The effect of beta-blockers on foetal birth weight in pregnancies in women with structural heart disease: a prospective cohort study

Objective:To examine whether treatment with beta-blockers(BBs) in pregnant women with structural heart disease (SHD)resulted in a decrease in foetal birth weight (FBW) in a SouthAfrican cohort.Methods:This was a prospective cohort study conducted in a tertiary-level hospital in Cape Town from 2010 to 2016. Of the 178 pregnant women with SHD, 24.2% received BBs fora minimum of two weeks. Adverse foetal outcomes andmean FBW were compared between the BB groups and subgroups(congenital, valvular, cardiomyopathy and other). Adversefoetal outcome was defined as: low birth weight (LBW)<2 500 g, Apgar score<7, premature birth (<37 weeks) and small for gestational age (SGA).Results:BB exposure during pregnancy was found to be associated with a non-significant increased FBW (2 912 vs2 807 g,p=0.347). A significantdecrease(p=0.009) wasnoted in FBW for valvular SHD pregnancies using BBs,while a significant increase (p=0.049) was observed for thesame outcome in the cardiomyopathy subgroup using BBs.A significant increase was observed for SGA (p=0.010) andLBW (p=0.003) pregnancies within the valvular subgroupwhen exposed to BBConclusion:BB use in pregnant women with SHD in a South African cohort showed no association with a decrease in FBW or an increase in adverse foetal outcomes when compared to non-BB usage

Hypertension; Chronic Kidney Disease; Atrial Fibrillation and the Newer Anticoagulants

Atrial fibrillation (AF) is a common clinical condition that is associated with increased morbidity and mortality that mainly relates to an embolic stroke. Dominant risk factors for AF are advanced age and hypertension in the absence of mitral valve disease.1 In turn; hypertension and ageing are determinants of the congestive heart failure; hypertension; age; diabetes mellitus; prior stroke or transient ischaemic attack or thromboembolism (CHADS2) criteria for assessing the indication for anticoagulation. In addition; they are important risk factors for chronic kidney disease (CKD). In itself; CKD is an independent risk factor for AF and a higher risk of stroke.2 It is highly likely that a practitioner will encounter older patients with AF and concomitant hypertension and CKD that require anticoagulation therapy. Thus; it is essential for the practitioner to understand the risks and benefits of anticoagulation in older patients with AF; hypertension and CKD