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USE OF METOPROLOL IN PREGNANCY

Date of issue: June 2024, Version: 4

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A corresponding patient information leaflet on USE OF METOPROLOL IN PREGNANCY is available.

Metoprolol is a cardioselective beta-blocker licensed for the treatment of hypertension, angina pectoris, cardiac arrhythmias, myocardial infarction, adjunctive management of thyrotoxicosis, and prophylaxis of migraine.

There are no published data on overall rates of congenital malformation following metoprolol use in pregnancy. Single case-control studies found no associations between first trimester metoprolol exposure and hypospadias and posterior cleft palate, respectively. Further studies are required to confirm these findings.

 The limited available data currently provide no convincing evidence that exposure to metoprolol in utero has clinically relevant effects on fetal growth or increases the risk of preterm delivery. However, reduced fetal growth has been observed following gestational exposure to other beta-blockers.

There are no controlled data comparing rates of miscarriage, stillbirth or neurodevelopmental outcomes following gestational metoprolol exposure.

Use of beta-blockers near term may result in beta-adrenoceptor blockade, leading to neonatal bradycardia, hypotension, and hypoglycaemia. There are limited data on rates of these neonatal complications in metoprolol-exposed infants and the absolute risk is unquantified. Assessment of the neonate for these effects is advised following gestational metoprolol use.

 Exposure to metoprolol at any stage of pregnancy would not usually be regarded as medical grounds for termination. In pregnancies complicated by maternal hypertension and/or where metoprolol has been administered, serial scanning for fetal growth surveillance 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 considering such factors when performing case-specific risk assessments.

Related document: Use of beta blockers 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.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from UKTIS.org to ensure you are using the most up-to-date version.