孕期合并母体心脏病时口服β受体阻滞剂治疗会增加胎儿生长受限的风险。
Treatment with oral beta-blockers during pregnancy complicated by maternal heart disease increases the risk of fetal growth restriction.
机构信息
Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
出版信息
BJOG. 2014 Apr;121(5):618-26. doi: 10.1111/1471-0528.12522. Epub 2014 Jan 9.
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.
目的
研究妊娠期间口服β受体阻滞剂治疗先天性或获得性心脏病妇女对胎儿生长的影响。
设计
历史匹配队列研究。
地点
丹麦哥本哈根大学医院妊娠心脏病中心。
人群
根据β受体阻滞剂治疗情况，将 175 名心脏病孕妇分为一组，并根据 7 个决定出生体重的因素与来自一般人群的 627 名孕妇匹配成一组。
方法
通过简单描述性统计检验和标准假设检验来检验组间差异。通过相关分析和多变量回归来估计相关性。
主要观察指标
小于胎龄儿（SGA）的婴儿比例。
结果
与未暴露组相比，暴露于β受体阻滞剂的婴儿中 SGA 比例更高（29.4%比 15.3%；P<0.05）。在调整出生体重决定因素、β受体阻滞剂治疗和母亲体重指数（BMI）后，β受体阻滞剂治疗和母亲 BMI 是与 SGA 独立相关的唯一因素（预期出生体重的相对差异为-8.6%；95%CI-13.3 至-3.9%；P=0.0004）。在调整 BMI 后，β受体阻滞剂治疗与 SGA 风险增加相关（OR 2.65；95%CI 1.15-6.10；P=0.02）。在孤立性心动过速的亚组中，与未暴露组相比，暴露组中 SGA 婴儿更常见（31%比 10%；P<0.005）。在调整影响胎儿生长的多个因素后，β受体阻滞剂治疗是 SGA 的唯一独立预测因素（预期出生体重的相对差异为-12.2%；95%CI-19.9 至-3.9%；P=0.001）。
结论
在一组患有母体心脏病的妊娠的历史队列中，发现β受体阻滞剂治疗与 SGA 婴儿的风险增加独立相关。
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