USE OF ATENOLOL IN PREGNANCY

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(Date of issue: March 2016, Version: 2)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

A corresponding patient information leaflet on atenolol use in pregnancy is available at www.medicinesinpregnancy.org.

Summary

Atenolol is a cardioselective (beta1 selective) beta-adrenoceptor blocking drug (beta-blocker) licensed for the treatment of hypertension, angina pectoris, cardiac dysrhythmia, and for early intervention in the acute phase of myocardial infarction.

Data on overall rates of fetal structural malformations, or of specific malformations following first trimester use of atenolol, are too limited to permit an evidence-based risk assessment. There are also insufficient data to assess the risk of spontaneous abortion, stillbirth and adverse neurodevelopmental outcomes following gestational atenolol exposure.

It is currently unclear whether gestational use of atenolol increases the risk of preterm delivery. Although the currently available limited data do not suggest that this is the case, further research is required to confirm this finding.

There is some evidence that atenolol exposure in pregnancy may adversely affect fetal growth, although data are conflicting. Some studies suggest that the risk of adverse effects on fetal growth may be higher when exposure commences prior to 20 gestational weeks but the possibility of a maternal disease effect cannot be excluded.

Use of beta-blockers near term may result in neonatal beta-adrenoceptor blockade leading to neonatal bradycardia, hypotension and hypoglycaemia. Accordingly, some (but not all) studies have reported increased rates of these neonatal complications in atenolol-exposed infants, although the absolute risk remains unquantified. Assessment of the neonate for these effects is thus advised.

Exposure to atenolol at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy. In pregnancies complicated by maternal hypertension and/or where atenolol has been administered, careful monitoring of fetal growth is advised. Other risk factors may also be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.