Atenolol (versus unexposed) - Medication and Pregnancy KB

Atenolol (versus unexposed)

Exposed non-exposed studies (cohort)

Study	Country Study period	Population source	Exposure definition	Non-exposure definition	Sample size	Rmk
Albertini, 2023	Canada 2012 - 2021	Pregnant women with long QT syndrome (LQTS), followed during pregnancy in the tertiary Pregnancy and Heart Disease Program at the University of Toronto.	Babies born to mothers with long QT syndrome who had taken Atenolol during pregnancy.	unexposed, sick Babies born to mothers with long QT syndrome who had not taken beta-blockers during pregnancy.	16 / 7
Bateman, 2016	USA 2003 - 2007	Women who were continuously eligible for Medicaid from 5 months after the Last menstrual period through 1 month postpartum.	Maternal consumption of Atenolol at the time of delivery, i.e prescriptions that were filled between 5 months after the last menstrual period and the day of delivery.	unexposed, sick Pregnant patients without any β blocker exposure at the time of delivery, notably matched on the preexisting hypertension.	1121 / 3363
Bayliss, 2002	United Kingdom (UK) 1980 - 1999	Consecutive chronic hypertensive pregnancies collected prospectively from the 2 included clinics.	Pregnancies in patient who had been taking atenolol from either conception or during the first trimester of pregnancy (i.e., before 15 weeks) until delivery.	unexposed, sick Pregnancies in women with hypertension who took no anti-hypertensive medication at all throughout their pregnancy.	50 / 189	Patients who suffered a miscarriage or intra-uterine death were excluded from the analysis. Also patients who started their pregnancies on one drug and later had a second added were excluded from the main analysis.
Darcie, 2004	Brazil 1994 - 1997	Singleton newborns of mothers with arterial hypertension (specific hypertensive disease of pregnancy (SHDP) or chronic arterial hypertension (CAH) and super-imposed SHDP).	Newborns of hypertensive mothers treated with atenolol (50 mg twice a day) for at least 2 weeks before the delivery.	unexposed, sick Newborns of hypertensive mothers whose hypertension was controlled with diet only (without antihypertensive medication), for a minimum period of 2 weeks.	40 / 14	Study considered as a prospective cohort because no precision indicating that a randomization was carried out.
Delteil, 2024	France 2004 - 2021	Pregnancies with a known outcome between July 2004 and December 2021 in Haute-Garonne, included in the EFEMERIS database.	Pregnancies with at least one dispensed prescription of Atenolol during pregnancy (between last menstrual period and delivery).	unexposed (general population or NOS) Pregnancies without dispensed prescription of beta-blockers and other anti-hypertensive agents during pregnancy.	100 / 172284	When available, data in women with chronic pathology (hypertension or cardiac), treated at least during the 1st trimester were preferred to all indications (including gestational hypertension, ...). Exposure at least T1 considered as chronic indications.
Duan, 2018	USA 2003 - 2014	All singleton births in the Kaiser Permanente Southern California (KPSC) Region during the study period, with at least 1‐year enrollment of the Kaiser Permanente Health Plan within the year prior to the estimated date of delivery.	Pregnant patients that filled a prescription for Atenolol between their estimated conception date and the date of delivery.	unexposed (general population or NOS) Pregnant women who were not exposed to beta‐blockers at any time during their pregnancy.	638 / 374391	The 4 most prescribed beta‐blockers were labetalol (n = 3357), atenolol (n = 638), propranolol (n = 489), and metoprolol (n = 324). Health plan members have a demographic and socioeconomic profile similar to the overall southern California population.
Fitton (Controls unexposed, disease free), 2020	Scotland 2010 - 2014	All women who had a singleton live birth in Scotland during the study period.	All women who had a singleton birth and who were dispensed at least one prescription for Atenolol during the 300 days before birth (whatever the indication).	unexposed, disease free All women who had a singleton birth during the same study period who were not dispensed antihypertensive medication during or 60 days following pregnancy, and who did not have an ICD-10 code for hypertension (chronic, gestational, or unspecified hypertension).	95 / 250693	The majority of offspring were exposed to a β-blocker only (58.66%, 4003 children), calcium channel blockers only (8.18%, 558 children), or a combination of >1 antihypertensive medication (20.53%, 1403 children).
Fitton (Controls unexposed, sick), 2020	Scotland 2010 - 2014	All women who had a singleton live birth in Scotland during the study period.	All women who had a singleton birth and who were dispensed at least one prescription for Atenolol during the 300 days before birth (whatever the indication).	unexposed, sick All women who had a singleton birth during the same study period, who had an ICD-10 code for hypertension (chronic, gestational, or unspecified hypertension) and who were not dispensed antihypertensive medication at any stage during or 60 days after pregnancy.	95 / 7971	The majority of offspring were exposed to a β-blocker only (58.66%, 4003 children), calcium channel blockers only (8.18%, 558 children), or a combination of >1 antihypertensive medication (20.53%, 1403 children).
Ishibashi, 2017	Japan 2000 - 2016	Congenital long QT syndrome (LQTS)	Pregnancies in long QT patients with Atenolol therapy.	unexposed, sick Pregnancies in long QT patients without β-blocker therapy.	1 / 94	Exposure: 1 atenolol (50mg/day, 0.89mg/kg/day).
Lydakis, 1999	United Kingdom 1980 - 1997	Pregnant women referred to this clinic either due to previous chronic hypertension, increased blood pressure (BP), or preeclampsia during a previous pregnancy, or because of high BP readings in the first weeks of pregnancy measured by the general practitioner or the obstetrician.	Pregnant women with chronic hypertension receiving atenolol (as monotherapy)	unexposed, sick Pregnant women with chronic hypertension receiving no antihypertensive drugs	78 / 91	Mean blood pressures did not differ between the three groups in the early (<20 weeks), mid- (between 20 and 30 weeks), and late (>30 weeks) stages of pregnancy.
Orbach, 2013	Israel 1998 - 2008	Women from 15-49 years old who were registered with Clalit and who lived in the southern district of Israel who gave birth at Soroka Medical Center (SMC).	Pregnant women with Atenolol dispensed during the third trimester of pregnancy.	unexposed, disease free All pregnant women without diagnosis of chronic hypertension and who were not exposed to antihypertensive drugs through the first or the third trimester during the study period.	107 / 97820	Chromosomal diseases were excluded. Five hundred fifteen infants who were exposed to antihypertensive drugs in utero for maternal indications other than hypertension were excluded from the cohort.
Tanaka, 2016	Japan 2000 - 2010	Women with singleton pregnancies and with cardiovascular disease who delivered infants at the National Cerebral and Cardiovascular Center in Osaka, Japan.	Pregnant women with cardiovascular disease treated with Atenolol for at least 2 weeks before delivery.	unexposed, sick Pregnant women with cardiovascular disease who were not treated with an oral α/β- or β-adrenergic blocker randomly identified over the same period.	6 / 100	Maternal cardiovascular diseases: congenital heart disease and pulmonary hypertension; aortic disease; valvular heart disease; coronary artery disease and acute coronary syndrome; cardiomyopathy and heart failure; and arrhythmia.

Case-control studies (cohort)

Study	Country Study period	Case	Control	Sample size	Rmk
Caton, 2009	USA 1997 - 2003	Cases of cardiovascular malformations in live births, fetal deaths occurring after 20 weeks, and elective pregnancy terminations.	Live births without birth defects randomly selected from birth certificates or hospital discharge listings in the same geographic areas as the cases.	5021 / 4796
Van Zutphen, 2014	USA 1997 - 2009	All cases (liveborn, stillborn after 20 weeks gestation, or induced abortions) with severe hypospadias (ie, subcoronal or penile, scrotal, or perineal meatal opening) diagnosed at the time of physical examination, surgery, or autopsy.	Male live births without birth defects randomly selected from birth certificates or hospital discharge listings in the same population as the case neonates.	2131 / 5129	Mothers reporting antihypertensive medications for the treatment of other indications (eg, b-blockers for migraine headaches) were excluded from the analyses. Overlapping: Caton 2008 (1997-2002) totally included in Van Zutphen 2014 (1997-2009).

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