Pregnancy outcomes after snakebite envenomations: A retrospective cohort in the Brazilian Amazonia

Abstract

Snakebite envenomations (SBEs) in pregnant women can result in adverse maternal or neonatal effects, such as abortion, placental abruption, preterm labor, fetal malformations, and maternal, fetal or neonatal deaths. Despite the high incidence of SBEs in the Brazilian Amazon, there is no literature on the impact of SBEs on pregnancy outcomes. The objective of this study was to describe clinical epidemiology and outcomes associated with SBEs in women of childbearing age and pregnant women in the state of Amazonas, Western Brazilian Amazon, from 2007 to 2021. Information on the population was obtained from the Reporting Information System (SINAN), Mortality Information System (SIM) and Live Birth Information System (SINASC) for the period from 2007 to 2021. A total of 36,786 SBEs were reported, of which 3,297 (9%) involved women of childbearing age, and 274 (8.3%) involved pregnant women. Severity (7.9% in pregnant versus 8.7% in non-pregnant women) (P = 0.87) and case-fatality (0.4% in pregnant versus 0.3% in non-pregnant women) rates were similar between groups (P = 0.76). Pregnant women who suffered snakebites were at higher risk for fetal death (OR: 2.17, 95%CI: 1.74–2.67) and neonatal death (OR = 2.79, 95%CI: 2.26–3.40). This study had major limitations related to the completeness of the information on the pregnancy outcomes. Although SBE incidence in pregnant women is low in the Brazilian Amazon, SBEs increased the risk of fetal and neonatal deaths.

Snakebite-Associated Infections: A Systematic Review and Meta-Analysis

“…93,94 M. morganii is considered an opportunistic secondary invader that was originally thought to be the cause of summer diarrhea. 94 However, this pathogen may also cause bacteremia, sepsis, brain abscesses, pyomyositis, meningitis, and pericarditis, 94 among other infections, [33][34][35][36][37][38][39][40][41][42][43] including the etiology of snakebite infections. Most studies did not indicate when coinfections or polymicrobial infections occurred.…”

Clinical Risk Factors Associated with Poor Outcomes in Snake Envenoming: A Narrative Review

“…Snakebite envenomation (SBE) can affect both the mother and foetus during pregnancy, leading to adverse outcomes such as maternal death, abruptio placenta, stillbirth, miscarriage, and preterm delivery [ 21 , 43 ]. Although the evidence is limited, these adverse outcomes appear to be primarily related to the effects of the venom on the mother [ 43 ].…”

“…One report from Brazil showed that envenomed pregnant women have a higher risk for foetal (Odds Ratio 2.17) or neonatal death (Odds Ratio 2.79) [ 19 ]. Foetal loss is more likely to occur early in the gestation period [ 21 , 44 ]. Abruptio placenta, especially in haemotoxic SBE, is the commonest cause of foetal loss [ 45 ].…”

“…Abruptio placenta, especially in haemotoxic SBE, is the commonest cause of foetal loss [ 45 ]. Interestingly, the Brazilian study [ 21 ] showed no difference in severity or case fatality between pregnant and non-pregnant women of childbearing age. In contrast, earlier studies demonstrated a significant increase in maternal mortality in envenomed pregnant women.…”