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Pregnant women with cardiovascular disease may need drug treatment, depending on the disease severity and type. Drug treatment during pregnancy should be individualized based on the maternal-fetal risk and benefit. Pregnancy increases the circulating blood volume and cardiac output by increasing the ventricular rate and stroke volume and decreasing peripheral vascular resistance. Circulating blood volume increases more rapidly after 20 gestational weeks, and the blood volume at 28–32 gestational weeks is 40–45% greater than the nonpregnancy volume. Therefore, in some pregnancies in women with cardiovascular disease, drug treatment needs to be initiated during pregnancy. For many years, β-adrenergic blockers have been used to treat hypertension in pregnant women. In addition, α/β-adrenergic blockers and β-adrenergic blockers are very often used to control arrhythmias and ventricular dysfunction in pregnant women with cardiovascular disease. It has been suggested, however, that β-adrenergic blockers are associated with fetal growth restriction (FGR). The US Food and Drug Administration (FDA) classifies β-adrenergic blockers as pregnancy category C drugs during the first and second trimesters and as pregnancy category D drugs during the third trimester. The FDA has classified the fetal risk of gestational prescription drug use into 5 categories: A, B, C, D, and X. Category C drugs carry risks that cannot be ruled out, but well-controlled clinical or animal studies showing a fetal risk have not been reported. Fetal damage is likely if these drugs are used during pregnancy, but their potential benefits may exceed their potential risks. Category D drugs carry evidence of risk. For these drugs, human studies conducted during pre- or post-marketing investigations demonstrated a fetal risk, but the potential benefits of these drugs may outweigh their potential risk. In a 1990 study, Butters et al examined pregnant women with hypertension. They compared patients treated with a β-adrenergic blocker, atenolol, with patients who did not receive medication and found a significantly higher rate of FGR in the atenolol group compared with the no-medication group. The fetal effects of α/β- and β-adrenergic blockers clearly merit further research. The aim of the present study was therefore to analyze the maternal and neonatal outcomes of pregnancy in women with cardiovascular disease who were treated with an α/β- or β-adrenergic blocker. The broader goal was to clarify the effects of these drugs in order to improve the drug treatment options for pregnant women with cardiovascular disease.
本文/Department of Obstetrics and Gynecology, Faculty of Medicine, Mie University, Tsu, Japan
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DOIinfo:doi/10.1253/circj.CJ-15-0617
Collection (particular)国立国会図書館デジタルコレクション > デジタル化資料 > 博士論文
Date Accepted (W3CDTF)2019-11-04T14:30:53+09:00
Data Provider (Database)国立国会図書館 : 国立国会図書館デジタルコレクション