Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Maternal Beta-Blocker Use & Risk of Malformations

Ann Intern Med; ePub 2018 Oct 16; Bateman, et al

Maternal use of β-blockers in the first trimester is not associated with a large increase in the risk for overall malformations or cardiac malformations, a recent study found. The international cohort study included pregnant women from health registries in the 5 Nordic countries and the US Medicaid database with a diagnosis of hypertension and their offspring. First-trimester exposure to β-blockers was assessed. Outcomes were any major congenital malformation, cardiac malformations, cleft lip or palate, and central nervous system (CNS) malformations. Researchers found:

  • Of 3,577 women with hypertensive pregnancies in the Nordic cohort and 14,900 in the US cohort, 682 (19.1%) and 1,668 (11.2%), respectively, were exposed to β-blockers in the first trimester.
  • Pooled adjusted relative risk (RR) and risk difference per 1,000 persons exposed associated with β-blockers were 1.07 and 3.0, respectively, for any malformation, 1.12 and 2.1 for any cardiac malformation, and 1.97 and 1.0 for cleft lip or palate.
  • The adjusted RR was 1.37 for CNS malformations and the risk difference per 1,000 persons exposed was 1.0.


Bateman BT, Heide-Jørgensen U, Einarsdóttir K, et al. β-blocker use in pregnancy and the risk for congenital malformations: An international cohort study. [Published online ahead of print October 16, 2018]. Ann Intern Med. doi:10.7326/M18-0338.

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