Are there teratogenic risks associated with antidotes used in the acute management of poisoned pregnant women?

Bailey, Barbara

doi:10.1002/bdra.10007

Cited by 59 publications

(22 citation statements)

References 91 publications

(79 reference statements)

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“…A systematic review on the teratogenicity of antidotes concluded that despite the limited supporting evidence, (1) Pyrethrins (1) Glyphosate (1) Unknown (1) The percentage represents the proportion of the total number of cases (n=103) in which the specific agent class and/or agent was reported. Respondents could report more than one agent and agent class for each case; therefore, percentages can add up to more than 100 APAP N-acetyl-p-aminophenol, ASA acetylsalicylic acid, NSAIDs non-steroidal anti-inflammatory drugs antidotes should be used when indicated to decrease maternal morbidity and mortality associated with poisoning despite potential fetal risks [18,19]. Acetaminophen crosses the placenta and is metabolized by fetal liver, where generation of the toxic metabolite (N-acetyl-p-benzoquinone imine) may occur [20].…”

Section: Discussionmentioning

confidence: 99%

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Acute Poisoning During Pregnancy: Observations from the Toxicology Investigators Consortium

et al. 2015

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Acute poisonings during pregnancy pose a particular challenge to health care providers because of the potential for an immediate life threat or possible life-long implications for both the mother and fetus, including teratogenicity of the poison or its antidote. We describe recent consequential exposures among pregnant women in the USA. We identified all poisoning cases involving pregnant women that were catalogued by the medical toxicology services across the 37 sites of the Toxicology Investigators Consortium (ToxIC) Registry of the American College of Medical Toxicology between January 2010 and December 2012. Of 17,529 exposure cases reported in the ToxIC Registry, 103 (0.6 %) involved pregnant women, 80 % of whom were symptomatic and about a quarter displayed a specific toxidrome. The majority of cases (n = 53; 51.5 %) involved intentional exposures, most commonly to pharmaceutical agents, followed by unintentional pharmaceutical exposures (10 %) and withdrawal syndromes (9 %). Non-opioid analgesics were the most common class of agents encountered (31 %), followed by sedative-hypnotics/muscle relaxants (18 %), opioids (17 %), anti-convulsants (10 %), and anti-depressants (10 %). Over a third of cases involved exposure to multiple substances, and 32 % involved exposure to more than one drug class. The most commonly administered antidotes were N-acetylcysteine (23 %), sodium bicarbonate (10 %), flumazenil (4 %), and physostigmine (4 %). About half of acute poisoning cases among pregnant women presenting for emergency care involved intentional exposures, mostly with over-the-counter analgesics and psychoactive medications. Clinicians should be cognizant of the unique circumstances, maternal and fetal risks, and management principles of the acutely poisoned pregnant woman.

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Section: Discussionmentioning

confidence: 99%

“…Little is known about its teratogenic risk [18]. It is classified by the FDA as a pregnancy category C drug [27].…”

Section: Discussionmentioning

confidence: 99%

Acute Poisoning During Pregnancy: Observations from the Toxicology Investigators Consortium

et al. 2015

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“…The management of organophosphate intoxication in a pregnant patient has been a matter of debate. Literature on the usage of atropine and pralidoxime during pregnancy is scanty (Karalliedde et al 1988;Tenenbein 1994;Bailey 2003) and is not part of the general therapeutic strategy (Okumara 1997). Since this middle-aged pregnant woman was finally carrying a viable baby after several miscarriages, no risks were taken.…”

Section: Discussionmentioning

confidence: 99%

“…while relevant parameters (clinical improvement and effects of atropine toxicity) were strictly monitored and further administration of atropine was discontinued at the first signs of hallucination. The decision to use pralidoxime was based on the limited literature available on its use in pregnancy (Tenenbein 1994;Bailey 1997Bailey & 2003, the fact that the pregnancy was well beyond the organogenesis and that the baby could be delivered if needed at any stage during the treatment. Moreover in order to obtain the most optimal outcome, pralidoxime has to be started as soon as the diagnosis is confirmed.…”

Section: Discussionmentioning

confidence: 99%

Organophosphate Poisoning in Pregnancy: A Case Report

Kamha

Omary

Zalabany

et al. 2005

Basic Clin Pharmacol Toxicol

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A 42-year-old pregnant woman (26 weeks of gestation, G 4 P 0π3 ) presented at the emergency department with a two-hour history of dizziness, blurred vision and repeated vomiting. These symptoms started during the use of an undiluted insecticide liquid (diazinon 60 EC) while cleaning a small non-aired bathroom. After clinical and laboratory confirmation for organophosphate poisoning (plasma pseudocholinesterase levels 161 U/l), treatment with atropine and pralidoxime was started. She recovered within 7 days and delivered a healthy baby 12 weeks later (Apgar score 9 and 10) by elective cesarean section. The child showed no signs or symptoms of organophospate, atropine or pralidoxime exposure.

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“…B. bei Methanolintoxikation ebenso beobachtet wie bei Überdosen von Paracetamol und Eisenpräparaten, die mit Antidota behandelt wurden. Zum Chelatbildner Dimercaprol, der dem bei uns gebräuchlichen DMPS (2,3-Dimercapto-1-propansulfonsäure) chemisch verwandt ist, liegen mehrere Fallberichte zur Anwendung bei Arsen-und Bleivergiftung vor, die keine Hinweise für ein embryotoxisches Risiko geben [2]. Antidotsubstanzen, die v. a. bei anderen Indikationen eingesetzt werden, wie z.…”

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Intoxikationen bei Schwangeren

Schaefer

Hoffmann-Walbeck

2012

Med Klin Intensivmed Notfmed

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Attempted suicides and poisonings in pregnancy are a challenge for health care professionals because of the unknown effects of the toxic agent and the antidote therapy on the unborn. In case of intoxication, the malformation risk is often overestimated. In contrast, pertinent data show that the risk is not very high as long as the drug is not known as a teratogen and the mother's health is not substantially impaired. This applies to suicide attempts with acetaminophen, iron-containing products, and multidrug overdoses with psychopharmaceuticals as well as snake and spider bites and the ingestion of poisonous mushrooms. It is of utmost importance that the pregnant patient receives the same detoxification and supportive therapy following pertinent guidelines as a non-pregnant patient. The fetus should be followed-up by ultrasound with special focus on its vital parameters, movement pattern, and normal growth and organ differentiation. As long as the maternal health status is not substantially impaired, there is no indication to discuss elective termination of pregnancy "for toxicological reasons".

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Are there teratogenic risks associated with antidotes used in the acute management of poisoned pregnant women?

Cited by 59 publications

References 91 publications

Acute Poisoning During Pregnancy: Observations from the Toxicology Investigators Consortium

Acute Poisoning During Pregnancy: Observations from the Toxicology Investigators Consortium

Organophosphate Poisoning in Pregnancy: A Case Report

Intoxikationen bei Schwangeren

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