1 Obstetrisk Klinik, Juliane Marie Centre, Rigshospitalet, The Capital Region of Denmark2 Department of Cardiology, Medical Center, Amager and Hvidovre Hospital, The Capital Region of Denmark3 Hjertemedicinsk Klinik, Hjertecentret Rigshospitalet, Rigshospitalet, The Capital Region of Denmark4 Neuroanæstesiologisk Klinik, Neurocentret, Rigshospitalet, The Capital Region of Denmark
OBJECTIVE: To investigate the effect on fetal growth of treatment with oral beta-blockers during pregnancy in women with congenital or acquired heart disease. DESIGN: Historical matched cohort study. SETTING: Centre for Pregnant Women with Heart Disease, Copenhagen University Hospital, Denmark. POPULATION: A cohort of 175 women with heart disease, grouped according to beta-blocker treatment, and a cohort of 627 women from the overall population matched on seven birthweight-determining factors. METHODS: Differences between groups were tested by simple descriptive statistics and assessed using standard hypothesis tests. Associations were estimated by correlational analysis and multivariable regression. MAIN OUTCOME MEASURE: Proportion of infants born small for gestational age (SGA). RESULTS: More of the infants exposed to beta-blockers were SGA compared with non-exposed infants (29.4 versus 15.3%; P < 0.05). After adjustment for birthweight-determining factors, beta-blocker treatment and maternal body mass index (BMI) were the only factors independently associated with SGA (the relative difference in expected birthweight was -8.6%; 95% CI -13.3 to -3.9%; P = 0.0004). After adjustment for BMI, beta-blocker treatment was associated with an increased risk of SGA (OR 2.65; 95% CI 1.15-6.10; P = 0.02). In a subgroup with isolated tachyarrhythmias, SGA infants were more frequent in the beta-blocker exposed group compared with the non-exposed group (31 versus 10%; P < 0.005). Beta-blocker treatment was the only independent predictor of SGA, adjusting for several factors influencing fetal growth (the relative difference in expected birthweight was -12.2%; 95% CI -19.9 to -3.9%; P = 0.001). CONCLUSIONS: In a historical cohort of pregnancies complicated by maternal heart disease, treatment with beta-blockers was found to be independently associated with an increased risk of delivering an SGA infant.
Bjog : an International Journal of Obstetrics and Gynaecology, 2014, Vol 121, Issue 5, p. 618-26
Administration, Oral; Adrenergic beta-Antagonists; Adult; Body Mass Index; Case-Control Studies; Cohort Studies; Female; Fetal Growth Retardation; Heart Diseases; Humans; Infant, Newborn; Infant, Small for Gestational Age; Pregnancy; Pregnancy Complications, Cardiovascular