Aarhus University Seal / Aarhus Universitets segl

β-Blocker Use in Pregnancy and the Risk for Congenital Malformations: An International Cohort Study

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

DOI

  • Brian T Bateman, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (B.T.B., K.F.H.).
  • ,
  • Uffe Heide-Jørgensen
  • Kristjana Einarsdóttir, University of Iceland, Reykjavik, Iceland (K.E.).
  • ,
  • Anders Engeland, Norwegian Institute of Public Health, Oslo, and University of Bergen, Bergen, Norway (A.E.).
  • ,
  • Kari Furu, Norwegian Institute of Public Health, Oslo, Norway (K.F., R.S.).
  • ,
  • Mika Gissler, University of Turku, Turku, Finland, and Karolinska Institutet, Stockholm, Sweden (M.G., H.K., J.R.).
  • ,
  • Sonia Hernandez-Diaz, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (S.H.).
  • ,
  • Helle Kieler, University of Turku, Turku, Finland, and Karolinska Institutet, Stockholm, Sweden (M.G., H.K., J.R.).
  • ,
  • Anna-Maria Lahesmaa-Korpinen, National Institute for Health and Welfare, Helsinki, Finland (A.L.).
  • ,
  • Helen Mogun, Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare, Helsinki, Finland; Brigham and Women's Hospital, Boston, Massachusetts (H.M.).
  • ,
  • Mette Nørgaard
  • Johan Reutfors, University of Turku, Turku, Finland, and Karolinska Institutet, Stockholm, Sweden (M.G., H.K., J.R.).
  • ,
  • Randi Selmer, Norwegian Institute of Public Health, Oslo, Norway (K.F., R.S.).
  • ,
  • Krista F Huybrechts, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (B.T.B., K.F.H.).
  • ,
  • Helga Zoega, University of Iceland, Reykjavik, Iceland, and University of New South Wales, Sydney, New South Wales, Australia (H.Z.).

Background: β-Blockers are a class of antihypertensive medications that are commonly used in pregnancy.

Objective: To estimate the risks for major congenital malformations associated with first-trimester exposure to β-blockers.

Design: Cohort study.

Setting: Health registries in the 5 Nordic countries and the U.S. Medicaid database.

Patients: Pregnant women with a diagnosis of hypertension and their offspring.

Measurements: First-trimester exposure to β-blockers was assessed. Outcomes were any major congenital malformation, cardiac malformations, cleft lip or palate, and central nervous system (CNS) malformations. Propensity score stratification was used to control for potential confounders.

Results: Of 3577 women with hypertensive pregnancies in the Nordic cohort and 14 900 in the U.S. cohort, 682 (19.1%) and 1668 (11.2%), respectively, were exposed to β-blockers in the first trimester. The pooled adjusted relative risk (RR) and risk difference per 1000 persons exposed (RD1000) associated with β-blockers were 1.07 (95% CI, 0.89 to 1.30) and 3.0 (CI, -6.6 to 12.6), respectively, for any major malformation; 1.12 (CI, 0.83 to 1.51) and 2.1 (CI, -4.3 to 8.4) for any cardiac malformation; and 1.97 (CI, 0.74 to 5.25) and 1.0 (CI, -0.9 to 3.0) for cleft lip or palate. For CNS malformations, the adjusted RR was 1.37 (CI, 0.58 to 3.25) and the RD1000 was 1.0 (CI, -2.0 to 4.0) (based on U.S. cohort data only).

Limitation: Analysis was restricted to live births, exposure was based on dispensed medication, and cleft lip or palate and CNS malformations had few outcomes.

Conclusion: The results suggest that maternal use of β-blockers in the first trimester is not associated with a large increase in the risk for overall malformations or cardiac malformations, independent of measured confounders.

Primary Funding Source: The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Söderström König Foundation.

Original languageEnglish
JournalAnnals of Internal Medicine
Pages (from-to)665-73
Number of pages9
ISSN0003-4819
DOIs
Publication statusPublished - 20 Nov 2018

See relations at Aarhus University Citationformats

ID: 134368616