Faculty of Medicine, Erasmus University Medical Center, 3015GD Rotterdam, The Netherlands.
Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad 500072, Telangana, India.
Int J Environ Res Public Health. 2022 Aug 4;19(15):9616. doi: 10.3390/ijerph19159616.
Beta-blockers are often used during pregnancy to treat cardiovascular diseases. The described neonatal side effects of maternal beta-blocker use are hypoglycemia and bradycardia, but the evidence base for these is yet to be evaluated comprehensively. Hence, this systematic review and meta-analysis was performed to evaluate the potential increased risk for hypoglycemia and bradycardia in neonates exposed to beta-blockers in utero or during lactation. A systematic search of English-language human studies was conducted until 21 April 2021. Both observational studies and randomized controlled trials investigating hypoglycemia and/or bradycardia in neonates following beta-blocker exposure during pregnancy and lactation were included. All articles were screened by two authors independently and eligible studies were included. Pair-wise and proportion-based meta-analysis was conducted and the certainty of evidence (CoE) was performed by standard methodologies. Of the 1.043 screened articles, 55 were included in this systematic review. Our meta-analysis showed a probable risk of hypoglycemia (CoE-Moderate) and possible risk of bradycardia (CoE-Low) in neonates upon fetal beta-blocker exposure. Therefore, we suggest the monitoring of glucose levels in exposed neonates until 24 h after birth. Due to the limited clinical implication, monitoring of the heart rate could be considered for 24 h. We call for future studies to substantiate our findings.
β受体阻滞剂常用于治疗心血管疾病。描述的母体使用β受体阻滞剂的新生儿副作用是低血糖和心动过缓，但这些证据基础尚未得到全面评估。因此，进行了这项系统评价和荟萃分析，以评估在宫内或哺乳期暴露于β受体阻滞剂的新生儿低血糖和心动过缓的潜在风险增加。系统搜索了截至 2021 年 4 月 21 日的英语人类研究。纳入了调查宫内和哺乳期β受体阻滞剂暴露后新生儿低血糖和/或心动过缓的观察性研究和随机对照试验。两名作者独立筛选所有文章，并纳入合格的研究。进行了两两和基于比例的荟萃分析，并通过标准方法进行了证据确定性（CoE）评估。在筛选出的 1043 篇文章中，有 55 篇被纳入本系统评价。我们的荟萃分析显示，胎儿暴露于β受体阻滞剂后，新生儿低血糖（CoE-中度）和心动过缓（CoE-低度）的风险可能增加。因此，我们建议在出生后 24 小时内监测暴露新生儿的血糖水平。由于临床意义有限，可考虑监测 24 小时心率。我们呼吁未来的研究来证实我们的发现。
