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Grand Rounds

Is the Use of Beta-blockers in Pregnancy Related to Fetal Cardiac Anomalies?

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BACKGROUND AND PURPOSE:

  • Beta-blockers are widely used for treating cardiac conditions in pregnancy, but safety data is limited
  • Duan et. al. (JAMA Internal Medicine, 2017) examined the risk of fetal congenital cardiac anomalies related to the use of beta-blockers in pregnancy

METHODS:

  • Retrospective population-based cohort study of pregnant women exposed to beta-blockers
  • Singleton pregnancies between 2003-2014
  • Primary outcome was fetal cardiac anomalies
  • Multivariable logistic regression models were used to address other possible contributing factors

RESULTS:

  • Out of 379,238 pregnancies, 4847 (1.3%) were exposed to beta-blockers and of those 2628 (0.7%) were exposed in the first trimester
  • Most common beta-blockers were
    • labetalol (n = 3357)
    • atenolol (n = 638)
    • propranolol (n = 489)
    • metoprolol (n = 324)
  • Any association between beta-blockers and fetal cardiac anomalies was no longer apparent after adjusting for maternal age, maternal BMI, and maternal comorbidities

CONCLUSION:

  • Any previous studies that demonstrated a relationship between beta-blockers and fetal cardiac anomalies may have been due to confounding
  • The authors conclude that while their study does not definitively rule out an association between beta-blockers and fetal cardiac anomalies, it should reassure patients and providers who do require these medications during pregnancy

Learn More – Primary Sources:

β-Blocker Exposure in Pregnancy and Risk of Fetal Cardiac Anomalies

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