Monitoring of early human fetal development in women exposed to large doses of chemicals

Czeizel, Andr̀ew E.; Mosonyi, Attila

doi:10.1002/(sici)1098-2280(1997)30:2<240::aid-em17>3.0.co;2-d

Cited by 11 publications

(10 citation statements)

References 18 publications

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“…Although the incidence of early fetal loss of pregnancy is very high in general, 36,37 our results have shown that it is particularly high in the earliest period of pregnant women after suicide attempt.…”

Section: Introductionmentioning

confidence: 55%

Attempted suicide and pregnancy

Czeizel

2011

J Inj Violence Res

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Abstract:Background:The aim of the Budapest Monitoring System of Self-Poisoning Pregnant Women was to evaluate the potential congenital abnormality inducing effect of extremely large doses of drugs among pregnant women who attempted suicide. This system was appropriate to describe the characteristics of these pregnant women as a secondary finding from this model. Methods:All self-poisoned patients were cared for at a toxicological inpatient clinic in Budapest, between 1960 and 1993. Of a total of 1,044 pregnant women identified from the three different periods of the project, only 19 (1.8%) died. Women who survived were visited at home to reveal birth outcomes, and their exposed children were examined medically to identify congenital abnormalities and tested to estimate their cognitive-behavioral status. The previous or subsequent children of these pregnant women were used as controls with a similar examination protocol. Results:In general, self-poisoned pregnant women were young (peak age was between 18 and 20 years), 62% had their first pregnancy, 55% were unmarried, they had lower socioeconomic status, 46% were smokers and 22.5% drinkers, but depression/panic disorder occurred only among 17 pregnant women. Suicide attempts with drugs were most frequent in the fourth post-conceptional week and second month of pregnancy. In general they used smaller doses of drugs for suicide than non-pregnant age-matched women. Of 1,044 self-poisoned pregnant women, 926 had known pregnancy outcomes and 411 (44.4%) delivered live-born babies.Conclusions:The self-poisoning model appears to have several benefits (e.g., dose-response estimation of drugs) in comparison with other methods when evaluating teratogenic/fetotoxic effect of drugs. It is suggested that an international monitoring system of self-poisoned pregnant women should be established to provide a larger data base.

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Section: Introductionmentioning

confidence: 55%

Attempted suicide and pregnancy

Czeizel

2011

J Inj Violence Res

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“…We report that women hospitalized for an intentional acute poisoning within the first 9 weeks of pregnancy exhibited higher rates of LBW deliveries; however, after we adjusted for gestational age, this relationship was attenuated and no longer significant. In a study of 126 pregnant women self‐poisoned in the first 4 weeks of fetal development, 114 pregnancies ended in very early fetal loss, and 12 fetuses survived until delivery (Czeizel & Mosonyi, 1997). The authors of that study suggested that though based on small numbers, these findings are consistent with an “all‐or‐nothing” effect of poisoning very early in human gestation (Czeizel & Mosonyi).…”

Section: Discussionmentioning

confidence: 99%

“…However, after excluding eight infants with fetal alcohol syndrome, the rate of congenital anomalies in the remaining infants (9%) was not significantly different than that in the control group (6.1%). Therefore, no teratogenic effects were identified, even though in 27 cases large doses of drugs were ingested between the 3rd and 8th weeks of fetal development (Czeizel & Mosonyi, 1997).…”

Section: Teratogenesismentioning

confidence: 99%

Birth Outcomes Following Self‐Inflicted Poisoning During Pregnancy, California, 2000 to 2004

McClure

Patrick

Katz

et al. 2011

Journal of Obstetric, Gynecologic & Neonatal Nursing

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“…The majority of such episodes are impulsive and frequently precipitated by violent interpersonal disputes [12]. The peak time reported for self-harm attempts in pregnancy is the first trimester, after which, it declines with advanced gestational age [8,9,11,[13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Acute Poisoning During Pregnancy: Observations from the Toxicology Investigators Consortium

et al. 2015

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Acute poisonings during pregnancy pose a particular challenge to health care providers because of the potential for an immediate life threat or possible life-long implications for both the mother and fetus, including teratogenicity of the poison or its antidote. We describe recent consequential exposures among pregnant women in the USA. We identified all poisoning cases involving pregnant women that were catalogued by the medical toxicology services across the 37 sites of the Toxicology Investigators Consortium (ToxIC) Registry of the American College of Medical Toxicology between January 2010 and December 2012. Of 17,529 exposure cases reported in the ToxIC Registry, 103 (0.6 %) involved pregnant women, 80 % of whom were symptomatic and about a quarter displayed a specific toxidrome. The majority of cases (n = 53; 51.5 %) involved intentional exposures, most commonly to pharmaceutical agents, followed by unintentional pharmaceutical exposures (10 %) and withdrawal syndromes (9 %). Non-opioid analgesics were the most common class of agents encountered (31 %), followed by sedative-hypnotics/muscle relaxants (18 %), opioids (17 %), anti-convulsants (10 %), and anti-depressants (10 %). Over a third of cases involved exposure to multiple substances, and 32 % involved exposure to more than one drug class. The most commonly administered antidotes were N-acetylcysteine (23 %), sodium bicarbonate (10 %), flumazenil (4 %), and physostigmine (4 %). About half of acute poisoning cases among pregnant women presenting for emergency care involved intentional exposures, mostly with over-the-counter analgesics and psychoactive medications. Clinicians should be cognizant of the unique circumstances, maternal and fetal risks, and management principles of the acutely poisoned pregnant woman.

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Monitoring of early human fetal development in women exposed to large doses of chemicals

Cited by 11 publications

References 18 publications

Attempted suicide and pregnancy

Attempted suicide and pregnancy

Birth Outcomes Following Self‐Inflicted Poisoning During Pregnancy, California, 2000 to 2004

Acute Poisoning During Pregnancy: Observations from the Toxicology Investigators Consortium

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