Is it harmful to my child?

The use of beta-blockers during pregnancy is controversial for a number of reasons. 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 in particular to the frequently used beta-blocker bisoprolol. Even if primarily no negative effects have to be assumed, in the interest of maximum safety for mother and child it is better to refrain from using it and to choose better investigated beta-blockers such as metoprolol.

In studies, a reduced birth weight was observed in some newborns under the administration of the beta-blocker atenolol. In general, the beta-blocker metoprolol is considered the drug of choice, as this is the best known beta-blocker. In principle, treatment to lower blood pressure can delay fetal growth, irrespective of the beta-blocker administered. This means that children are born with a reduced birth weight and show delayed growth during pregnancy. However, in these cases the consequences of high blood pressure must be weighed against the consequences of drug therapy.

Which beta-blockers are approved during pregnancy?

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

For many beta-blockers there is therefore a lack of sufficient experience. Metoprolol remains the drug of choice among beta blockers. For this beta-blocker, quite simply the most empirical values are available, so that it is also preferred.

In principle, however, there is no contraindication for the other selective beta blockers such as atenolol or bisoprolol. They may be used during pregnancy, although this is usually not the case. There is a risk of fetal growth retardation for all beta-blockers.

However, this must be weighed up individually and can be accepted in justified cases. Some beta-blockers are not approved at all during pregnancy. These include carvedilol and nebivololol.

Metoprolol belongs to the group of selective beta blockers. The active ingredient is mainly used to treat arterial hypertension, heart failure and coronary heart disease. Metoprolol also plays an important role in the prophylaxis of migraine attacks.

In pregnancy, metoprolol is the beta-blocker of choice. This is because the highest and best empirical values are available for this beta-blocker. In general, other beta-blockers such as bisoprolol do not present a different risk to metoprolol.

Nevertheless, metoprolol is preferred due to the better state of knowledge. During pregnancy, the main area of application is high blood pressure. Although alpha-methyldopa is the drug of first choice, the therapy can also be switched to metoprolol in justified cases.

Reasons for this are, for example, a lack of tolerance of alpha-methyldopa or contraindications against this active substance. Another indication for metoprolol in pregnancy is the prevention of migraine attacks. The use of metoprolol is also possible in this case in justified cases.

Propanolol belongs to the group of non-selective beta blockers. Unlike most of the known beta blockers, this active substance is not used for the treatment of high blood pressure. However, special indications such as essential tremor or heart rate control in hyperthyroidism justify the use of propanolol.

During pregnancy the use of propanolol must be strictly weighed. In principle, the active ingredient is not contraindicated, but overall experience is limited. Therefore, therapy with metoprolol is preferred if possible. 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.