EXPOSURE TO INORGANIC AND ELEMENTAL MERCURY IN PREGNANCY

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(Date of issue: July 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

There are three forms of mercury: elemental (metallic) mercury (a heavy silver-white metallic element), inorganic mercury, and organic mercury. It is important to distinguish between these forms as risk of toxicity is dependent on the chemical form of the metal as well as the route of exposure. Inorganic mercury is primarily found in batteries, disinfectants, art pigments, and in some traditional remedies and cosmetics. Poisoning may occur following ingestion, injection, inhalation or dermal absorption. Elemental mercury occurs naturally in the environment and is used in the production of dental amalgam, thermometers and electric light bulbs. Elemental mercury is poorly absorbed by the skin and GI tract but readily absorbed if inhaled as mercury vapour, potentially resulting in toxic effects. 

There are few published reports that focus specifically on the possible adverse reproductive or fetal effects following acute exposure to inorganic or elemental mercury compounds in human pregnancy. The small number of available studies on exposure to dental amalgam fillings provide no evidence of an association with effects on birth weight, gestational age at delivery, or stillbirth. Published data on chronic occupational exposure also provide no evidence of an association between in utero exposure to inorganic or elemental mercury and the occurrence of congenital malformation, miscarriage, stillbirth or low birth weight in the offspring. However, the limited and retrospective nature of these studies renders them unsuitable for use in a formal risk assessment and therefore an increase in risk cannot be ruled out, and not all pregnancy outcomes have been adequately studied to inform a risk assessment. Where exposure to inorganic or elemental mercury occurs, associated maternal toxicity is likely to be a major determinant of risk to the fetus. Treatment of the mother should not be delayed or withheld on account of pregnancy and should be as for the non-pregnant patient. 

As with all chemicals, unnecessary exposure to inorganic or elemental mercury should be avoided during pregnancy. However, where occupational exposure is unavoidable, adequate health and safety precautions should be taken to ensure that exposure is well within recommended limits to reduce the risk of maternal toxicity.

Inadvertent exposure to inorganic or elemental mercury at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments. Where exposure to inorganic or elemental mercury has occurred, even in the absence of maternal toxicity, enhanced fetal monitoring may be warranted. Once the mother has been assessed and treated, discussion with UKTIS regarding fetal risk is recommended.
                      
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.