Effect of betablocker use on fetal birth weight
Effect of beta-blocker use on fetal birth weight in pregnancies complicated with structural heart disease. Baard JA 1, Sliwa K 2, Anthony J 2, Dowling W 3, Osman A 3 Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town 2 Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa. 1 Hatter Background Results Structural heart disease (SHD) leads to a higher maternal mortality rate and an increase in adverse fetal outcomes. This is complicated by the use of beta-blockers which have been associated with small for gestational age (SGA) and low birth weight (LBW) previously. We aimed to examine whether treatment with beta-blockers (BB) in pregnancies complicated with SHD result in a decrease in fetal birth weight within a South-African cohort. Baseline Clinical characteristic Methods A prospective cohort study was conducted in a tertiary multidisciplinary maternal care facility in Cape Town South Africa from 2010 to 2016. From 178 consecutive pregnant women with structural heart disease (SHD), 24. 2 percent received BB (n= 43) throughout pregnancy. SHD pregnancies were further sub-divided into congenital, valvular, cardiomyopathy and other for extended analysis. Outcomes of mean gestational age of delivery and mean fetal birth weight (FBW) were compared between groups and subgroups. Adverse fetal outcome was defined as: Low birth weight (LBW) <2500 g; Apgar score < 7, premature birth (< 37 weeks) and (SGA). Birth weight (g) 2906(60. 9) 2561(121) P-value. 009 Comparison between beta-blocker groups for adverse fetal outcomes BB not used (n=135) p-value Age (years) 28 ± 6 30 ± 6 28 ± 6 0. 008 Parity, n (range) 2 (1 -5) 2 (1 -4) 1 (1 -5) 0. 153 BMI (kg/cm 2) 28. 1 ± 7. 3 28. 4 ± 7. 0 27. 9 ± 7. 4 0. 664 Systolic blood pressure (mm Hg) 121 ± 16 121 ± 17 121 ± 15 0. 721 Diastolic blood pressure (mm Hg) 74 ± 12 76 ± 13 73 ± 12 0. 199 Heart rate (beats/min) 86 ± 17 88 ± 15 85 ± 12 0. 176 I/II 152 (88) 31 (74) 121 (92) III/IV 21 (12) 11 (26) 10 (8) 11. 6 ± 1. 7 11. 7 ± 1. 5 11. 5 ± 1. 7 0. 340 LVEDD (mm) 48. 5 ± 7. 6 50. 1 ± 8. 3 48. 1 ± 7. 3 0. 112 LVESD (mm) 33. 6 ± 7. 6 35. 5 ± 9. 7 33. 0 ± 6. 7 0. 099 Ejection fraction (%) 58. 6 ± 11. 8 56. 1 ± 13. 7 59. 6 ± 10. 5 0. 132 Comparison between BB types and mean fetal birth weight Hemoglobin (g/dl) 0. 001 Echocardiography Comparison between BB groups for mean birth weight and gestational age General medical history (%) Cardiomyopathy BB not used BB used (n=18) ) 2774(139) BB used (n=43) NYHA functional class, n (%) Comparison of FBW and BB groups among two SHD subgroups Valvular BB not used (n=45) BB used (n=14) All (n=178) 3225(171) P-value. 049 Chronic hypertension 17 (10) 4 (9) 13 (10) 0. 949 HIV 38 (21) 9 (21) 29 (21) 0. 921 Family history of CVD 31 (17) 7 (16) 24 (17) 0. 843 Caesarian section, n (%) 90 (51) 25 (58) 65 (48) 0. 291 Comparison between BB groups for adverse fetal outcomes in valvular subgroup BB not used (n=45) Valvular BB used (n=14) Distribution among SHD subgroups P-value BB not used (n = 135) BB used (n = 43) P-value Apgar score < 7 Preterm birth < 37 weeks 23 (85) 32 (74) 4 (15) 11 (26) 0. 326 0. 802 Apgar score < 7 Preterm birth < 37 weeks 9(75) 10(71) 3(25) 4(29) . 938. 722 Low Birth Weight < 2500 g 28 (76) 9 (24) 0. 868 Low Birth Weight < 2500 g 4(40) 6(60) . 003 SGA 41 (77) 12 (23) 0. 824 SGA 12(57) 9(43) . 010 Conclusion Beta-blocker use in pregnancies complicated with SHD within a South African cohort showed no association with a decrease in FBW or with an increase in fetal adverse outcomes as compared to non-BB usage is associated with a significant decrease in FBW within the valvular SHD sub-group and an significant increase within the cardiomyopathy SHD sub-group. A significant increase in SGA births was observed within the valvular SHD sub-group for those using BB. The α- and β-receptor blocker Carvedilol, was associated with a non-significant increase in mean fetal birth weight of 410 grams as compared to Atenolol within the BB usage group. Beta-blocker usage appears safe within these pregnancies with regards to FBW and adverse fetal outcomes although usage should be evaluated on a individual basis with careful consideration towards fetal growth.
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