Beta blockers are used in the management of numerous conditions, including hypertension, angina, myocardial infarction, arrhythmia, heart failure, thyrotoxicosis, anxiety, and migraine prophylaxis. Topical preparations are also used to treat glaucoma.
Labetalol is the only beta blocker licensed in the UK for the treatment of hypertension in pregnancy and The National Institute for Health and Care Excellence (NICE) guidelines state that labetalol is the preferred antihypertensive for use in pregnancy.
Studies of beta blockers as a class do not, collectively, provide conclusive evidence that use during pregnancy is associated with an overall increased risk of fetal structural malformation, or of a number of specific malformations.
Use of beta blockers in pregnancy has been associated with adverse effects on fetal growth; however, because maternal hypertension itself increases the risk of intrauterine growth restriction, causal analysis is complex and any contribution of beta blocker exposure to this outcome remains unquantified.
Overall, the available data do not suggest that gestational beta blocker exposure increases the risk of preterm delivery. There are no data on rates of miscarriage, stillbirth and neurodevelopmental outcomes following use of beta blockers in pregnancy.
Use of beta blockers near term may result in neonatal beta-adrenoceptor blockade, leading to neonatal bradycardia, hypotension and hypoglycaemia. Neonatal respiratory distress has also been reported. Assessment of the neonate for these effects is advised.
Exposure to beta blockers 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 beta blockers have 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.
Related document: Use of labetalol in pregnancy
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.