USE OF ATENOLOL IN PREGNANCY
Date of issue: March 2020, Version: 3
Atenolol is a cardioselective beta-blocker licensed for the treatment of hypertension, angina pectoris, cardiac arrhythmias, for secondary prevention after acute myocardial infarction, and also off-license for migraine prophylaxis.
Data on overall rates of fetal structural malformations, or of specific malformations following first trimester use of atenolol, are too limited to permit an evidence-based risk assessment. There are also insufficient data to assess the risk of miscarriage, stillbirth, and adverse neurodevelopmental outcomes following gestational atenolol exposure.
It is currently unclear whether gestational use of atenolol increases the risk of preterm delivery. Although the currently available limited data do not suggest that this is the case, further research is required to confirm this finding.
There is some evidence that atenolol exposure in pregnancy may adversely affect fetal growth, although data are conflicting. Some studies suggest that the risk of adverse effects on fetal growth may be higher when exposure commences prior to 20 gestational weeks but the possibility of a maternal disease effect cannot be excluded.
Use of beta-blockers near term may result in neonatal beta-adrenoceptor blockade, leading to neonatal bradycardia, hypotension and hypoglycaemia. Accordingly, some (but not all) studies have reported increased rates of these neonatal complications in atenolol-exposed infants, although the absolute risk remains unquantified. Assessment of the neonate for these effects is thus advised.
Exposure to atenolol at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy. In pregnancies complicated by maternal hypertension and/or where atenolol has been administered, careful monitoring of fetal growth is advised. Other risk factors may also be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.
This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to NHS health care professionals who are logged in.
If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.
If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.