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

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.…”

At the Heart of the Pregnancy: What Prenatal and Cardiovascular Genetic Counselors Need to Know about Maternal Heart Disease

“…Beta blockers are frequently used to prevent aortic dilation during pregnancy in Marfan syndrome and other aortopathies (Lind and Wallenburg 2001;Meijboom et al 2005;Omnes et al 2013). Although atenolol has been studied the most at prevention of aortic dilation in Marfan syndrome, other beta blockers are preferred in pregnancy, as atenolol is more frequently associated with intrauterine growth restriction (Tanaka et al 2016).…”

Thyroid Disorders

“…Teratogenicity (see section 3.5.2, table 3.9) BB beyond 6 weeks of gestation may increase the risk of foetal growth restriction (110) Other treatment options RAI is absolutely contraindicated in pregnant women due to the possible risk of miscarriages, foetal thyroid ablation and birth defects.…”