{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:19:58Z","timestamp":1790144398844,"version":"4.0.1"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["K01 HD100222"],"award-info":[{"award-number":["K01 HD100222"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01 HD080471"],"award-info":[{"award-number":["R01 HD080471"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["K23 HD088230"],"award-info":[{"award-number":["K23 HD088230"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["P01 HD107670"],"award-info":[{"award-number":["P01 HD107670"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K24 AI131924"],"award-info":[{"award-number":["K24 AI131924"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Paediatric Perinatal Epid"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Data on antihypertensive medication for non\u2010severe gestational hypertension may suffer from immortal time and selection bias. Emulating target trials can prevent these biases by aligning follow\u2010up with treatment initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We estimated the safety of antihypertensive medication initiation for the treatment of non\u2010severe gestational hypertension on adverse birth outcomes in Botswana using sequential target trial emulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from the Tsepamo study (2014\u20132022), capturing birth outcomes at government delivery sites in Botswana, was used to examine antihypertensive medication initiation \u2265\u200924\u2009weeks gestation for non\u2010severe gestational hypertension (140\u2013159 systolic or 90\u2013109 diastolic blood pressure \u2265\u200920\u2009weeks gestation without chronic hypertension). Sequential weekly target trial emulation compared initiation versus no initiation during 24\u201335\u2009weeks' gestation on the risk of stillbirth and birth of infant small for gestational age (SGA), with secondary outcomes including very SGA, preterm birth, very preterm birth, neonatal death, and severe gestational hypertension. For each trial, eligible individuals were without chronic hypertension, had not previously initiated antihypertensive medication and had \u2265\u20092 non\u2010severe blood pressure readings, at least one within 1\u2009week of trial start. Log\u2010binomial models estimated gestational week\u2010specific and pooled risk ratios (RR) with 95% confidence intervals (CI) using bootstrapping.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of eligible individuals, there were 1676 antihypertensive initiator \u2018person\u2010trials\u2019 and 5211 non\u2010initiator \u2018person\u2010trials\u2019. In the pooled analysis, the adjusted RR for stillbirth and SGA comparing initiators to non\u2010initiators was 0.92 (0.68, 1.19) and 1.09 (0.97, 1.23), respectively. The pooled adjusted RR for secondary outcomes were: very SGA, 1.05 (95% CI 0.88, 1.25); preterm birth, 1.09 (95% CI 0.96, 1.22); very preterm birth, 1.05 (95% CI 0.78, 1.47); neonatal death, 1.23 (95% CI 0.68, 2.24); severe gestational hypertension, 0.88 (95% CI 0.74, 1.07).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this retrospective cohort study, antihypertensive medication initiation between 24 and 35\u2009weeks' gestation for non\u2010severe gestational hypertension was not associated with increased risk of adverse birth outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ppe.70079","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T04:31:51Z","timestamp":1761107511000},"page":"248-260","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Safety of Antihypertensive Medication for the Management of Non\u2010Severe Gestational Hypertension Among Pregnant Individuals in Botswana\u2014Emulating a Series of Target Trials"],"prefix":"10.1111","volume":"40","author":[{"given":"Julia D.","family":"DiTosto","sequence":"first","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Zash","sequence":"additional","affiliation":[{"name":"Botswana\u2010Harvard AIDS Initiative Partnership for HIV Research and Education  Gaborone Botswana"},{"name":"Division of Infectious Disease Beth Israel Deaconess Medical Center  Boston Massachusetts USA"},{"name":"Department of Obstetrics and Gynecology University of Massachusetts Chan Medical School  Worcester Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise L.","family":"Jacobson","sequence":"additional","affiliation":[{"name":"Department of Immunology and Infectious Diseases Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"},{"name":"Center for Biostatistics in AIDS Research Harvard School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Massachusetts Chan Medical School  Worcester Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Modiegi","family":"Diseko","sequence":"additional","affiliation":[{"name":"Botswana\u2010Harvard AIDS Initiative Partnership for HIV Research and Education  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Mayondi","sequence":"additional","affiliation":[{"name":"Botswana\u2010Harvard AIDS Initiative Partnership for HIV Research and Education  Gaborone 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L.","family":"Mumford","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Obstetrics and Gynecology, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahin","family":"Lockman","sequence":"additional","affiliation":[{"name":"Botswana\u2010Harvard AIDS Initiative Partnership for HIV Research and Education  Gaborone Botswana"},{"name":"Center for Biostatistics in AIDS Research Harvard School of Public Health  Boston Massachusetts USA"},{"name":"Division of Infectious Diseases Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Botswana\u2010Harvard AIDS Initiative Partnership for HIV 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