Kubota Kana, Inai Kei, Shimada Eriko, Shinohara Tokuko
Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University.
Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University.
Circ J. 2023 Mar 24;87(4):569-577. doi: 10.1253/circj.CJ-22-0647. Epub 2023 Feb 23.
α/β- and β-blockers are essential in pregnant women's perinatal congenital heart disease management. Nevertheless, data on the effects of α/β- and β-blockers on pregnant women and fetuses are limited. We examined the risks of neonatal hypoglycemia and small for gestational age (SGA) associated with maternal exposure to α/β- and β-blockers.
All consecutive pregnant women with heart disease admitted to our hospital between January 2014 and October 2020 were included. Of 306 pregnancies (267 women), 32 were in the α/β-blocker group, 11 were in the β-blocker group, and 263 were in the control group. All 32 pregnancies in the α/β-blocker group were treated with carvedilol. In the β-blocker group, 4 women were treated with bisoprolol, 3 were treated with propranolol, 2 were treated with atenolol, 1 was treated with metoprolol, and 1 was treated nadolol. The incidence of neonatal hypoglycemia was higher in pregnant women taking carvedilol than in the control group (P=0.025). SGA was observed significantly more frequently in pregnant women taking β-blockers than in the carvedilol and control groups (P<0.001).
Carvedilol administration during pregnancy was associated with neonatal hypoglycemia; however, it did not occur in a time- or dose-dependent manner. Routine monitoring of blood glucose levels in newborns exposed to α/β- and β-blockers is essential.
α/β受体阻滞剂和β受体阻滞剂在孕妇围产期先天性心脏病管理中至关重要。然而，关于α/β受体阻滞剂和β受体阻滞剂对孕妇及胎儿影响的数据有限。我们研究了孕妇暴露于α/β受体阻滞剂和β受体阻滞剂与新生儿低血糖及小于胎龄儿（SGA）的风险。
纳入2014年1月至2020年10月期间我院收治的所有连续妊娠合并心脏病的孕妇。在306例妊娠（267名女性）中，32例在α/β受体阻滞剂组，11例在β受体阻滞剂组，263例在对照组。α/β受体阻滞剂组的所有32例妊娠均接受了卡维地洛治疗。在β受体阻滞剂组中，4名女性接受了比索洛尔治疗，3名接受了普萘洛尔治疗，2名接受了阿替洛尔治疗，1名接受了美托洛尔治疗，1名接受了纳多洛尔治疗。服用卡维地洛的孕妇新生儿低血糖发生率高于对照组（P = 0.025）。服用β受体阻滞剂的孕妇中SGA的发生率显著高于服用卡维地洛的孕妇及对照组（P < 0.001）。
孕期服用卡维地洛与新生儿低血糖有关；然而，其发生并非呈时间或剂量依赖性。对暴露于α/β受体阻滞剂和β受体阻滞剂的新生儿进行血糖水平的常规监测至关重要。
