Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie.
Beuth Hochschule für Technik - University of Applied Sciences, Berlin, Germany.
J Hypertens. 2020 Feb;38(2):354-361. doi: 10.1097/HJH.0000000000002256.
Our aim was to evaluate the effects of beta-blockers during the second and third trimester on fetal growth, length of gestation and postnatal symptoms in exposed infants.
The current prospective observational cohort study compares 294 neonates of hypertensive mothers on metoprolol or bisoprolol during the second and/or third trimester with 225 methyldopa-exposed infants and 588 infants of nonhypertensive mothers. The risks for reduced birth weight, prematurity, neonatal bradycardia, hypoglycaemia and respiratory disorders were analysed.
The rate of small-for-gestational-age children was significantly higher in long-term beta-blocker exposed infants (24.1%) compared with the methyldopa cohort [10.2%, odds ratio (OR)adj 2.5, 95% confidence interval (CI) 1.2-5.2] and the nonhypertensive cohort (9.9%, ORadj 4.3, 95% CI 2.6-7.1). The risk for preterm birth was significantly increased compared with nonhypertensive pregnancies (ORadj 2.2, 95% CI 1.3-3.8) but not compared with the methyldopa cohort. Neonatal adverse outcomes occurred more frequently in the study cohort (11.5%) compared with the nonhypertensive comparison group (6.5%) and the methyldopa cohort (8.4%), but without statistical significance (ORadj 1.5, 95% CI 0.7-3.0 and ORadj 1.5, 95% CI 0.7-3.3, respectively).
Long-term intrauterine exposure to metoprolol or bisoprolol may increase the risk of being born small-for-gestational-age. It is still a matter of debate to which extent maternal hypertension contributes to the lower birth weight. Serious neonatal symptoms are rare. Altogether, metoprolol and bisoprolol are well tolerated treatment options, but a case-by-case decision on close neonatal monitoring is recommended.
评估母亲妊娠中晚期使用β受体阻滞剂（比索洛尔或美托洛尔）对子代胎儿生长、胎龄及新生儿期症状的影响。
前瞻性观察性队列研究比较了 294 例中、晚期应用比索洛尔或美托洛尔的高血压母亲所娩新生儿与 225 例应用甲基多巴的新生儿及 588 例非高血压母亲所娩新生儿的情况。分析了出生体重低、早产、新生儿心动过缓、低血糖及呼吸障碍的发生风险。
长期（中晚期）β受体阻滞剂暴露儿的小于胎龄儿发生率（24.1%）明显高于甲基多巴组（10.2%）[比值比（OR）调整后为 2.5，95%可信区间（CI）为 1.2-5.2]和非高血压组（9.9%）[OR 调整后为 4.3，95% CI 为 2.6-7.1]。与非高血压妊娠相比，早产的风险显著增加（OR 调整后为 2.2，95% CI 为 1.3-3.8），但与甲基多巴组无显著差异。与非高血压对照组（6.5%）和甲基多巴组（8.4%）相比，研究组新生儿不良结局发生率（11.5%）更高，但差异无统计学意义（OR 调整后为 1.5，95% CI 为 0.7-3.0 和 OR 调整后为 1.5，95% CI 为 0.7-3.3）。
妊娠中晚期宫内暴露于比索洛尔或美托洛尔可能会增加小于胎龄儿的发生风险。但母亲高血压在多大程度上导致低出生体重仍存在争议。严重的新生儿症状罕见。总之，比索洛尔和美托洛尔是耐受良好的治疗选择，但建议根据具体情况决定是否进行密切的新生儿监测。
