Contemporary maternal and fetal outcomes in the treatment of LQTS during pregnancy: Is nadolol bad for the fetus?

Preventing and Treating Torsades de Pointes in the Mother, Fetus and Newborn in the Highest Risk Pregnancies with Inherited Arrhythmia Syndromes

“…Obstetrical and neonatal nursing teams can work with their hospital emergency preparedness (code) teams to provide mock codes appropriate to maternal or fetal arrhythmias and to review available equipment to be sure that it is sufficient for both a maternal cardiac arrest or a neonatal cardiac arrest due to LQTS. A recent study from two decades of LQTS pregnancy care at the Cleveland Clinic showed that only five cardiac syncopal events or cardiac arrests occurred during that time and that none were pre-partum or during labor or delivery, but instead, all were in the post-partum period up to 9 months post-delivery, and all were in women who were not aware of their disease at the time [13]. Four of five were in women with LQT2, which is known to be associated with a higher risk for post-partum cardiac arrest.…”

“…Nadolol is the most commonly used and most effective beta-blocker (due to its long half-life). A recent study showed that while growth restriction was seen with beta-blockers [12], it was no more likely to be present with nadolol than with other drugs [13]. The best beta blocker for LQTS during pregnancy has not been proven.…”

“…Care of the fetus exposed to maternal cardiac medications: It is important to review with the mother that she should stay on her medications and should not discontinue them because of pregnancy or breastfeeding. The transition to the commonly used obstetrical beta blocker, metoprolol, is controversial, may potentially provide inferior arrhythmia control, and is unlikely to be necessary [13,14].…”