Is Carbon Monoxide a Workplace Teratogen? A Review and Evaluation of the Literature

Norman, C.; Halton, David M.

doi:10.1093/annhyg/34.4.335

Cited by 46 publications

(8 citation statements)

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“…Hyperbaric oxygen is mandatory for all pregnant women with either impaired consciousness or COHb levels of 20% or higher [ 6 ]. The literature shows that COHb > 48% is most often, but not always, associated with a poor prognosis [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Carbon Monoxide Poisoning during Pregnancy: Presentation of a Rare Severe Case with Fetal Bladder Complications

Delomenie

Schneider

Beaudet

et al. 2015

Case Reports in Obstetrics and Gynecology

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Carbon monoxide poisoning during pregnancy is a rare and potentially serious condition. Fetal complications are uncommon, related to anoxic lesions. The severity of these complications does not depend on the level of maternal COHb. We report the case of a 22-year-old pregnant woman who at 30 weeks of gestation had carbon monoxide poisoning secondary to a fire in her home, complicated by cardiac arrest and severe fetal damage. The child had not brain damage, but presented bladder lesions not previously described, with urinary ascites complicating megacystis.

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Section: Discussionmentioning

confidence: 99%

Carbon Monoxide Poisoning during Pregnancy: Presentation of a Rare Severe Case with Fetal Bladder Complications

Delomenie

Schneider

Beaudet

et al. 2015

Case Reports in Obstetrics and Gynecology

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“…women can be as high as 2.6%, whereas for smokers the levels may range from 2.0% to 8.3% (most typically around 6%) (Norman & Halton, 1990;Woody & Brewster, 1990). Women who experience CO poisoning often have nonspecific findings, such as headache, shortness of breath, nausea, and dizziness; loss of consciousness is seen in the most severe cases (Greingor et al, 2001).…”

Section: Normal Carboxyhemoglobin Levels In Nonsmoking Pregnantmentioning

confidence: 99%

“…While several case reports of in utero CO poisoning in humans mention birth defects outside of the brain, details about the specific findings are often lacking (Norman & Halton, 1990). Fetal CO exposure past the critical timing of organogenesis may not be sufficient to cause structural defects, as prolonged CO exposure leading to chronic fetal hypoxia is rare and may likely lead to fetal and/or maternal death as opposed to fetal disruptive defects, except in the organs that are most dependent on oxygen, such as the developing brain.…”

Section: Normal Carboxyhemoglobin Levels In Nonsmoking Pregnantmentioning

confidence: 99%

Hypoxia: A teratogen underlying a range of congenital disruptions, dysplasias, and malformations

Adam¹,

Payton

Sanchez‐Lara

et al. 2021

American J of Med Genetics Pt A

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In this review, we explore evidence that hypoxia in the developing human fetus can lead not only to the more commonly accepted disruptive-type defects, but also patterns of anomalies that suggest that hypoxia can exert a more classic teratogenic effect, using the brain as one example. We review neuropathology in the context of intrauterine hypoxia, particularly as it relates to carbon monoxide poisoning, in utero strokes, and homozygous alpha-thalassemia. In general, the associated brain injuries resemble those seen with other causes of hypoxic-ischemic injury. Fetal strokes during development usually lead to loss of brain tissue in areas that do not follow a typical embryologic pattern, and therefore are considered disruptions. However, there is also evidence that fetal brain ischemia can cause more classically recognized patterns of abnormal embryonic neuronal migration and organization such as polymicrogyria, cortical dysplasia, or dysgenesis, including select types of focal cortical dysplasia. This study summarizes available literature and evidence to raise clinicians' awareness regarding the association between hypoxia and congenital anomalies, including brain malformations.

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“…The later gestational ages are more susceptible to neurologic complications such as anoxic encephalopathy. 7,8,38,39…”

Section: Mechanism Of Injury To Mother and Fetusmentioning

confidence: 99%

“…7 Among the pregnant population, accidental exposure in the domestic setting is the primary cause of CO poisoning. 8 A non-irritating, tasteless, and odorless gas, CO is difficult to detect. The exact incidence of CO intoxication of pregnant women is unknown but is estimated at 4.6–8.5% of all patients diagnosed with CO poisoning.…”

Section: Introductionmentioning

confidence: 99%

Carbon Monoxide and Cyanide Poisoning in the Burned Pregnant Patient

Culnan¹,

Craft-Coffman²,

Bitz³

et al. 2018

Annals of Plastic Surgery

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Carbon monoxide (CO) is a small molecule poison released as a product of incomplete combustion. Carbon monoxide binds hemoglobin, reducing oxygen delivery. This effect is exacerbated in the burned pregnant patient by fetal hemoglobin that binds CO 2.5- to 3-fold stronger than maternal hemoglobin. With no signature clinical symptom, diagnosis depends on patient injury history, elevated carboxyhemoglobin levels, and alterations in mental status. The standard of care for treatment of CO intoxication is 100% normobaric oxygen, which decreases the half-life of CO in the bloodstream from 5 hours to 1 hour. Hyperbaric oxygen (HBO2) is a useful adjunct to rapidly reduce the half-life of CO to 20 minutes and the incidence of delayed neurologic sequelae. Because of the slow disassociation of CO from hemoglobin in the fetus, there is a far stronger indication for HBO2 in the burned pregnant patient than in other burn patient populations.Cyanide intoxication is often a comorbid disease with CO in inhalation injury from an enclosed fire, but may be the predominant toxin. It acts synergistically with CO to effectively lower the lethal doses of both cyanide and CO. Diagnosis is best made in the presence of high lactate levels, carboxyhemoglobin concentrations greater than 10%, injury history of smoke inhalation from an enclosed fire, and alterations in consciousness. While treatment with hydroxocobalamin is the standard of care and has the effect of reducing concomitant CO toxicity, data indicate cyanide may also be displaced by HBO2.Carbon monoxide and cyanide poisoning presents potential complications impacting care. This review addresses the mechanism of action, presentation, diagnosis, and treatment of CO and cyanide poisonings in the burned pregnant patient and the use of HBO2 therapy.

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Is Carbon Monoxide a Workplace Teratogen? A Review and Evaluation of the Literature

Cited by 46 publications

References 0 publications

Carbon Monoxide Poisoning during Pregnancy: Presentation of a Rare Severe Case with Fetal Bladder Complications

Carbon Monoxide Poisoning during Pregnancy: Presentation of a Rare Severe Case with Fetal Bladder Complications

Hypoxia: A teratogen underlying a range of congenital disruptions, dysplasias, and malformations

Carbon Monoxide and Cyanide Poisoning in the Burned Pregnant Patient

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