To β or Not to β? Very Likely OK to β
Authors: Joel G. Ray
Journal: Annals of Internal Medicine (2018)

Editorials20 November 2018To β or Not to β? Very Likely OK to βJoel G. Ray, MD, MScJoel G. Ray, MD, MScSt. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (J.G.R.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-2500 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail There is little reason to believe that daily use of an oral β-antagonist in the first trimester of pregnancy heightens risk for congenital malformations. There is reason, however, why the fetus of a woman prescribed this class of medication might be at higher risk for a structural birth defect: Women with chronic hypertension are more likely than women without hypertension to have higher body mass index, older age, and prepregnancy diabetes mellitus (1), factors which are themselves risk factors for birth defects (2). In fact, chronic hypertension itself, whether treated or not, is associated with slightly higher odds of fetal ...References1. Bateman BT, Bansil P, Hernandez-Diaz S, Mhyre JM, Callaghan WM, Kuklina EV. Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions. Am J Obstet Gynecol. 2012;206:134.e1-8. [PMID: 22177190] doi:10.1016/j.ajog.2011.10.878 CrossrefMedlineGoogle Scholar2. Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA. 2009;301:636-50. [PMID: 19211471] doi:10.1001/jama.2009.113 CrossrefMedlineGoogle Scholar3. Bateman BT, Huybrechts KF, Fischer MA, Seely EW, Ecker JL, Oberg AS, et al. Chronic hypertension in pregnancy and the risk of congenital malformations: a cohort study. Am J Obstet Gynecol. 2015;212:337. [PMID: 25265405] doi:10.1016/j.ajog.2014.09.031 CrossrefMedlineGoogle Scholar4. 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Bartsch E, Medcalf KE, Park AL, Ray JG; High Risk of Pre-eclampsia Identification Group. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ. 2016;353:i1753. [PMID: 27094586] doi:10.1136/bmj.i1753 CrossrefMedlineGoogle Scholar9. LeFevre ML; U.S. Preventive Services Task Force. Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161:819-26. [PMID: 25200125]. doi:10.7326/M14-1884 LinkGoogle Scholar10. Mason E, Rosene-Montella K, Powrie R. Medical problems during pregnancy. Med Clin North Am. 1998;82:249-69. [PMID: 9531925] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (J.G.R.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2500.Corresponding Author: Joel G. Ray, MD, MSc, Departments of Medicine and Obstetrics and Gynaecology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; e-mail, [email protected]ca.This article was published at Annals.org on 16 October 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee Alsoβ-Blocker Use in Pregnancy and the Risk for Congenital Malformations Brian T. Bateman , Uffe Heide-Jørgensen , Kristjana Einarsdóttir , Anders Engeland , Kari Furu , Mika Gissler , Sonia Hernandez-Diaz , Helle Kieler , Anna-Maria Lahesmaa-Korpinen , Helen Mogun , Mette Nørgaard , Johan Reutfors , Randi Selmer , Krista F. Huybrechts , and Helga Zoega Metrics Cited byWhat's new in obstetric anesthesia in 2018? 20 November 2018Volume 169, Issue 10Page: 718KeywordsCongenital disordersDiabetes mellitusDrugsFetusesHeart rateHospital medicineHypertensionMaternal healthPregnancyUltrasound imaging ePublished: 16 October 2018 Issue Published: 20 November 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...