Beta blockers in pregnancy

introduction

Beta blockers are important and commonly prescribed drugs. They are used for arterial high blood pressure and in the treatment of heart failure and coronary artery disease.

There is a relative contraindication to beta blockers during pregnancy. This means that they may only be used after a strict risk-benefit assessment.

However, there are also reasons for the justified use of beta blockers during pregnancy. The best experience is with the active ingredient metoprolol.

Beta blockers are a therapeutic approach, particularly in the case of hypertension in pregnancy. In the following article, interesting aspects relating to the use of beta blockers during pregnancy are explained in more detail.
In addition, important questions about the tolerance of the active ingredients for mother and child are answered.

Common clinical pictures that require therapy with a beta blocker are explained in more detail, particularly with regard to drug therapy.

Indications for a beta blocker in pregnancy

There has been a high level of experience with beta blockers in general for many years. It is the active ingredients that are frequently used that play an important role in the treatment of widespread diseases.
This includes above all the High blood pressure, heart failure and coronary artery disease.

But what about pregnancy? What are the indications for the use of beta blockers during pregnancy?

The main reason to use beta blockers during pregnancy is if you have a hypertensive pregnancy disease - that is high blood pressure.

A antihypertensive treatment must always take into account the well-being of both the mother and the unborn child.
Blood pressure values ​​that are systolic above 160 mmHg or diastolic above 110 mmHg should be reduced with medication.

In these cases, beta blockers are a legitimate way to lower blood pressure. As a rule, however, they are only used if the drug of first choice - alpha-methyldopa - may not be used. The beta blocker of choice is then Metoprolol.

Beta blockers for migraines

Beta blockers are well established and effective drugs in the Migraine prophylaxis. That means that they are used to Migraine attacks to prevent.
Beta blockers can also be used during pregnancy limited can be used. It is only recommended Metoprolol.

Unfortunately lying hardly controlled studies on this subject. However, around 50 to 80% report one Improvement of migraines during pregnancyso that prophylaxis is not always necessary.
If so, there is an option to take metoprolol. Alternatively come magnesium, but also non-drug options like Relaxation exercises in question.

Beta blockers for a high pulse

A high pulse as such is initially no reason for drug therapy - not even during pregnancy.
Frequently there is a high pulse Nervousness, stress or even other - noncardiac - causes, like one Hyperthyroidism traced back.

Therefore, the cause of the high pulse should first be clarified before a beta blocker is used to lower the pulse. Another adapted therapy, for example against a Hyperthyroidism or a heart rhythm disorder, may be necessary.
Often enough, however Relaxation exercises and a Stress reduction out.

The heart rate also increases during pregnancy as part of the body's natural adaptation mechanisms and may therefore be increased to a certain extent. In principle, a beta blocker such as metoprolol can be used, but the benefit and the sensibility of the therapy must be checked beforehand.

Beta blockers for kidney congestion

A Kidney congestion is a not uncommon complication in pregnancy and can occur due to the changed space in the abdomen, so that urinary congestion occurs. It often goes unnoticed and free of symptoms.
In some cases, however, it can lead to impairments for the mother, which can be not only painful but also dangerous.
In particular one infection as part of a Urinary congestion can lead to complications. Therefore, therapy is necessary in some cases.

If the urinary tract is severely blocked, a Ureteral splint be used, which makes the flow of urine possible again.
Antibiotics are used early on if an infection is suspected due to kidney congestion. In some cases, beta blockers, particularly metoprolol, are also used. However, the benefit is controversial.

Is that harmful to my child?

The use of Beta blockers during pregnancy is for various reasons controversial.
For some beta blockers, there is insufficient experience to accurately assess side effects and potentially harmful effects on the child.
It is therefore very difficult to speak of “harmfulness”. However, it cannot be excluded in any case.

This applies especially to the commonly used beta blockers Bisoprolol. Even if there are no primary negative effects to be assumed, in the interests of maximum safety for mother and child, use should be avoided and better to choose studied beta blockers like metoprolol.

Studies have shown that some newborns have a decreased birth weight under the administration of the beta blocker Atenolol observed.

In general, the beta blocker applies Metoprolol as a means of choicel, since the best empirical values ​​are available for this active ingredient.

In principle, antihypertensive therapy - regardless of the beta blocker administered - can delay fetal growth. That means children with one decreased birth weight come into the world and enter pregnancy retarded growth demonstrate.

However, in these cases, the consequences of high blood pressure must be weighed against the consequences of drug therapy.

Which beta blockers are permitted during pregnancy?

The use of medication during pregnancy is very delicate. On the one hand, the best interests of the mother and, on the other hand, that of the child must be taken into account.
It is difficult to test drugs with regard to their tolerance during pregnancy, as studies can only be carried out under strict guidelines.

There is therefore a lack of sufficient empirical values ​​for many beta blockers. The drug of choice among beta blockers remains unchallenged Metoprolol. Most empirical values ​​are simply available for this beta blocker, so that it is also preferred.
In principle, however, there are also other selective beta blockers, such as Atenolol or Bisoprolol no contraindication. They can be used during pregnancy, even if this is usually not the case.

For all beta blockers there is a risk of one fetal growth retardation. However, this must be weighed up individually and can be accepted in justified cases.
Some beta blockers are not even allowed during pregnancy. This includes Carvedilol and Nebivolol.

Metoprolol

Metoprolol belongs to the active ingredient group of selective beta blocker. The active ingredient is mainly used to treat the arterial hypertension, heart failure and coronary artery disease used.
Also with the Prophylaxis of migraine attacks Metoprolol plays an important role.

In pregnancy, metoprolol is the Beta blocker of choice. That's because for this beta blocker the highest and best empirical values exist. In general it is also with other beta blockers like Bisoprolol no other risk to be expected than with metoprolol.
Nevertheless, due to the better knowledge Metoprolol preferred.
In pregnancy the main area of ​​application is high blood pressure.

The first choice remedy is though alpha-methyldopa, however, the therapy can be switched to metoprolol in justified cases. Reasons for this are, for example, poor tolerance of alpha-methyl dopaz or contraindications to this active ingredient.

Another indication for metoprolol during pregnancy is the prevention of migraine attacks. In this case, too, the use of metoprolol is possible in justified cases.

Propanolol

Propanolol belongs to the group of unselective beta blockers. Unlike most known beta blockers, this active ingredient is not used to treat high blood pressure. Special indications such as essential tremor or the frequency control of the heart in one Hyperthyroidism justify the use of propanolol, however.

Propanolol must be used during pregnancy strictly weighed become. In principle, the active ingredient is not contraindicated, but the empirical values ​​are overall low. Therefore - if possible - therapy with Metoprolol prefers.
Contrary to what is often feared, there is no risk of malformations in the unborn child. Propanolol may therefore also be used during pregnancy in justified cases.

Beta blockers after pregnancy

The use of beta blockers may also be necessary after pregnancy.
After pregnancy it is important between lactating and non-lactating To distinguish women.

Women who do not breastfeed can in principle take any beta blocker depending on the clinical picture and cause. Needless to say, individual Contraindications, like for example Kidney or liver damage, get noticed.

Breastfeeding women on the other hand, therapy with every beta blocker must not be used, as some substances are included in the Breast milk pass over and thus harm the child.

In principle, only the beta blockers metoprolol, propanolol and sotalol (if no other beta blockers come into question) are not contraindicated during breastfeeding, so these drugs may be used.

The most common reason for beta-blocker therapy after pregnancy is high blood pressure, however, other diseases can also be a reason for therapy with a beta blocker.
Ultimately, post-pregnancy women who do not breastfeed are to be evaluated in the same way as non-pregnant patients in general. Only the period of breastfeeding represents a special situation, since the well-being of the breastfed child must be taken into account here, as the child can absorb the active ingredient through breast milk.