Portal Hypertension Complicating Pregnancy: Safety, Tolerability, and Maternal-Fetal Outcomes of Non-Selective Beta-Blocker Therapy

Abstract

Background: Portal hypertension during pregnancy is associated with increased maternal and fetal risks, particularly variceal bleeding and hepatic decompensation. Non-selective beta-blockers (NSBBs) are widely used for variceal bleeding prophylaxis; however, pregnancy-specific safety data remain limited.

Objectives: To describe the maternal, fetal, and neonatal outcomes, clinical characteristics, treatment tolerability, and complications among pregnant women with portal hypertension receiving NSBB therapy.

Methods: This retrospective observational study included 30 pregnant women with portal hypertension who received NSBB at Raichur Institute of Medical Sciences and OPEC/RGSSH, Raichur, between January 2021 and June 2026. Demographic and clinical characteristics, NSBB exposure, maternal complications, and fetal and neonatal outcomes were retrieved from medical records and analyzed using descriptive statistics.

Results: Of 30 women, 53.3% had vascular causes of portal hypertension and 46.7% had cirrhosis-related portal hypertension. Propranolol was administered in 80.0% and carvedilol in 20.0%. NSBB therapy was continued throughout pregnancy in 90.0%, while 6.7% required dose reduction and 3.3% discontinued treatment because of intolerance. Variceal/gastrointestinal bleeding occurred in 6.7%, hepatic decompensation in 13.3%, and NSBB-related adverse effects in 10.0%. Maternal survival was 100%. Live births constituted 86.7% of pregnancies, with abortion and stillbirth occurring in 6.7% each. Among 26 live births, preterm birth occurred in 19.2%, low birth weight in 26.9%, intrauterine growth restriction in 23.1%, and neonatal intensive care admission in 15.4%. No congenital anomalies or neonatal deaths were recorded.

Conclusion: NSBB therapy was generally well tolerated in pregnant women with portal hypertension, with high treatment continuation and no maternal or neonatal mortality. Nevertheless, clinically important maternal and fetal complications remained, supporting individualized therapy with close multidisciplinary maternal and fetal monitoring.