Anaphylaxis in Pregnancy in the United States: Risk Factors and Temporal Trends Using National Routinely Collected Data

Abstract

BackgroundAnaphylaxis in pregnancy is an understudied, rare, and severe complication of pregnancy.ObjectiveTo describe the incidence and temporal trends, and to identify potential risk factors for anaphylaxis-related hospitalizations while pregnant in the United States.MethodsAll hospitalizations while pregnant and any anaphylactic reactions were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes from the National Inpatient Sample, United States, over the period 2004 to 2014. Annual incidence rates of anaphylaxis during pregnancy were calculated. Logistic regression models assessed risk factors for anaphylaxis during pregnancy, presented as odds ratios (ORs) and 95% CIs.ResultsDuring the period 2004 to 2014, the incidence of anaphylaxis during pregnancy was 3.8 (95% CI, 3.4-4.2) per 100,000 hospitalizations while pregnant. The incidence did not statistically differ during the period 2004 to 2014. After adjustment, there were 3 factors that increased the odds of anaphylaxis during pregnancy: cesarean delivery (adjusted OR [aOR], 4.19; 95% CI, 3.28-5.35) compared with noncesarean delivery; history of an allergic reaction (aOR, 4.05; 95% CI, 2.64-6.23) compared with no history; and a black race (aOR, 1.57; 95% CI, 1.15-2.15) and other race (aOR, 1.69; 95% CI, 1.08-2.63) compared with white race.ConclusionsDespite increased rates of cesarean delivery in the United States and consequent drug administration, there was no evidence of an increasing trend in anaphylaxis. Cesarean delivery and history of an allergic reaction allow the identification of women at risk of anaphylaxis. Not all women had clear risk factors, and preparations should always be in place to ensure timely management if this uncommon event occurs.

Successful Management of a Suspected Case of Meperidine-Induced Anaphylaxis in Cesarean Delivery

“…Based on the current evidence, cesarean delivery and history of any allergic reactions could be the potential risk factors for anaphylaxis (8). Prognosis depends on early recognition and timely management.…”

“…Studies demonstrate that even previously safe administration of a drug does not guarantee the safety of the next administration (9). Moreover, more than 90% of these cases during pregnancy had no clear history of drug or food allergy (8). Thus, great caution should be paid to early diagnosis and intervention while all the required equipment is available.…”

Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report

“…Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. The estimated incidence is 1.6 to 3.8 cases per 100,000 maternities, which is much lower than that in other populations [1][2][3]. Since numerous drugs are contraindicated for pregnant women, the fewer opportunities for drug use may contribute to the low incidence of anaphylaxis during pregnancy.…”

“…Since numerous drugs are contraindicated for pregnant women, the fewer opportunities for drug use may contribute to the low incidence of anaphylaxis during pregnancy. Antibiotics have been reported as the main causative agent of anaphylaxis during pregnancy, whereas local anesthetics have rarely been reported [1,2].…”

Lessons from peculiar cases of anaphylaxis: why allergists should be prepared for the unexpected

“…Anaphylaxis and pregnancy Anaphylaxis (A) is considered uncommon during pregnancy. However, among potential risk factors such as age and history of allergy, cesarean delivery could be recognized as the main culprit condition because the necessity of using anaesthesia, surgical procedures and drugs (22). An amoxicillin-induced anaphylaxis at the end of pregnancy determined newborn death by hypoxic-ischaemic cerebral injuries (23).…”