Abstract：
BACKGROUND: Beta-blockers are commonly used drugs during pregnancy, especially in women with heart disease, and are regarded as relatively safe although evidence is sparse. Differences between beta-blockers are not well-studied.
METHODS: In the Registry of Pregnancy And Cardiac disease (ROPAC, n = 5739), a prospective global registry of pregnancies in women with structural heart disease, perinatal outcomes (small for gestational age (SGA), birth weight, neonatal congenital heart disease (nCHD) and perinatal mortality) were compared between women with and without beta-blocker exposure, and between different beta-blockers. Multivariable regression analysis was used for the effect of beta-blockers on birth weight, SGA and nCHD (after adjustment for maternal and perinatal confounders).
RESULTS: Beta-blockers were used in 875 (15.2%) ROPAC pregnancies, with metoprolol (n = 323, 37%) and bisoprolol (n = 261, 30%) being the most frequent. Women with beta-blocker exposure had more SGA infants (15.3% vs 9.3%, p < 0.001) and nCHD (4.7% vs 2.7%, p = 0.001). Perinatal mortality rates were not different (1.4% vs 1.9%, p = 0.272). The adjusted mean difference in birth weight was -177 g (-5.8%), the adjusted OR for SGA was 1.7 (95% CI 1.3-2.1) and for nCHD 2.3 (1.6-3.5). With metoprolol as reference, labetalol (0.2, 0.1-0.4) was the least likely to cause SGA, and atenolol (2.3, 1.1-4.9) the most.
CONCLUSIONS: In women with heart disease an association was found between maternal beta-blocker use and perinatal outcomes. Labetalol seems to be associated with the lowest risk of developing SGA, while atenolol should be avoided.
METHODS: In the Registry of Pregnancy And Cardiac disease (ROPAC, n = 5739), a prospective global registry of pregnancies in women with structural heart disease, perinatal outcomes (small for gestational age (SGA), birth weight, neonatal congenital heart disease (nCHD) and perinatal mortality) were compared between women with and without beta-blocker exposure, and between different beta-blockers. Multivariable regression analysis was used for the effect of beta-blockers on birth weight, SGA and nCHD (after adjustment for maternal and perinatal confounders).
RESULTS: Beta-blockers were used in 875 (15.2%) ROPAC pregnancies, with metoprolol (n = 323, 37%) and bisoprolol (n = 261, 30%) being the most frequent. Women with beta-blocker exposure had more SGA infants (15.3% vs 9.3%, p < 0.001) and nCHD (4.7% vs 2.7%, p = 0.001). Perinatal mortality rates were not different (1.4% vs 1.9%, p = 0.272). The adjusted mean difference in birth weight was -177 g (-5.8%), the adjusted OR for SGA was 1.7 (95% CI 1.3-2.1) and for nCHD 2.3 (1.6-3.5). With metoprolol as reference, labetalol (0.2, 0.1-0.4) was the least likely to cause SGA, and atenolol (2.3, 1.1-4.9) the most.
CONCLUSIONS: In women with heart disease an association was found between maternal beta-blocker use and perinatal outcomes. Labetalol seems to be associated with the lowest risk of developing SGA, while atenolol should be avoided.
摘要：
背景：β受体阻滞剂是怀孕期间常用的药物，尤其是患有心脏病的女性，尽管证据很少，但被认为是相对安全的。β受体阻滞剂之间的差异尚未得到充分研究。
方法：在妊娠和心脏病登记（ROPAC，n=5739),结构性心脏病女性怀孕的前瞻性全球登记，围产期结局（小于胎龄（SGA），出生体重,新生儿先天性心脏病（nCHD）和围产期死亡率）在有和没有β受体阻滞剂暴露的妇女之间进行比较，和不同的β受体阻滞剂之间。多变量回归分析用于β受体阻滞剂对出生体重的影响，SGA和nCHD（在调整孕产妇和围产期混杂因素后）。
结果：在875例（15.2%）ROPAC妊娠中使用了β受体阻滞剂，最常见的是美托洛尔（n=323，37％）和比索洛尔（n=261，30％）。暴露于β受体阻滞剂的女性有更多的SGA婴儿（15.3％vs9.3％，p<0.001)和nCHD(4.7%对2.7%，p=0.001)。围产期死亡率没有差异(1.4%vs1.9%，p=0.272）。调整后的平均出生体重差异为-177g（-5.8％），SGA的校正OR为1.7(95%CI1.3-2.1),nCHD的校正OR为2.3(1.6-3.5).以美托洛尔为参考，拉贝洛尔（0.2，0.1-0.4）是最不可能引起SGA，阿替洛尔（2.3，1.1-4.9）最多。
结论：在患有心脏病的女性中，发现母亲使用β受体阻滞剂与围产期结局之间存在关联。拉贝洛尔似乎与发生SGA的风险最低有关，而阿替洛尔应该避免。
方法：在妊娠和心脏病登记（ROPAC，n=5739),结构性心脏病女性怀孕的前瞻性全球登记，围产期结局（小于胎龄（SGA），出生体重,新生儿先天性心脏病（nCHD）和围产期死亡率）在有和没有β受体阻滞剂暴露的妇女之间进行比较，和不同的β受体阻滞剂之间。多变量回归分析用于β受体阻滞剂对出生体重的影响，SGA和nCHD（在调整孕产妇和围产期混杂因素后）。
结果：在875例（15.2%）ROPAC妊娠中使用了β受体阻滞剂，最常见的是美托洛尔（n=323，37％）和比索洛尔（n=261，30％）。暴露于β受体阻滞剂的女性有更多的SGA婴儿（15.3％vs9.3％，p<0.001)和nCHD(4.7%对2.7%，p=0.001)。围产期死亡率没有差异(1.4%vs1.9%，p=0.272）。调整后的平均出生体重差异为-177g（-5.8％），SGA的校正OR为1.7(95%CI1.3-2.1),nCHD的校正OR为2.3(1.6-3.5).以美托洛尔为参考，拉贝洛尔（0.2，0.1-0.4）是最不可能引起SGA，阿替洛尔（2.3，1.1-4.9）最多。
结论：在患有心脏病的女性中，发现母亲使用β受体阻滞剂与围产期结局之间存在关联。拉贝洛尔似乎与发生SGA的风险最低有关，而阿替洛尔应该避免。
