USE OF BETA-ADRENOCEPTOR BLOCKING DRUGS (BETA-BLOCKERS) IN PREGNANCY

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(Date of issue: February 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.

Summary

Fifteen beta-adrenoceptor blocking drugs (beta-blockers) are currently licensed in the UK. Beta-blockers are used in the management of numerous conditions, including hypertension, angina, myocardial infarction, arrhythmia, heart failure, thyrotoxicosis, anxiety, and migraine prophylaxis. Topical preparations are also used to treat glaucoma. 

Labetalol is the only beta-blocker licensed in the UK for the treatment of hypertension in pregnancy and NICE guidelines state that labetalol is the preferred antihypertensive for use in pregnancy. 

A meta-analysis has suggested that gestational beta-blocker exposure may be linked to increased risks of cleft lip and/or palate and neural tube defects in the infant, although these findings remain to be confirmed. Some studies have also suggested a possible increased risk of congenital heart defects amongst infants of women who were treated with beta-blockers in pregnancy, however increased rates of cardiovascular malformation have been observed with other antihypertensive therapies. This association may therefore reflect a physiological effect of lowering the maternal blood pressure rather than a drug-specific teratogenic effect, or may be causally related to other factors associated with the underlying maternal conditions for which these medications are prescribed.

Use of beta-blockers in pregnancy has been associated with adverse effects on fetal growth, however, because maternal hypertension itself increases the risk of intrauterine growth restriction, causal analysis is complex and any contribution of beta-blocker exposure to this outcome remains unquantified.

Overall, the available data do not suggest that gestational beta-blocker exposure increases the risk of preterm delivery. Data on rates of spontaneous abortion, stillbirth and neurodevelopmental outcomes are too limited to permit a risk assessment.

Use of beta-blockers near term may result in neonatal beta-adrenoceptor blockade leading to neonatal bradycardia, hypotension and hypoglycaemia. Neonatal respiratory distress has also been reported.

Exposure to beta-blockers 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 beta-blockers have 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.