EXPOSURE TO CARBON MONOXIDE IN PREGNANCY

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(Date of issue: May 2017, Version: 2)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

Summary

Carbon monoxide is a colourless, odourless and tasteless gas produced by incomplete combustion of carbon-containing products. Common sources of exposure include faulty heating appliances (gas and solid fuel boilers), BBQs being used inside homes, caravans and tents, car exhausts, open fires, kerosene stoves and cigarette smoke.

Following maternal exposure carbon monoxide crosses the placenta and may reach higher concentrations in the fetus than in the mother. The elimination half-life in the fetus may be up to 4-5 times longer than in the mother. High maternal carboxyhaemoglobin (COHb) concentrations may confer a greater risk to both the mother and fetus, but the correlation between maternal COHb blood concentrations and the clinical severity of maternal poisoning is weak. The possible need for treatment of asymptomatic pregnant women therefore needs to be considered on a case-by-case basis.
 
Adverse outcomes have been reported after acute carbon monoxide poisoning in pregnancy. Fetal and neonatal death, congenital malformations and neurological problems have all occurred in association with reported moderate to severe (loss of consciousness/coma) maternal toxicity. However, the available data suggest that an increased risk of adverse outcomes cannot be excluded in the absence of maternal toxicity, for example following low level chronic exposure. Some studies investigating chronic environmental in utero exposure to carbon monoxide have reported associations with preterm delivery, low birth weight, congenital malformations, sudden infant death and neurodevelopmental problems. Increased risks for these adverse outcomes have also been reported with maternal smoking in pregnancy – please refer to the UKTIS monograph on ‘Use of tobacco in pregnancy’ for further information.

Maternal toxicity is likely to be a major determinant of risk to the fetus. UK guidance on antenatal testing for carbon monoxide exposure during pregnancy is available online from Public Health England (click here).

There are no published guidelines on the management of carbon monoxide poisoning during pregnancy. Initial management of the poisoned pregnant patient should be the same as for the non-pregnant patient, although treatment may need to be continued for longer given the reduced capacity of the fetus to clear CO. For current guidelines on the management of carbon monoxide poisoning the reader should consult TOXBASE or contact UKTIS. Where exposure to carbon monoxide has occurred, even in the absence of maternal toxicity, enhanced fetal monitoring may be warranted. Discussion with UKTIS is recommended for all cases of carbon monoxide poisoning in pregnancy.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.