Propranolol in Pregnancy Three Year Prospective Study

Abstract

We compared propranolol with methyldopa in a randomized prospective study of 28 women with pregnancy associated hypertension. Both drugs were equally effective in controlling maternal hypertension. There was no significant difference in the birthweights of the babies in each group. However one infant born to a mother receiving propranolol had symptomatic hypoglycaemia. The mean peak levels of propranolol, propranolol glucuronide, 4-hydroxypropranolol, and 4-hydroxypropranolol glucuronide were not significantly different in the first, second, third trimesters and at least 3 months post partum. The mean peak plasma level of naphthoxylactic acid however was significantly less in the third trimester compared with post partum levels. Propranolol and its metabolites were found to cross into breast milk with the maximum dose likely to be ingested by the infant as either propranolol or propranolol glucuronide being 7 micrograms of propranolol per 100 g of breast milk, being approximately 0.1% of the maternal dose.

Impact of Antihypertensive Treatment on Maternal and Perinatal Outcomes in Pregnancy Complicated by Chronic Hypertension: A Systematic Review and Meta‐Analysis

“…Of the 23 articles that were excluded, 14 studies included a mixed population of gestational and chronic hypertension and did not report outcomes separately, 6 studies included only gestational hypertension, 1 article reported no additional outcomes for a trial already included in the meta‐analysis (Table ) . In addition, Leather and colleagues reported a randomized controlled trial in 1968 that recruited 47 chronic hypertensive participants randomized to bendroflumethiazide and methyldopa versus no treatment.…”

Do Commonly Used Oral Antihypertensives Alter Fetal or Neonatal Heart Rate Characteristics? A Systematic Review

“…26, 4.39)]. In three drug [labetalol (N = 2) and propranolol] vs. drug [methyldopa (N = 2) and hydralazine] trials (19,23,29), neonatal bradycardia [defined as heart rate < 120 bpm (24,29), or not at all (19)] was not reported (0/24 vs. 0/26).…”

Cardiovascular Pharmacotherapeutic Considerations During Pregnancy and Lactation

“…They estimated that a nursing infant ingesting 500 mL of breast milk from a mother receiving a total daily dose of 160 mg would have an accumulative dose of 21 mg over 24 hours, far below the usual therapeutic range. Other studies 97,98 also have demonstrated that propranolol is transferred into breast milk in amounts that would be unlikely to cause adverse effects in the infant.…”

“…96 In the past 3 decades since the clinical introduction of propranolol, there are numerous reports favorably documenting its use in pregnancy. 88,92,94,97,98 However, adverse fetal effects have been described, including bradycardia, 99 birth apnea, 100 hypoglycemia, 99 intrauterine growth retardation (IUGR), 99,101,102 hyperbilirubinemia, 99 polycythemia, 99 prolonged labor, 99 and a single case of fetal death. 103 None of these complications, however, were reported consistently in chronic therapy studies.…”