Late Pregnancy β Blocker Exposure and Risks of Neonatal Hypoglycemia and Bradycardia

American Academy of Pediatrics (AAP) - Tập 138 Số 3 - 2016
Brian T. Bateman1,2, Elisabetta Patorno2, Rishi Desai2, Ellen W. Seely3, Helen Mogun2, Ayumi Maeda1, Michael A. Fischer2, Sonia Hernández–Dı́az4, Krista F. Huybrechts2
1Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and
2Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, and
3Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts;
4Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

Tóm tắt

BACKGROUND AND OBJECTIVES: β blockers are widely used in the treatment of hypertensive disorders during pregnancy. These medications cross the placenta and may cause physiologic changes in neonates exposed in utero. We sought to define the risks of neonatal hypoglycemia and bradycardia associated with maternal exposure to β blockers at the time of delivery in a large, nationwide cohort of Medicaid beneficiaries. METHODS: We used a cohort of 2 292 116 completed pregnancies linked to liveborn infants of Medicaid-enrolled women from 2003 to 2007. We examined the risks of neonatal hypoglycemia and neonatal bradycardia associated with maternal exposure to β blockers at the time of delivery. Propensity score matching was used to control for potential confounders including maternal demographics, obstetric and medical conditions, and exposure to other medications. RESULTS: There were 10 585 (0.5%) pregnancies exposed to β blockers at the time of delivery. The risk of neonatal hypoglycemia was 4.3% in the β blocker–exposed neonates versus 1.2% in the unexposed; the risk of neonatal bradycardia was 1.6% in the exposed versus 0.5% in the unexposed. After controlling for confounders, risk remained elevated for both neonatal hypoglycemia and bradycardia among exposed pregnancies versus unexposed (adjusted odds ratio, 1.68, 95% confidence interval, 1.50–1.89 and adjusted odds ratio, 1.29, 95% confidence interval, 1.07–1.55, respectively). CONCLUSION Our findings suggest that neonates born to mothers exposed to β blockers in late pregnancy, including labetalol, are at elevated risk for neonatal hypoglycemia and bradycardia.

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American Academy of Pediatrics (AAP)

Tập 138 Số 3

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