Beta-Blockers and Fetal Growth Restriction in Pregnant Women With Cardiovascular Disease

Abstract

Background:The effects of β-adrenergic blockers on the fetus are not well understood. We analyzed the maternal and neonatal outcomes of β-adrenergic blocker treatment during pregnancy to identify the risk of fetal growth restriction (FGR). Methods and Results:We retrospectively reviewed 158 pregnancies in women with cardiovascular disease at a single center. Maternal and neonatal outcomes were analyzed in 3 categories: the carvedilol (α/β-adrenergic blocker; α/β group, n=13); β-adrenergic blocker (β group, n=45), and control groups (n=100). Maternal outcome was not significantly different between the groups. FGR occurred in 1 patient (7%) in the α/β group, in 12 (26%) in the β group, and in 3 (3%) in the control group; there was a significant difference between the incidence of FGR between the β group and control group (P<0.05). The β group included propranolol (n=22), metoprolol (n=12), atenolol (n=6), and bisoprolol (n=5), and the individual incidence of FGR with these medications was 36%, 17%, 33%, and 0%, respectively. Conclusions:As a group, β-adrenergic blockers were significantly associated with FGR, although the incidence of FGR varied with individual β-blocker. Carvedilol, an α/β-adrenergic blocker, had no association with FGR. More controlled studies are needed to fully establish such associations. (Circ J 2016; 80: 2221 -2226

In Utero Exposure to Antihypertensive Medication during the First Trimester: Is the Risk Worth Taking?

“…Fitton et al (8), in a recent data linkage cohort study, associated in-utero exposure to β-blockers with an increased risk of preterm birth, low birth weight and being Born Small for Gestational Age, SGA. Other studies (7,15,(18)(19)(20)(21)(22) suggest similar findings. Furthermore, some of them introduce the increased risk of fetal growth restriction (FGR), (7,19,22,23) and perinatal mortality (15).…”

“…Other studies (7,15,(18)(19)(20)(21)(22) suggest similar findings. Furthermore, some of them introduce the increased risk of fetal growth restriction (FGR), (7,19,22,23) and perinatal mortality (15). Duan et al (7) analyzed the effect of diverse β-blocker subtypes on birth weight, suggesting that labetalol and atenolol were associated with the highest rate of low birth weight and an increased risk of being born SGA.…”

In Utero Exposure to Antihypertensive Medication during the First Trimester: Is the Risk Worth Taking?

“…Fitton et al (8), in a recent data linkage cohort study, associated in-utero exposure to β-blockers with an increased risk of preterm birth, low birth weight and being Born Small for Gestational Age, SGA. Other studies (7,15,(18)(19)(20)(21)(22) suggest similar findings. Furthermore, some of them introduce the increased risk of fetal growth restriction (FGR), (7,19,22,23) and perinatal mortality (15).…”

“…Other studies (7,15,(18)(19)(20)(21)(22) suggest similar findings. Furthermore, some of them introduce the increased risk of fetal growth restriction (FGR), (7,19,22,23) and perinatal mortality (15). Duan et al (7) analyzed the effect of diverse β-blocker subtypes on birth weight, suggesting that labetalol and atenolol were associated with the highest rate of low birth weight and an increased risk of being born SGA.…”

Arrhythmia risk and β-blocker therapy in pregnant women with long QT syndrome

“…Other adverse effects of β-blockers include reduced umbilical blood flow,16hypoglycaemia and bradycardia, all of which may cause IUGR 12. In this study, premature birth and LBWI were observed and may be more strongly associated in the BB group than in the non-BB group, whereas β-blockers may not be associated with IUGR.…”

Successful Pregnancy Outcome With Preconception Care in a Symptomatic Carrier of Duchenne Muscular Dystrophy: Case Report and Literature Review

“…2016; Tanaka et al. 2016), raising the possibility of bisoprolol as a cause of fetal atrioventricular conduction disorder in this case. Fetal bradycardia below 55 bpm is known to carry a high risk of developing fetal hydrops (Groves, Allan, and Rosenthal 1996), but in this fetus, the heart rate did not drop below 70 bpm.…”

In Utero Exposure to Antihypertensive Medication during the First Trimester: Is the Risk Worth Taking?

“…Fitton et al (8), in a recent data linkage cohort study, associated in-utero exposure to β-blockers with an increased risk of preterm birth, low birth weight and being Born Small for Gestational Age, SGA. Other studies (7,15,(18)(19)(20)(21)(22) suggest similar findings. Furthermore, some of them introduce the increased risk of fetal growth restriction (FGR), (7,19,22,23) and perinatal mortality (15).…”

“…Other studies (7,15,(18)(19)(20)(21)(22) suggest similar findings. Furthermore, some of them introduce the increased risk of fetal growth restriction (FGR), (7,19,22,23) and perinatal mortality (15). Duan et al (7) analyzed the effect of diverse β-blocker subtypes on birth weight, suggesting that labetalol and atenolol were associated with the highest rate of low birth weight and an increased risk of being born SGA.…”

Arrhythmia risk and β-blocker therapy in pregnant women with long QT syndrome

“…Other adverse effects of β-blockers include reduced umbilical blood flow,16hypoglycaemia and bradycardia, all of which may cause IUGR 12. In this study, premature birth and LBWI were observed and may be more strongly associated in the BB group than in the non-BB group, whereas β-blockers may not be associated with IUGR.…”

Successful Pregnancy Outcome With Preconception Care in a Symptomatic Carrier of Duchenne Muscular Dystrophy: Case Report and Literature Review

“…2016; Tanaka et al. 2016), raising the possibility of bisoprolol as a cause of fetal atrioventricular conduction disorder in this case. Fetal bradycardia below 55 bpm is known to carry a high risk of developing fetal hydrops (Groves, Allan, and Rosenthal 1996), but in this fetus, the heart rate did not drop below 70 bpm.…”

In Utero Exposure to Antihypertensive Medication during the First Trimester: Is the Risk Worth Taking?

“…Fitton et al (8), in a recent data linkage cohort study, associated in-utero exposure to β-blockers with an increased risk of preterm birth, low birth weight and being Born Small for Gestational Age, SGA. Other studies (7,15,(18)(19)(20)(21)(22) suggest similar findings. Furthermore, some of them introduce the increased risk of fetal growth restriction (FGR), (7,19,22,23) and perinatal mortality (15).…”

“…Other studies (7,15,(18)(19)(20)(21)(22) suggest similar findings. Furthermore, some of them introduce the increased risk of fetal growth restriction (FGR), (7,19,22,23) and perinatal mortality (15). Duan et al (7) analyzed the effect of diverse β-blocker subtypes on birth weight, suggesting that labetalol and atenolol were associated with the highest rate of low birth weight and an increased risk of being born SGA.…”

Arrhythmia risk and β-blocker therapy in pregnant women with long QT syndrome

“…Other adverse effects of β-blockers include reduced umbilical blood flow,16hypoglycaemia and bradycardia, all of which may cause IUGR 12. In this study, premature birth and LBWI were observed and may be more strongly associated in the BB group than in the non-BB group, whereas β-blockers may not be associated with IUGR.…”

Successful Pregnancy Outcome With Preconception Care in a Symptomatic Carrier of Duchenne Muscular Dystrophy: Case Report and Literature Review

“…2016; Tanaka et al. 2016), raising the possibility of bisoprolol as a cause of fetal atrioventricular conduction disorder in this case. Fetal bradycardia below 55 bpm is known to carry a high risk of developing fetal hydrops (Groves, Allan, and Rosenthal 1996), but in this fetus, the heart rate did not drop below 70 bpm.…”