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

Kasper Meidahl Petersen, Espen Jimenez-Solem, Jon Traerup Andersen, Morten Petersen, Kasper Brødbæk, Lars Køber, Christian Torp-Pedersen, Henrik Enghusen Poulsen, Kasper Meidahl Petersen, Espen Jimenez-Solem, Jon Traerup Andersen, Morten Petersen, Kasper Brødbæk, Lars Køber, Christian Torp-Pedersen, Henrik Enghusen Poulsen

Abstract

Objective: To 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.

Design: A 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.

Setting: Register-based survey.

Participants: 911'685 births between 1995 and 2008 obtained from the Danish Fertility Database.

Outcome measures: Being 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.

Results: The 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.

Conclusions: The 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.

Conflict of interest statement

Competing interests: None.

References

    1. Sibai BM. Treatment of hypertension in pregnant women. N Engl J Med 1996;335:257–65
    1. Magee LA, Ornstein MP, von Dadelszen P. Fortnightly review: management of hypertension in pregnancy. BMJ 1999;318:1332–6
    1. Afifi Y, Churchill D. Pharmacological treatment of hypertension in pregnancy. Curr Pharm Des 2003;9:1745–53
    1. Magee LA, Duley L. Oral beta-blockers for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev 2003;(3):CD002863.
    1. Lyons KE, Pahwa R. Pharmacotherapy of essential tremor: an overview of existing and upcoming agents. CNS Drugs 2008;22:1037–45
    1. Modi S, Lowder DM. Medications for migraine prophylaxis. Am Fam Physician 2006;73:72–8
    1. Sibai BM, Gonzalez AR, Mabie WC, et al. Comparison of labetalol plus hospitalization versus hospitalization alone in the management of preeclampsia remote from term. Obstet Gynecol 1987;70:323–7
    1. Magee LA, Elran E, Bull SB, et al. Risks and benefits of beta-receptor blockers for pregnancy hypertension: overview of the randomized trials. Eur J Obstet Gynecol Reprod Biol 2000;88:15–26
    1. Nakhai-Pour HR, Rey E, Berard A. Antihypertensive medication use during pregnancy and the risk of major congenital malformations or small-for-gestational-age newborns. Birth Defects Res B Dev Reprod Toxicol 2010;89:147–54
    1. Lydakis C, Lip GY, Beevers M, et al. Atenolol and foetal growth in pregnancies complicated by hypertension. Am J Hypertens 1999;12:541–7
    1. Abalos E, Duley L, Steyn DW, et al. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev 2007;(1):CD002252.
    1. Zeitlin J, El AM, Jarreau PH, et al. Impact of foetal growth restriction on mortality and morbidity in a very preterm birth cohort. J Pediatr 2010;157:733–9
    1. Challis JR, Lye SJ, Gibb W, et al. Understanding preterm labor. Ann N Y Acad Sci 2001;943:225–34
    1. Knudsen LB. The Danish fertility database. Dan Med Bull 1998;45:221–5
    1. Andersen TF, Madsen M, Jorgensen J, et al. The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull 1999;46:263–8
    1. Gaist D, Sorensen HT, Hallas J. The Danish prescription registries. Dan Med Bull 1997;44:445–8
    1. Baadsgaard M, Quitzau J. Danish registers on personal income and transfer payments. Scand J Public Health 2011;39(7 Suppl):103–5
    1. Jensen VM, Rasmussen AW. Danish education registers. Scand J Public Health 2011;39(7 Suppl):91–4
    1. Pedersen CB, Gotzsche H, Moller JO, et al. The Danish Civil Registration System. A cohort of eight million persons. Dan Med Bull 2006;53:441–9
    1. Knudsen LB, Børlum Kristensen F. Monitoring perinatal mortality and perinatal care with a national register: content and usage of the Danish Medical Birth Register. Community Med 1986;8:29–36
    1. Karthikeyan VJ, Lip GY. Hypertension in pregnancy: pathophysiology and management strategies. Curr Pharm Des 2007;13:2567–79
    1. Magee LA, Schick B, Donnenfeld AE, et al. The safety of calcium channel blockers in human pregnancy: a prospective, multicenter cohort study. Am J Obstet Gynecol 1996;174:823–8
    1. Podymow T, August P. Update on the use of antihypertensive drugs in pregnancy. Hypertension 2008;51:960–9
    1. Lennestal R, Otterblad OP, Kallen B. Maternal use of antihypertensive drugs in early pregnancy and delivery outcome, notably the presence of congenital heart defects in the infants. Eur J Clin Pharmacol 2009;65:615–25
    1. World Health Organization Levels & Trends in Child Mortality. Report 2011. Estimates Developed by the UN Inter-agency for Child Mortality Estimation. World Health Organization, 2011. Ref type: online source.
    1. Olesen C, Sondergaard C, Thrane N, et al. Do pregnant women report use of dispensed medications? Epidemiology 2001;12:497–501

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren