Treatment with oral beta-blockers during pregnancy complicated by maternal heart disease increases the risk of fetal growth restriction
Abstract
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.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The main concern with beta-blockers in pregnancy is intrauterine growth retardation.
“The main concern is related to intrauterine growth retardation.404”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [404]
Cites
The Danish National Hospital Register. A valuable source of data for modern health sciences.
Andersen, T. F., Madsen, M., Jørgensen, J. O. L., Mellemkjoer, L., & Olsen, J. H. (1999) · PubMed · Cited by 2,034 · see citing works
ESC Guidelines on the management of cardiovascular diseases during pregnancy
Endorsed by the European Society of Gynecology (ESG), T. A. F. E. P. C. (., Authors/Task Force Members, Regitz-Zagrosek, V., Blomstrom Lundqvist, C., Borghi, C., Cifkova, R., Ferreira, R., Foidart, J.-M., Gibbs, J. S. R., Gohlke-Baerwolf, C., et al. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr218 · Cited by 1,924 · see citing works
Intrauterine growth curves based on ultrasonically estimated foetal weights
Maršál, K., Persson, P., Larsen, T., Lilja, H., Selbing, A., & Sultan, B. (1996) · Acta paediatrica · doi:10.1111/j.1651-2227.1996.tb14164.x · Cited by 1,900 · see citing works
DeGroot, L. J., Abalovich, M., Alexander, E. K., Amino, N., Barbour, L. A., Cobin, R. H., Eastman, C. J., Lazarus, J. H., Luton, D., Mandel, S. J., et al. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-2803 · Cited by 1,862 · see citing works
In utero programming of chronic disease
BARKER, D. J. P. (1998) · Clinical Science · doi:10.1042/cs0950115 · Cited by 1,765 · see citing works
Prospective Multicenter Study of Pregnancy Outcomes in Women With Heart Disease
Siu, S. C., Sermer, M., Colman, J. M., Alvarez, A. N., Mercier, L., Morton, B. C., Kells, C. M., Bergin, M. L., Kiess, M. C., Marcotte, F., et al. (2001) · Circulation · doi:10.1161/hc3001.093437 · Cited by 1,401 · see citing works
Birth weight in relation to morbidity and mortality among newborn infants
McIntire, D. D., Bloom, S. L., Casey, B. M., & Leveno, K. J. (1999) · New England Journal of Medicine · doi:10.1056/nejm199904223401603 · Cited by 1,258 · see citing works
The Danish Medical Birth Registry.
Lb, K., & Olsen, J. (1998) · PubMed · Cited by 809 · see citing works
Antihypertensive drug therapy for mild to moderate hypertension during pregnancy
Abalos, E., Duley, L., & Steyn, D. W. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002252.pub3 · Cited by 705 · see citing works
Outcome of Pregnancy in Women With Congenital Heart Disease
Drenthen, W., Pieper, P. G., Roos‐Hesselink, J. W., van Lottum, W. A., Voors, A. A., Mulder, B. J. M., van Dijk, A. P. J., Vliegen, H. W., Yap, S., Moons, P., et al. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.03.027 · Cited by 608 · see citing works
von Dadelszen, P., Ornstein, M. P., Bull, S., Logan, A. G., Koren, G., & Magee, L. A. (2000) · The Lancet · doi:10.1016/s0140-6736(98)08049-0 · Cited by 509 · see citing works
Pregnancy Outcomes in Women With Congenital Heart Disease
Khairy, P., Ouyang, D. W., Fernandes, S. M., Lee-Parritz, A., Economy, K. E., & Landzberg, M. J. (2006) · Circulation · doi:10.1161/circulationaha.105.589655 · Cited by 498 · see citing works
Roos‐Hesselink, J. W., Ruys, T. P. E., STEIN, J. I., Thilén, U., Webb, G. D., Niwa, K., Kaemmerer, H. M., Baumgartner, H., Budts, W., Maggioni, A. P., et al. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs270 · Cited by 462 · see citing works
The effect of valvular heart disease on maternal and fetal outcome of pregnancy
Hameed, A. B., Karaalp, I. S., Tummala, P. P., Wani, O. R., Canetti, M., Akhter, M. W., Goodwin, M., Zapadinsky, N., & Elkayam, U. (2001) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(00)01198-0 · Cited by 440 · see citing works
Adverse Neonatal and Cardiac Outcomes Are More Common in Pregnant Women With Cardiac Disease
Siu, S. C., Colman, J. M., Sorensen, S., Smallhorn, J. F., Farine, D., Amankwah, K. S., Spears, J. C., & Sermer, M. (2002) · Circulation · doi:10.1161/01.cir.0000015699.48605.08 · Cited by 369 · see citing works
Atenolol and fetal growth in pregnancies complicated by hypertension
Lydakis, C. (1999) · American Journal of Hypertension · doi:10.1016/s0895-7061(99)00031-x · Cited by 325 · see citing works
Chronic kidney disease in pregnancy
Williams, D. J., & Davison, J. M. (2008) · BMJ · doi:10.1136/bmj.39406.652986.be · Cited by 319 · see citing works
Management of hypertension in pregnancy
Magee, L. A., Ornstein, M. P., & von Dadelszen, P. (1999) · BMJ · doi:10.1136/bmj.318.7194.1332 · Cited by 317 · see citing works
Antihypertensive drug therapy for mild to moderate hypertension during pregnancy
Abalos, E. J., Duley, L., Steyn, D. W., & Henderson-Smart, D. J. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002252.pub2 · Cited by 261 · see citing works
Silversides, C. K., Harris, L., Haberer, K., Sermer, M., Colman, J. M., & Siu, S. C. (2006) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2005.11.041 · Cited by 255 · see citing works
Oral beta-blockers for mild to moderate hypertension during pregnancy
Magee, L. A., & Duley, L. (2003) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002863 · Cited by 228 · see citing works
Pregnancy and contraception in heart disease and pulmonary arterial hypertension
Thorne, S., Nelson‐Piercy, C., Rosenthal, É., MacGregor, E. A., Gibbs, S., Crowhurst, J. A., Panay, N., Walker, F., Williams, D. J., de Swiet, M., et al. (2006) · Journal of Family Planning and Reproductive Health Care · doi:10.1783/147118906776276486 · Cited by 177 · see citing works
How to manage hypertension in pregnancy effectively
Magee, L. A., Abalos, E. J., von Dadelszen, P., Sibai, B. M., Easterling, T., Walkinshaw, S. A., & for the CHIPS Study Group (2011) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.2011.04002.x · Cited by 139 · see citing works
Petersen, K. M., Jimenez‐Solem, E., Andersen, J. T., Petersen, M. R., Brødbæk, K., Køber, L., Torp-Pedersen, C. T., & Poulsen, H. E. (2012) · BMJ Open · doi:10.1136/bmjopen-2012-001185 · Cited by 122 · see citing works
Davis, R. L., Eastman, D., McPhillips, H. A., Raebel, M. A., Andrade, S. E., Smith, D. H., Yood, M. U., Dublin, S., & Platt, R. G. (2010) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.2068 · Cited by 111 · see citing works
Effect of Maternal Heart Disease on Fetal Growth
Gelson, E., Curry, R., Gatzoulis, M. A., et al. (2011) · Obstetrics and Gynecology · doi:10.1097/aog.0b013e31820cab69 · Cited by 103 · see citing works
Nakhai-Pour, H. R., Rey, É., & Bérard, A. (2010) · Birth Defects Research Part B Developmental and Reproductive Toxicology · doi:10.1002/bdrb.20238 · Cited by 67 · see citing works
Pregnancy issues in scleroderma
Lidar, M., & Langevitz, P. (2011) · Autoimmunity Reviews · doi:10.1016/j.autrev.2011.11.021 · Cited by 65 · see citing works
Correlation Between Beta- and Alpha-Adrenergic Receptor Concentrations in Human Placenta
Falkay, G., Melis, K., & Kovács, L. (1994) · Journal of Receptor Research · doi:10.3109/10799899409066030 · Cited by 19 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Gravholt, C. H., Andersen, N. H., Conway, G. S., Dekkers, O. M., Geffner, M. E., Klein, K. O., Lin, A. E., Mauras, N., Quigley, C. A., Rubin, K., et al. (2017) · European Journal of Endocrinology · doi:10.1530/eje-17-0430 · Cited by 1,101 · see citing works
2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H., Conti, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.08.856 · Cited by 439 · see citing works
Clinical practice guidelines for the care of girls and women with Turner syndrome.
Gravholt, C. H., Andersen, N. H., Christin-Maitre, S., Davis, S. M., Duijnhouwer, A., Gawlik, A., Maciel-Guerra, A. T., Gutmark-Little, I., Fleischer, K., Hong, D., et al. (2024) · European Journal of Endocrinology · doi:10.1093/ejendo/lvae050 · Cited by 224 · see citing works
Katritsis, D. G., Boriani, G., Cosio, F. G., Hindricks, G., Jaïs, P., Josephson, M. E., Keegan, R., Kim, Y.-H., Knight, B. P., Kuck, K.-H., et al. (2017) · Europace · doi:10.1093/europace/euw301 · Cited by 188 · see citing works
Creeley, C. E., & Denton, L. K. (2019) · Brain Sciences · doi:10.3390/brainsci9090235 · Cited by 78 · see citing works
Pregnancy outcomes in women with aortic coarctation
Ramlakhan, K. P., Tobler, D., Greutmann, M., Schwerzmann, M., Baris, L., Yetman, A. T., Nihoyannopoulos, P., Manga, P., Boersma, E., Maggioni, A. P., et al. (2021) · Heart · doi:10.1136/heartjnl-2020-317513 · Cited by 42 · see citing works
- Authors
- Ersbøll, A., Hedegaard, M., Søndergaard, L., Ersbøll, M., & Johansen, M.
- Affiliations
- Department of Obstetrics Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
- Copenhagen University Hospital (DK)
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2014-01-09
- Volume
- 121
- Issue
- 5
- Pages
- 618-626
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W2045416188
- Cited by
- 102
- References
- 29
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 5 · 2023: 10 · 2022: 7 · 2021: 6 · 2020: 14 · 2019: 11 · 2018: 8 · 2017: 9 · 2016: 8 · 2015: 12 · 2014: 2
- FWCI
- 10.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sundhedsstyrelsen
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Issues in Pregnancy
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- oral beta-blockers, cardiac disease in pregnancy, fetal growth restriction, small for gestational age, congenital heart disease, acquired heart disease, tachyarrhythmias, body mass index, pregnancy, birth weight
- MeSH terms
- Administration, Oral, Adrenergic beta-Antagonists, Adult, Female, Fetal Growth Retardation, Heart Diseases, Humans, Infant, Newborn, Infant, Small for Gestational Age, Pregnancy, Pregnancy Complications, Cardiovascular, Cohort Studies, Body Mass Index, Case-Control Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
