Perspective:

Beta-blockers are a first-line medication for hypertension during pregnancy and are also used during pregnancy for various other maternal cardiac conditions. This large study provides further reassurance that the use of beta-blocker medication during the first trimester is not associated with an increased risk of congenital malformations. This conclusion is in agreement with prior studies that have controlled for the presence of hypertension as a confounder, since maternal hypertension itself is associated with increased risk for congenital malformations. While labetalol is useful for the treatment of hypertension, metoprolol is the most commonly used beta-blocker for arrhythmias, cardiomyopathies, and aortopathies. Not addressed in this study, but also important to consider, is the association between beta-blockers and intrauterine fetal growth restriction. Patients should be counseled appropriately and the obstetrics team can monitor fetal growth during pregnancy.