Venomous Snake and Spider Bites in Pregnancy

Abstract

Importance: Venomous snake and spider bites are relatively rare in the Unites States and even more so in the pregnant population. However, the impact of a venomous bite, also known as an envenomation, can be serious in a pregnant patient. Thus, providers in endemic and high-risk areas must be familiar with the management of envenomation in the pregnant population.Objective: The purpose of this article is to review the current literature on the most common snake and spider envenomations in the United States, the effects of envenomation on maternal and fetal health, and the management of envenomation in pregnancy.Evidence Acquisition: Original research articles, review articles, and guidelines on snake and spider envenomation were reviewed.Results: Snake envenomation carries higher risks of maternal morbidity and fetal morbidity and mortality than spider envenomation. Although the data are limited, current literature suggests that both snake and spider antivenom can be used in the pregnant population without significant adverse outcomes. However, the risks of an adverse hypersensitivity reaction with antivenom administration should be weighed carefully with the benefits.Conclusions and Relevance: The use of antivenom therapy in the symptomatic envenomated pregnant population is likely safe with the appropriate monitoring and follow-up. Knowledge of the indications for antivenom therapy and proper escalation of care are vital to optimizing maternal and fetal outcomes. More research is needed to determine the effects of both envenomation and antivenom therapy on the pregnant patient and their fetus.Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After participating in this activity, the provider should be better able to identify the most common venomous snakes and spiders in the United States; describe the maternal presentation and potential maternal and fetal effects of envenomation; and explain the appropriate use of antivenom therapy in pregnancy.Venomous bites are a rare occurrence due to the generally reclusive nature of both snakes and spiders. Within the United Sates, a large proportion of venomous bites (particularly snakebites) occur in the Southeast, due to the warmer climate. Overall, there are approximately 5000 reported venomous snakebites per year in the United States, leading to approximately 5 deaths per year. 1 The most common venomous snakebites are from members of the Viperidae and Elapidae families. Although rare, these bites provide a significant dilemma for providers as there are no specific guidelines for therapy in pregnancy, and maternal and fetal outcomes are typically only discussed in case reports.Similarly, each year, approximately 4000 individuals experience spider envenomation in the United States. In this population, mortalities are even rarer, although this is limited by accurate reporting. 2 Almost all clinically significant spider bites are attributed to the black widow