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<p>Nadolol is the preferred beta-blocker for prophylactic therapy in congenital long QT syndrome (LQTS), but data on infant exposure during breastfeeding are scarce. We describe a 34-year-old woman with LQTS type 1, stabilized on nadolol 80&#xa0;mg/day, who chose to breastfeed her healthy full-term infant. An individualized follow-up plan was developed by the multidisciplinary pregnancy heart team at Lille University Hospital, including serial maternal and infant nadolol plasma measurements, ECG, growth and clinical assessments. Maternal and infant plasma samples were collected on days 3, 10, 17, and 5.5 months postpartum. On day 3, infant exposure via colostrum was low. On day 10 and 17, after steady-state exposure from exclusive breastfeeding, nadolol was detectable in the infant at very low concentrations, below the neonatal therapeutic range and 10-fold lower than maternal levels. By 5.5 months, during mixed feeding, nadolol in the infant was undetectable. No adverse effects were observed. This is the first report of paired maternal–infant nadolol plasma concentrations with extended follow-up. Despite pharmacokinetic concerns, infant systemic exposure was minimal even during exclusive breastfeeding. These findings support integrating maternal cardiovascular treatment with breastfeeding goals in a multidisciplinary care approach, though confirmation with additional cases is needed.</p>

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Breastfeeding During Maternal Nadolol Therapy for Long QT Syndrome: Five-Month Infant Follow-Up

  • 期刊论文

  • 发表日期：

    2025年12月3日

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  • Romane Freppel,
  • Louise Gaboriau,
  • Beatrice Mestdagh,
  • Louise Ghesquière,
  • Luisa Marsili,
  • Benjamin Hennart,
  • Marjorie Richardson,
  • Sophie Gautier

摘要

Nadolol is the preferred beta-blocker for prophylactic therapy in congenital long QT syndrome (LQTS), but data on infant exposure during breastfeeding are scarce. We describe a 34-year-old woman with LQTS type 1, stabilized on nadolol 80 mg/day, who chose to breastfeed her healthy full-term infant. An individualized follow-up plan was developed by the multidisciplinary pregnancy heart team at Lille University Hospital, including serial maternal and infant nadolol plasma measurements, ECG, growth and clinical assessments. Maternal and infant plasma samples were collected on days 3, 10, 17, and 5.5 months postpartum. On day 3, infant exposure via colostrum was low. On day 10 and 17, after steady-state exposure from exclusive breastfeeding, nadolol was detectable in the infant at very low concentrations, below the neonatal therapeutic range and 10-fold lower than maternal levels. By 5.5 months, during mixed feeding, nadolol in the infant was undetectable. No adverse effects were observed. This is the first report of paired maternal–infant nadolol plasma concentrations with extended follow-up. Despite pharmacokinetic concerns, infant systemic exposure was minimal even during exclusive breastfeeding. These findings support integrating maternal cardiovascular treatment with breastfeeding goals in a multidisciplinary care approach, though confirmation with additional cases is needed.