Pregnancy outcome after first trimester exposure to bisoprolol

Hoeltzenbein, Maria; Fietz, Anne‐Katrin; Kayser, Angela; Zinke, Sandra; Meister, Reinhard; Weber-Schoendorfer, Corinna; Schaefer, Christof

doi:10.1097/hjh.0000000000001818

Cited by 13 publications

(9 citation statements)

References 30 publications

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“…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).…”

Section: β-Adrenergic Receptor Blocking Agentssupporting

confidence: 70%

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

Papadopoulou

Tsialiou

Styanidou

et al. 2022

ama

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The aim of this study is to evaluate and present the evidence so far, regarding fetal outcomes after in utero exposure to antihypertensive medication. Hypertensive disorders during pregnancy constitute a significant risk factor for maternal and fetal outcomes, necessitating antihypertensive treatment. However, current data concerning the safety of in utero exposure to antihypertensive medication are controversial. While some studies recommend the administration of certain agents, others underline the possible adverse effects on fetal development. This review aims to summarize the outcomes of studies published during the last decade, referring to first trimester in utero exposure to antihypertensive agents. In general, a-methyldopa, β-blockers and calcium channel blockers are the first or second treatment line for hypertension during pregnancy. However, ACEIs, ARBs and diuretics are mostly contraindicated, as the potential risk outweighs the benefits of their administration. Additionally, several drugs should be avoided, due to the lack of data regarding their safety.Conclusion. As current studies are restricted for ethical reasons, there is a significant lack of evidence concerning diverse antihypertensive agent use. In utero exposure to antihypertensive medication needs to be carefully evaluated and supported by further research.

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Section: β-Adrenergic Receptor Blocking Agentssupporting

confidence: 70%

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

Papadopoulou

Tsialiou

Styanidou

et al. 2022

ama

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“…This is supported by evidence of ß1 receptors 54,55 in placental vasculature and placental vasoconstriction seen following exposure to ß blockers in vitro 56,57 . The potential negative effect of antenatal ß blocker use on fetal growth has long been considered 51,[58][59][60][61] . A recent meta-analysis including 13 cohort studies demonstrated a significant increase in SGA associated with antenatal ß blocker use (OR 1.72 [95% C.I.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of pre-eclampsia and adverse pregnancy outcomes in women with pre-existing cardiomyopathy: a multi-centre retrospective cohort study

Ormesher

Vause

Higson

et al. 2023

Sci Rep

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Pre-eclampsia is associated with postnatal cardiac dysfunction; however, the nature of this relationship remains uncertain. This multicentre retrospective cohort study aimed to determine the prevalence of pre-eclampsia in women with pre-existing cardiac dysfunction (left ventricular ejection fraction < 55%) and explore the relationship between pregnancy outcome and pre-pregnancy cardiac phenotype. In this cohort of 282 pregnancies, pre-eclampsia prevalence was not significantly increased (4.6% [95% C.I 2.2–7.0%] vs. population prevalence of 4.6% [95% C.I. 2.7–8.2], p = 0.99); 12/13 women had concurrent obstetric/medical risk factors for pre-eclampsia. The prevalence of preterm pre-eclampsia (< 37 weeks) and fetal growth restriction (FGR) was increased (1.8% vs. 0.7%, p = 0.03; 15.2% vs. 5.5%, p < 0.001, respectively). Neither systolic nor diastolic function correlated with pregnancy outcome. Antenatal ß blockers (n = 116) were associated with lower birthweight Z score (adjusted difference − 0.31 [95% C.I. − 0.61 to − 0.01], p = 0.04). To conclude, this study demonstrated a modest increase in preterm pre-eclampsia and significant increase in FGR in women with pre-existing cardiac dysfunction. Our results do not necessarily support a causal relationship between cardiac dysfunction and pre-eclampsia, especially given the population’s background risk status. The mechanism underpinning the relationship between cardiac dysfunction and FGR merits further research but could be influenced by concomitant ß blocker use.

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“…A comparison of the 339 patients in the bisoprolol cohort group with the 678 patients in the control group reported no increased risk of spontaneous abortions and fetal malformations but a high probability of preterm birth and SGA. 26 On the contrary, Tanaka et al argued that SGA was observed in the propranolol, metoprolol, and atenolol groups; however, no SGA was observed with bisoprolol administration in five patients. 27 Our study included four cases administered bisoprolol, three cases administered propranolol, two cases administered atenolol, one case administered metoprolol, and one case administered nadolol; however, similar to the report by Tanaka et al, 27 the number of cases was too small to discuss the differences between the types of β-blockers.…”

Section: Neonatal Outcomesmentioning

confidence: 94%

“…than labetalol and atenolol on pregnant women and fetuses. 18, 26 Tanaka et al pointed out that the effects on pregnant women and fetuses may differ depending on the type of α/β-blocker and β-blocker. 27 Therefore, we examined the risks of neonatal hypoglycemia and SGA associated with maternal exposure to α/β-and β-blockers.…”

Section: Neonatal Hypoglycemia and Sgamentioning

confidence: 99%

α/β- and β-Blocker Exposure in Pregnancy and the Risk of Neonatal Hypoglycemia and Small for Gestational Age

Kubota

Inai

Shimada

et al. 2023

Circ J

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Background: α/β-and β-blockers are essential in pregnant women's perinatal congenital heart disease management. Nevertheless, data on the effects of α/β-and β-blockers on pregnant women and fetuses are limited. We examined the risks of neonatal hypoglycemia and small for gestational age (SGA) associated with maternal exposure to α/β-and β-blockers. Methods and Results:All consecutive pregnant women with heart disease admitted to our hospital between January 2014 and October 2020 were included. Of 306 pregnancies (267 women), 32 were in the α/β-blocker group, 11 were in the β-blocker group, and 263 were in the control group. All 32 pregnancies in the α/β-blocker group were treated with carvedilol. In the β-blocker group, 4 women were treated with bisoprolol, 3 were treated with propranolol, 2 were treated with atenolol, 1 was treated with metoprolol, and 1 was treated nadolol. The incidence of neonatal hypoglycemia was higher in pregnant women taking carvedilol than in the control group (P=0.025). SGA was observed significantly more frequently in pregnant women taking β-blockers than in the carvedilol and control groups (P<0.001).Conclusions: Carvedilol administration during pregnancy was associated with neonatal hypoglycemia; however, it did not occur in a time-or dose-dependent manner. Routine monitoring of blood glucose levels in newborns exposed to α/β-and β-blockers is essential.

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Pregnancy outcome after first trimester exposure to bisoprolol

Abstract: Our study supports the hypothesis that first trimester bisoprolol treatment does not increase the risk for spontaneous abortions or major birth defects. However, an influence of prolonged bisoprolol exposure on fetal growth cannot be ruled out.

Cited by 13 publications

References 30 publications

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

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

Prevalence of pre-eclampsia and adverse pregnancy outcomes in women with pre-existing cardiomyopathy: a multi-centre retrospective cohort study

α/β- and β-Blocker Exposure in Pregnancy and the Risk of Neonatal Hypoglycemia and Small for Gestational Age

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