Poisonings and toxins

Christof Schaefer mLm m

2.22.1

The general risk of poisoning in pregnancy

543

2.22.2

Treatment of poisoning in pregnancy

544

2.22.3

Chemicals

545

2,22.4

Medicines

549

2.22.5

Animal toxins

554

2.22.6

Mushrooms

555

2.22.7

Other plant toxins

556

2.22.8

Bacterial endotoxins

556

2.22.1 The general risk of poisoning in pregnancy

Experience involving the effects of toxins and poisoning during pregnancy is principally based on case reports and smaller case series (sec, for example, Bailey 2003, McElhatton 2001, Little 1998, Czeizel 1997, 1988, Tenenbein 1994). Therefore, a differentiated evaluation of the risk for the unborn is difficult,

A study from Hungary investigated 109 women who were treated in hospitals because of acute poisoning during different phases of pregnancy. In 70% of these cases, suicide was attempted, mostly with drugs (Czeizel 1988). Of 96 children born alive, seven had malformations, but only in two of them a causal association could not be eliminated. The only significant deviation in development was a slightly higher proportion (6.5%) of mentally retarded children. This finding, though, should not be generalized, as the number of cases is too small. However, an investigation based on larger figures, which the same author published later, showed no significantly increased rate of birth defects. This was also valid for the 27 women who had taken high doses of drugs during early pregnancy between weeks 5 and 10 (Czeizel 1997). In a more recent Danish study of 122 pregnant women, a doubled rate of spontaneous abortions was found, but no higher risk of birth defects and no increase in premature deliveries (Flint 2002). These data should not be used to say that poisoning in pregnancy does not affect the fetus. However, there is some indication that the majority of poisonings do not result in a high malformation risk, at least if the mother was adequately treated. Therefore, termination of pregnancy should not be decided without careful individual evaluation.

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