EXPOSURE TO TRICHLOROACETIC ACID IN PREGNANCY

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(Date of issue: September 2016, Version: 1.2)

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

Trichloroacetic acid (TCAA) is an analogue of acetic acid used topically in the treatment of condylomata acuminata (genital warts), common warts and plantar warts (verrucas).  TCAA is also used in cosmetic chemical facial peels. 

Formerly used as a herbicide and soil sterilant, TCAA is a common drinking water contaminant formed from organic material during the process of chlorination.

Animal studies have found increased fetal resorption and an increased incidence of fetal malformations with maternal exposure to high doses (~1000mg/kg/day) of trichloroacetic acid associated with significant maternal toxicity.  Human data of trichloroacetic acid exposure is limited to four cohort studies involving low level environmental exposure.  One prospective cohort study found a significant association between detection of TCCA in maternal urine and limb defects.  One retrospective study found a significant association between maternal exposure to >6mcg/L trichloroacetic acid in drinking water in the third trimester and an increased incidence of intrauterine growth restriction in the offspring. 

Topical application to unbroken skin is not expected to be associated with high systemic absorption, and trichloroacetic acid is considered an appropriate treatment for condylomata acuminata in pregnancy if clinically indicated.  However, as with all chemicals, unnecessary non-therapeutic exposure should be avoided.  

Inadvertent exposure to trichloroacetic acid at any stage of pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring.  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.

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.