Neonatal effects of intrauterine metoprolol/bisoprolol exposure during the second and third trimester: a cohort study with two comparison groups. Issue 2 (February 2020)

• Record Type: Journal Article
• Authors: Kayser, Angela; Beck, Evelin; Hoeltzenbein, Maria; Zinke, Sandra; Meister, Reinhard; Weber-Schoendorfer, Corinna; Schaefer, Christof
• Is Part Of: Journal of hypertension. Volume 38:Issue 2(2020:Feb.)
• Publication Date: 2020-02
• Subjects: 'Bisoprolol'[Mesh] -- 'Cohort Studies'[Mesh] -- 'Fetal Growth Retardation'[Mesh] -- 'Hypertension'[Mesh] -- 'Metoprolol'[Mesh] -- 'Pregnancy Outcome'[Mesh]; Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/HJH.0000000000002256
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objectives: Our aim was to evaluate the effects of beta-blockers during the second and third trimester on fetal growth, length of gestation and postnatal symptoms in exposed infants. Methods: The current prospective observational cohort study compares 294 neonates of hypertensive mothers on metoprolol or bisoprolol during the second and/or third trimester with 225 methyldopa-exposed infants and 588 infants of nonhypertensive mothers. The risks for reduced birth weight, prematurity, neonatal bradycardia, hypoglycaemia and respiratory disorders were analysed. Results: The rate of small-for-gestational-age children was significantly higher in long-term beta-blocker exposed infants (24.1%) compared with the methyldopa cohort [10.2%, odds ratio (OR)adj 2.5, 95% confidence interval (CI) 1.2–5.2] and the nonhypertensive cohort (9.9%, ORadj 4.3, 95% CI 2.6–7.1). The risk for preterm birth was significantly increased compared with nonhypertensive pregnancies (ORadj 2.2, 95% CI 1.3–3.8) but not compared with the methyldopa cohort. Neonatal adverse outcomes occurred more frequently in the study cohort (11.5%) compared with the nonhypertensive comparison group (6.5%) and the methyldopa cohort (8.4%), but without statistical significance (ORadj 1.5, 95% CI 0.7–3.0 and ORadj 1.5, 95% CI 0.7–3.3, respectively). Conclusion: Long-term intrauterine exposure to metoprolol or bisoprolol may increase the risk of being born small-for-gestational-age. It is still a matter of debate to which extent maternal hypertension contributes to the lower birth weight. Serious neonatal symptoms are rare. Altogether, metoprolol and bisoprolol are well tolerated treatment options, but a case-by-case decision on close neonatal monitoring is recommended. Abstract : Supplemental Digital Content is available in the text