Article

C-a4-03: risks to the newborn associated with in-utero exposure to Beta-blockers and calcium-channel blockers.

Clinical Medicine &amp Research 03/2010; 8(1):57. DOI: 10.3121/cmr.8.1.57-a
Source: PubMed

ABSTRACT Background: While medication use to manage cardiovascular disease during pregnancy is widespread, data on its safety for the developing infant is scarce. We used population-based data from 5 HMOs to study risks for perinatal complications and congenital defects among infants exposed in-utero to beta -blockers and calcium-channel blockers. Methods: We studied women older than 15 years who delivered an infant between 1/1/96 to 12/31/00, and who had been continuously enrolled with prescription drug coverage for one year prior to delivery. We further limited our study to mother-infant pairs with 30 and 365 days follow-up for the evaluation of perinatal outcomes and congenital anomalies, respectively. Information on prescription drug dispensing, and inpatient and outpatient diagnoses and procedures was obtained from automated databases at each health plan. Results: There were a total of 87,407 mother-infant pairs with at least 30 days follow- up in the five health plans. Of these, a total of 405 full- term infants were exposed during pregnancy to beta-blockers and 721 full- term infants were exposed to calcium-channel blockers. Infants exposed to beta-blockers in the third trimester of pregnancy were at over three-fold increased risk for hypoglycemia (RR 3.1; 95% CI 2.2, 4.2), for feeding problems (RR 1.8; 95% CI 1.3, 2.5) and for prolonged hospitalization (RR 2.0; 95% CI 1.3, 3.1). Infants exposed to calcium-channel blockers in the third trimester had an increased risk for neonatal seizures (RR 3.6; 95% CI 1.3, 10.4), and for hematological disorders (RR 2.6; 95% 1.4, 5.1). A chart review confirmed the seizures and hypoglycemia cases but found no serious hematologic conditions common to the calcium-channel exposed infants. There were no increased risks for congenital anomalies among either group of infants. Conclusions: Infants whose mothers receive beta-blockers are at increased risk for neonatal hypoglycemia. Beta-blockers can cross the placenta, increasing insulin and decreasing glucagon in the newborn, leading to hypoglycemia. Infants whose mothers take calcium-channel blockers are at increased risk for neonatal seizures, although the mechanism leading to this increased risk is less clear. These data should be disseminated to the obstetric and neonatal community so that appropriate newborn management strategies may be developed.

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