Are there teratogenic risks associated with antidotes used in the acute management of poisoned pregnant women?
OBJECTIVE
We reviewed evidence suggesting teratogenic risk associated with the use of antidotes in the acute management of poisoned pregnant women.


METHODS
Medline, Toxline, and DART/ETIC searches; references of retrieved articles, pertinent databases and textbooks were also searched.


RESULTS
There are case reports or case series of women who received antidotes for poisoning during (*) or after (+) the period of organogenesis who showed no fetal adverse effects. Some antidotes, however, have no teratogenic risk: atropine (cohort/surveillance studies)+, calcium (oral supplement: cohort study)+ and pyridoxine (Bendectin studies). Also, ethanol+, methylene blue (intra-amniotic injection but not oral) and penicillamine* can be considered teratogens but their risks in the treatment of poisonings are unknown. There is no epidemiologic study evaluating the risk of the following antidotes during pregnancy: N-acetylcysteine(*+), BAL (dimercaprol)+, black widow spider antivenin+, calcium EDTA+, crotalidae antivenin, crotalidae polyvalent immune FAB, cyanide antidote kit (amyl and sodium nitrate, sodium thiosulfate), deferoxamine(*+), digoxin immune FAB+, DMSA+, flumazenil+, fomepizole, methylene blue (IV), naloxone, physostigmine, pralidoxime+, protamine+; and parenteral pharmacologic doses of calcium+, folinic acid*, glucagon+, hydroxycobalamin, phytonadione (vitamin K), and pyridoxine.


CONCLUSIONS
Despite the limited evidence supporting the risk of antidote use during pregnancy, antidotes should be used when there is a clear maternal indication to decrease the morbidity or mortality associated with poisoning. The only exception may be penicillamine, which is a teratogen. Better antidotes exist for most poisonings that penicillamine could potentially treat. At this time, there is no known fetal indication for all antidotes. Reporting the use of an antidote during pregnancy should be encouraged, especially if used during the critical period of organogenesis.
Bailey
Benoit
B
Division of Emergency Medicine, Department of Pediatrics, Hôpital Ste-Justine, Université de Montréal, Montréal, Québec, Canada. baileyb@med.umontreal.ca
D000014:Abnormalities, Drug-Induced / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D000931:Antidotes / Q000009:adverse effects*; D000075202:Contraindications; D005314:Embryonic and Fetal Development / Q000187:drug effects; D005260:Female; D006801:Humans; D011041:Poisoning / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D012306:Risk
D000931:Antidotes