Hypertension is a common concern during pregnancy. Beta-blockers are one potential treatment, but third trimester exposure has correlated with an increased risk of perinatal events. Nadolol, a nonselective beta blocker, has properties that differ from those of its selective counterparts, including longer half-life, decreased protein binding, and renal excretion in the unchanged form. There is very limited data on the use of nadolol during pregnancy, and its safety has not been completely evaluated. This case study documents the perinatal outcomes of nadolol use throughout a medical student’s pregnancy and explores the experience in obtaining and undergoing medical care.
Conflict(s) of Interest
References with DOI
1. Magee L. Drugs in pregnancy. Antihypertensives. Best Practice and Research: Clinical Obstetrics & Gynaecology. 2001;15(6)827-45. https://doi.org/10.1053/beog.2001.0232
2. D’Amore C. Trotta F. Da Cas R. Zocchetti C. Cocci A. Traversa G. Antihypertensive drug use during pregnancy: a population based study. Annali dell’Istituto Superiore di Sanità. 2015;51(3):236-43.
3. Fox RE. Marx C. Stark AR. Neonatal effects of maternal nadolol therapy. American Journal of Obstetrics & Gynecology. 1985;152(8):1045-6. https://doi.org/10.1016/0002-9378(85)90559-9
4. Roberts LW. Warner TD. Carter D. Frank E. Ganzini L. Lyketsos C. Caring for medical students as patients: access to services and care-seeking practices of 1,027 students at nine medical schools. Collaborative research group on medical student healthcare. Academic Medicine: Journal of the Association of American Medical Colleges. 2000;75(3):272-7. https://doi.org/10.1097/00001888-200003000-00019
5. Roberts LW. Hardee JT. Franchini G. Stidley CA. Siegler M. Medical students as patients: a pilot study of their health care needs, practices, and concerns. Academic Medicine: Journal of the Association of American Medical Colleges. 1996;71(11):1225-32. https://doi.org/10.1097/00001888-199611000-00019
6. Hooper C. Meakin R. Jones M. Where students go when they are ill: how medical students access health care. Medical Education. 2005;39(6):588-93. https://doi.org/10.1111/j.1365-2929.2005.02175.x
7. Rakusan K. Drugs in pregnancy: implications for a cardiologist. Experimental and Clinical Cardiology. 2010 Winter;15(4):e100-3.
8. Xie RH. Guo Y. Krewski D. Mattison D. Walker MC. Nerenberg K. Wen SW. Beta-blockers increase the risk of being born small for gestational age or of being institutionalized during infancy. British Journal of Obstetrics and Gynaecology. 2014;121(9):1090-6. https://doi.org/10.1111/1471-0528.12678
9. Pruyn SC. Phelan JP. Buchanan GC. Long-term propranolol therapy in pregnancy: maternal and fetal outcome. American Journal of Obstetrics & Gynecology. 1979;135(4):485-9. https://doi.org/10.1016/0002-9378(79)90436-8
10. Cottrill CM. McAllister RG Jr. Gettes L. Noonan JA. Propranolol therapy during pregnancy, labor, and delivery: Evidence for transplacental drug transfer and impaired neonatal drug disposition. Journal of Pediatrics. 1977;91(5):812-4. https://doi.org/10.1016/s0022-3476(77)81049-4
11. Daskas N. Crowne E. Shield JP. Is labetalol really a culprit in neonatal hypoglycemia? Archives of Disease in Childhood: Fetal and Neonatal Edition. 2013;98(2):F185. https://doi.org/10.1136/archdischild-2012-303057
King-Mallory, Rebecca; Barker, Shawndra; McGrogan, Kaitlin; and Franks, Adam M.
"Nadolol in Pregnancy: A medical student’s reflection on her pregnancy,"
Marshall Journal of Medicine:
4, Article 5.
Available at: https://mds.marshall.edu/mjm/vol4/iss4/5