β-Blocker treatment during pregnancy and adverse pregnancy outcomes: a nationwide population-based cohort study

Abstract

ObjectiveTo investigate the association between exposure to β-blockers during pregnancy and the risk of being born small for gestational age (SGA), preterm birth and perinatal mortality in a nationwide cohort.DesignA population-based retrospective cohort study, using the Danish Fertility Database. The authors identified all pregnant women redeeming a prescription for β-blockers using the National Prescription Registry. Multivariate logistic regression models were used to assess the association between exposure and our outcomes.SettingRegister-based survey.Participants911'685 births between 1995 and 2008 obtained from the Danish Fertility Database.Outcome measuresBeing born SGA was defined as having a birth weight below the 10th percentile for the corresponding gestational week. Preterm birth was defined as birth before the 37th gestational week. Perinatal mortality was defined as either death occurring within the first 28 days of life or stillbirth. Before 2004, fetal deaths were recorded as stillbirths if they occurred after 28 weeks of gestation, but since then stillbirth is recorded for deaths after 22 gestational weeks.ResultsThe authors identified 2459 pregnancies exposed to β-blockers. β-Blocker exposure during pregnancy was found to be associated with increased risk of SGA (adjusted OR 1.97, 95% CI 1.75 to 2.23), preterm birth (adjusted OR 2.26, 95% CI 2.03 to 2.52) and perinatal mortality (adjusted OR 1.89, 95% CI 1.25 to 2.84). Analyses were adjusted for socioeconomic and maternal variables. The authors found similar risk profiles for pregnancies exposed to labetalol and for pregnancies exposed to other β-blockers.ConclusionsThe authors found that exposure to β-blockers during pregnancy was associated with being born SGA, preterm birth and perinatal mortality. Our findings show that labetalol is not safer than other β-blockers during pregnancy.

Combined caesarean with splenectomy in pregnancy with portal hypertension: defining plausibility

“…Patients with NCPH who conceived after the treatment of oesophageal varices by endoscopic sclerotherapy or a decompression surgery had a successful pregnancy outcome 10 11. Beta blockers reduce portal pressure and decrease the risk of variceal haemorrhage but their use in pregnancy is limited due to the risk of fetal growth restriction and fetal bradycardia 12. Predictors of variceal bleeding include history of variceal bleed in the past, presence of jaundice, hypersplenism, ascites, thrombocytopaenia and endoscopic signs of large varices.…”

Pharmacological management of hypertension in pregnancy

“…In a study of 2459 women exposed to pure β-blockers or labetalol compared to women not prescribed medication, Meidahl also found an increased risk of SGA [aOR 1.98; CI 1.75–2.23] preterm birth [aOR 2.26; CI 2.03–2.52] and perinatal mortality [aOR 1.89; CI 1.25–2.84]. 22 In each, the authors conclude that the risk described is likely due to the underlying disease process rather than treatment. Clearly treatment of hypertension does not result in a complete normalization of risk profile.…”

Treatment of Peripartum Cardiomyopathy (Review)

“…Petersen et al [49] Авторы изучили влияние β-АБ на течение беременности в 2 459 слу-чаях и сравнили полученные результаты с группами беременных, не получавших медикаментозную тера-пию вообще, либо принимавших другие препараты (антагонисты кальция, метилдопа и др.). В целом, лечение β-АБ ассоциировалось с увеличенным ри-ском снижения веса плода на период гестации, пре-ждевременных родов и перинатальной смертности, хотя отмечено, что лабеталол был более безопасным в сравнении с другими представителями этой группы и не оказывал влияние на сердечный ритм плода [49].…”