Beta-Blockers and Their Current Role in Maternal and Neonatal Health: A Narrative Review of the Literature

Abstract

Beta-blockers are a class of medications that act on beta-adrenergic receptors and are categorized as cardio-selective and non-selective. They are principally used to treat cardiovascular conditions such as hypertension and arrhythmias. Beta-blockers have also been used to treat non-cardiogenic indications in non-pregnant individuals and the pediatric population. In pregnancy, labetalol is the mainstay treatment for hypertension and other cardiovascular indications. However, contraindications to certain sub-types of beta-blockers include bradycardia, heart failure, obstructive lung diseases, and hemodynamic instability. There is conflicting evidence of the adverse effects on fetal and neonatal health due to a scarce safety and efficacy profile, and further studies are necessary to understand the pharmacokinetics of the different classes of beta-blockers in pregnancy and fetal health. Understanding the hemodynamic changes during the stages of pregnancy is important to target a more beneficial therapy for both mother and fetus as well as better neonatal outcomes. Beta-blocker use in the pediatric population is less documented in studies but does have the potential to treat various cardiogenic and non-cardiogenic conditions. Future comprehensive studies would further benefit the direction of beta-blocker treatment during pregnancy in neonates and pediatrics.

Keywords: beta-blockers; cardiovascular disease; future directions; hypertension; lactation; maternal and fetal health; neonates; pregnancy.

Figure 1. All-cause mortality from the Carvedilol or Metoprolol European Trial (COMET)

Reproduced under the terms of the Creative Commons Attribution license. Adult patients with chronic heart failure demonstrated all-cause mortality of 34% (512 of 1511) with carvedilol and 40% (600 of 1518) with metoprolol (hazard ratio: 0.83; 95% confidence interval (CI): 0.74–0.93; p = 0.0017). A total of 3029 patients with heart failure (NYHA II–IV), a prior admission for cardiovascular reasons, and a left ventricular ejection fraction of less than 35% were randomized to metoprolol tartrate or carvedilol and showed a reduction in all-cause mortality in the carvedilol group: 34% (512 or 1511) for carvedilol and 40% (600 of 1518) for metoprolol [102].