USE OF INSECTICIDES IN PREGNANCY

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(Date of issue: October 2018, Version: 1.1)

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.

A corresponding patient information leaflet on Use of Insecticides in Pregnancy is available at www.medicinesinpregnancy.org.

Summary

SUMMARY: Insecticides are chemical compounds that are used in public health to kill vectors of disease such as mosquitoes, in agriculture to kill pests that damage crops, domestically to eradicate household and garden pests, and medically to eradicate body lice. Commonly used classes of insecticide include carbamates, organophosphates, pyrethrins/pyrethroids, and neonicotinoids.

There are a wealth of data describing pregnancy outcomes following gestational exposure to insecticides in general, but data relating to exposure to specific insecticides are generally scarce. Although associations with various adverse pregnancy outcomes and negative effects on infant/child neurodevelopment have been described following (usually chronic) insecticide exposure, findings of studies are generally inconsistent, and data are often confounded by multiple exposures and sociodemographic factors. Studies are further limited by potential misclassification of exposure as this is often assumed due to job title or place of residence. Few conclusions can therefore be drawn and there are no data specifically relating to acute exposure. Pregnant women should be advised to avoid exposure to insecticides. Where exposure cannot be avoided, personal protective equipment (PPE) should be employed as per the manufacturer’s instructions.

Low-level exposure to insecticides at any stage in pregnancy would not be regarded as medical grounds for termination of pregnancy. The need for additional fetal monitoring should be determined on a case-by-case basis, taking into account factors such as whether exposure was acute or chronic, whether personal protective equipment was employed, and the stage of pregnancy. Where high level exposure and/or symptoms of maternal toxicity have occurred, please contact UKTIS for a case-specific assessment of the risk of fetal harm. Maternal toxicity should be treated as for the non-pregnant patient and where a specific antidote is clinically indicated this should not be withheld on account of pregnancy. 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.

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.