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Metoprolol
Published Nov 1, 2020 ·
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Abstract
Intrauterine growth restriction: case report A fetus of 25 weeks and 1 day of gestational age [sex not stated] experienced growth restriction following in-utero exposure to metoprolol. The mother of the fetus received oral progesterone 200 μ/day due to threat of miscarriage at 6 weeks of gestation to control the situation. Her prenatal examinations and prenatal multivitamin consumption was normal from the onset of pregnancy. The mother of the fetus developed urinary tract infection in the first and second trimester of pregnancy and started receiving oral nitrofurantoin 100 mg/8 hours for 7 days and oral cefalexin 500 mg/8 hours for 7 days. At 20 weeks and 5 days of gestation, the mother of the fetus presented with orthopnoea and palpitations both at rest and on physical exertion. The mother was suspected to have inappropriate sinus tachycardia. Therefore, she started receiving oral metoprolol 25 mg/12 hours. At a follow-up, one month previously, the ultrasound suggested fetal growth was in 84th percentile, above the 98th percentile for gestational age. At 24 weeks and 1 day of gestation, due to the potential risk of pre-eclampsia, the mother was prescribed aspirin 100 mg/day and calcium 1200 mg/day. Gestational diabetes was suspected due to large fetus, but later it was ruled out. Thirty-one days after starting treatment with metoprolol, and at 25 weeks and 1 day of gestation, the ultrasound revealed 24 weeks gestational age by biometrics suggesting reduced fetal growth rate. The estimated weight of the fetus was noted to be 649g in the 3rd percentile for gestational age. The Doppler assessment revealed a normal fetal haemodynamic profile. The mother was initiated on higher protein intake diet. At 27 weeks of gestation, an ultrasound revealed 25.3 weeks gestational age by biometrics and decrease in fetal growth rate. The estimated weight was noted to be 836g in the 5th percentile for gestational age. Sixty-three days after metoprolol initiation, ultrasound showed 29.5 weeks gestational age by biometry and estimated fetal weight of 1405g in the 5th percentile, which indicated a small fetus for gestational age. Biophysical profile score was found to be 8/10 and fetal/placental Doppler assessment was normal. Based on the fetal growth results, the mother’s metoprolol treatment was discontinued. Fifteen days after metoprolol discontinuation, at 32.5 weeks of gestation, 31.5 weeks gestational age was reported by biometry, which was consistent with fetal growth curves. Estimated fetal weight was noted to be 1866g in the 18th percentile. The biophysical profile score was 8/10 and fetalplacental Doppler assessment was normal. At 34.2 weeks of gestation, the gestational age by biometry, gestational age per fetal ultrasound moniroting was similar. Fetal weight was 2189g in the 13th percentile, which was consistent with fetal growth curves. Biophysical profile score was 8/10, fetal-placental Doppler evaluation and Doppler assessment of uterine arteries were observed to be normal. The fetal weight gain was achieved progressively until the end of pregnancy. A healthy neonate was born, consistent with gestational age. The birth weight of the neonate was 2870g, head circumference was 33.5cm, height was 45cm, thoracic circumference was 33cm and abdominal circumference was 31cm. Neonatal TSH (thyroid stimulating hormone) was found to be 7.88 mIU/mL and the blood type was A positive Rh. Naranjo causality analysis suggested a probable association between the intrauterine growth restriction and metoprolol.
Case ReportMetoprolol exposure during pregnancy can cause intrauterine growth restriction, but discontinuing treatment can lead to a normal fetal growth outcome.
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