risks of adverse maternal and fetal outcomes. It also presents challenges in clinical decision-making regarding treatment strategies, pre-pregnancy counseling, and care coordination before, during, and after pregnancy.
Our study focuses on treatment during early pregnancy in individuals with pre-existing hypertension, a time often underrepresented in clinical trials. The goal is to provide evidence-based guidance for optimizing treatment strategies as individuals with hypertension and their healthcare providers plan pregnancies. Specifically, we aim to:
Study 1: Examine the utilization patterns of antihypertensive medications among pregnant individuals with pre-existing hypertension before, during, and after pregnancy.
Study 2: Compare maternal and fetal outcomes in individuals with pre-existing hypertension treated with labetalol versus nifedipine during the first trimester. Outcomes of interest include superimposed preeclampsia, cardiovascular-related severe maternal morbidities, postpartum depression, stillbirth, preterm delivery, and small for gestational age.
Study 3: Evaluate whether switching to preferred antihypertensive agents by the end of the first trimester reduces the risk of pregnancy loss in individuals with pre-existing hypertension and treated with non-preferred agents before pregnancy.
Inspiration
My dissertation idea was inspired by one of our previous graduate students’ dissertation, in which he explored whether GLP-1 antagonist could reduce the risk of COPD exacerbation. The assumption was established based on the literature review of GLP-1 antagonists’ pharmacological properties and leveraged claim databases to prove the assumption. The clinical topic came from my experience working as a research assistant with Dr. Winterstein, during which I was introduced to the clinical roles of P2Y12 inhibitors and the nuance between these three options in terms of their pharmacological properties and clinical safety and effectiveness profiles.
Real-world data is an important source to generate additional safety and effectiveness evidence not covered by trials and can be useful for drug reporposing/repositioning.
Cool methodological features
To provide a comprehensive picture of study population, I will used both MarketScan (commercial insured populations, typically aged less than 65) and Medicare (senior populations aged 65 or above) for my dissertation aims. Methodologically wise, I will utilize target trial emulation framework for the first two aims for the purpose of a more transparent evidence generation with higher quality. In the aim 3, to adjust for unmeasured confounding factors, I will use self-controlled study design to control for time-fixed factors such as genetic polymorphisms in order to assess the additional muscle-related adverse event risk processed by the addition of ticagrelor.
Impact
I hope my dissertation will provide some translational insights from bench side to patients at bedside for a safer and more effective use of ticagrelor. More specifically, the evidence can help the clinicians make a more informed decision on selecting the most appropriate P2Y12 inhibitors as well as medications co-prescribed such as statins for patients with ACS.
Next steps
I’m looking for an academic position after completion of my dissertation. I wish to use the training I have received at POP and the research experience I gained through working with Dr. Winterstein and the team to prepare myself as a next-generation pharmacoepidemiologist.