EXPOSURE TO NERVE AGENTS IN PREGNANCY

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(Date of issue: December 2017, Version: 1)

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

Organophosphate (OP) nerve agents are HIGHLY TOXIC acetylcholinesterase (AChE) inhibitors. There are two main classes of nerve agent: G-series nerve agents (NATO designation) include tabun (GA), sarin (GB), soman (GD) and cyclosarin (GF), and V-series agents include VG and VX.

There is limited published experience of confirmed OP nerve agent exposure in human pregnancy. The available data currently consists of one small case series of five pregnant women exposed to sarin at various stages of pregnancy. No evidence of adverse fetal effects were described in this case series, though only one woman was exposed during the period of organogenesis and no major symptoms of toxicity were reported, indicating limited exposure. Evidence from preclinical animal studies does not indicate that OP nerve agent exposure in pregnancy results in reproductive toxicity or teratogenic effects, even at maternally toxic doses.

In all cases of OP nerve agent exposure in pregnancy, maternal toxicity is likely to be a major determinant of risk to the fetus. However, due to the limited data concerning the teratogenicity of OP nerve agents, the absence of maternal toxicity does not exclude the possibility of adverse fetal effects. Where maternal treatment of OP nerve agent poisoning is required, this should be as for the non-pregnant patient. While there are limited data concerning the safety of maternal pralidoxime and atropine use in human pregnancy, where indicated, these should not be withheld on the account of pregnancy. In cases where OP nerve agent exposure occurs close to term or delivery, neonatal toxicity may arise. Owing to the lack of available evidence, close monitoring of the neonate is recommended in all cases of maternal OP nerve agent exposure in pregnancy.

Due to the lack of data, where exposure to OP nerve agents has occurred, even in cases which did not result in maternal toxicity, enhanced fetal monitoring may be warranted and should be considered on a case-by-case basis. Other risk factors may also 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. Discussion with UKTIS is recommended for all cases of exposure.

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.