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Sert ZS, Menekse TS. Drug-induced poisoning during pregnancy: Four-year experience. Am J Emerg Med 2022; 54:22-25. [DOI: 10.1016/j.ajem.2022.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022] Open
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Leonard JB, Minhaj FS, Paterson E, Klein-Schwartz W. Exposures in pregnant patients reported to United States Poison Centers. Clin Toxicol (Phila) 2021; 60:356-361. [PMID: 34406096 DOI: 10.1080/15563650.2021.1968420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Limited data describe poisoning exposures in pregnant women. Previous studies are limited to inpatient populations, those seen only by toxicologists, or single poison centers. This study aimed to describe poison exposures reported to U.S. poison control centers in pregnant patients compared to non-pregnant controls. METHODS This was a retrospective observational study of exposures reported to the American Association of Poison Control Centers National Poison Data System from 2000 through 2019. Pregnant patients were included from 15-44 years along with a random sampling of 5:1 age and year matched control group of non-pregnant exposures. Demographics, primary substance, and known medical outcomes were described. Chi square analysis was performed for comparisons. RESULTS From 2000 to 2019, a total of 131,619 pregnant cases and 658,095 non-pregnant controls were identified. The median age was 27 years (IQR: 22, 31) for the matched groups. For known trimester of pregnancy: 29.8, 37.0, and 28.2% were in the first, second, and third trimester, respectively. Most common exposures were analgesics and cleaning products. Intentional exposures were more common in non-pregnant compared to pregnant cases (41.2 vs 21.9%; OR 2.71, 95% CI 2.67-2.75), mostly self-harm attempts (31.5 vs. 15.8%). Notably, there was a large discrepancy in the proportion of environmental exposures, with fewer in non-pregnant controls compared with pregnant cases (3.8 vs. 12.1%; OR 0.29, 95% CI 0.28-0.29). More non-pregnant cases had multiple substance exposures compared with pregnant cases (22.2 vs. 10.9%; OR 2.34, 95% CI 2.29-2.38). There were more moderate effect outcomes in non-pregnant compared with pregnant cases (13.2 vs. 6.3%; OR 2.25, 95% CI 2.20-2.30). CONCLUSIONS Outcomes of poisoning exposures in pregnant patients reported to U.S. poison centers are less serious compared to non-pregnant controls, likely due to the lower rates of intentional abuse and self-harm exposures and greater number of minimally toxic environmental exposures.
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Affiliation(s)
- James B Leonard
- Department of Pharmacy Practice and Science, Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Faisal S Minhaj
- Department of Pharmacy Practice and Science, Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Emily Paterson
- Department of Pharmacy Practice and Science, Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Wendy Klein-Schwartz
- Department of Pharmacy Practice and Science, Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Mbongwe B, Moinami J, Masupe T, Tapera R, Molefe T, Erick P, Godman B, Massele A. Nature and sources of poisoning in patients admitted to a referral hospital in Gaborone, Botswana; findings and implications. Hosp Pract (1995) 2020; 48:100-107. [PMID: 32133895 DOI: 10.1080/21548331.2020.1739415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intentional poisoning is becoming an important public health concern particularly among young women globally. Consequently, there is a need to analyze this further within countries to establish pertinent policies to reduce current incidence rates. This includes sub-Saharan African countries where there has been a scarcity of information. Consequently, we sought to establish the nature and sources of poisoning in patients admitted to a leading hospital in Botswana to help develop pertinent future policies for Botswana and surrounding countries. METHODS Retrospectively reviewing the medical records of all patients admitted to Princess Marina Hospital (PMH), which is a leading tertiary hospital in the capital city of Botswana, due to acute poisoning over a six-year period. RESULTS The records for 408 patients were reviewed. The majority of admissions (58%) were females, and the mean age of patients was 21(±14) years. Most poisoning cases (53%) were intentional. The 15-45 years age group was most likely to intentionally poison themselves compared to other age groups, with females four and half times more likely to intentionally poison themselves compared to males (AOR 4.53, 95% CI: 2.68-7.89, p < 0.001). Half of the patients were poisoned by medicines followed by household chemicals (22%), with females overall four times more likely to be poisoned by medicines compared to males. The medicine mostly ingested was paracetamol (30%). Failing relationships (57%) were the principal reason for intentional poisoning. Six patients died from poisoning representing a 1.5% mortality rate. CONCLUSIONS The findings suggest in-depth and urgent investigations on intentional poisoning are needed among young women across countries including sub-Saharan African countries to inform future policies on prevention strategies. Further, strategies for poisoning prevention should target social and family relationship problems. We will be following this up in the future.
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Affiliation(s)
- Bontle Mbongwe
- Department of Environmental Health, Faculty of Health Sciences, University of Botswana , Gaborone, Botswana
| | - Jacqueline Moinami
- Department of Environmental Health, Faculty of Health Sciences, University of Botswana , Gaborone, Botswana
| | - Tiny Masupe
- Department of Family Medicine & Public Health, Faculty of Medicine, University of Botswana , Gaborone, Botswana
| | - Roy Tapera
- Department of Environmental Health, Faculty of Health Sciences, University of Botswana , Gaborone, Botswana
| | - Tshenkego Molefe
- Department of Environmental Health, Faculty of Health Sciences, University of Botswana , Gaborone, Botswana
| | - Patience Erick
- Department of Environmental Health, Faculty of Health Sciences, University of Botswana , Gaborone, Botswana
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University , Pretoria, South Africa.,Health Economics Centre, Liverpool University Management School , Liverpool, UK
| | - Amos Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana , Gaborone, Botswana
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Zipursky JS, Yaphe H, Hudson H, Wong A, Thompson M. Acute poisoning in pregnancy: a province-wide perspective from a poison center. Clin Toxicol (Phila) 2019; 58:736-741. [PMID: 31621422 DOI: 10.1080/15563650.2019.1676898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Poisoning in pregnancy can cause maternal and neonatal morbidity and mortality, but few data detail such events. Herein, we describe poisoning exposures in pregnant women identified by a large Canadian Poison Centre.Methods: This retrospective study evaluated poisoning exposures in pregnant women aged 12-60 years, reported to the Ontario Poison Centre from 2010 to 2017. Exposures were identified from the Poison Centre database by calls received, in which the patient was also reported to be pregnant. We collected patient demographics (age, trimester, and location), as well as information about the poisoning exposure (number and type of substances, route of exposure, reason for exposure, decontamination, and treatment recommendations).Results: There were 1716 cases of poisoning exposures during pregnancy over the eight-year study period, representing 0.28% of all 619,539 calls over the period. Median maternal age was 29 years (IQR 25-33), and exposures were most frequent in the second trimester of pregnancy (41%). Unintentional exposures (n = 1397) accounted for 81% of all calls. Of the 18% of calls (n = 305) for intentional exposures, 71% (n = 219) were suspected attempted suicides. Intentional exposures were more frequent in the first (OR 2.64, 95% CI 1.85-3.76) and second trimesters (OR 1.61, 95% CI 1.13-2.28), relative to third trimester. The associated risk of intentional exposures was more likely in women aged ≤19 years (OR 21.41, 95% CI 12.75-35.94) and 20-29 years (OR 3.72, 95% CI 2.70-5.14), relative to women ≥30 years old.Conclusions: Intentional poisoning exposures in pregnancy most commonly involve young women in the first two trimesters. Population-based studies are needed to further examine risk factors for overdose, poisoning, and self-harm in pregnancy, as well as perinatal outcomes.
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Affiliation(s)
- Jonathan S Zipursky
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Clinical Pharmacology and Toxicology, Sunnybrook Health Sciences Centre, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Hannah Yaphe
- Ontario Poison Centre, Hospital for Sick Children, Toronto, Canada
| | - Heather Hudson
- Ontario Poison Centre, Hospital for Sick Children, Toronto, Canada
| | - Albert Wong
- Ontario Poison Centre, Hospital for Sick Children, Toronto, Canada
| | - Margaret Thompson
- Ontario Poison Centre, Hospital for Sick Children, Toronto, Canada.,Division of Emergency Medicine, St. Michael's Hospital, Toronto, Canada
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Ozturk Z, Ugras K. Pregnancy outcomes after suicide attempts by self-poisoning and drug overdose: experience of a clinical pharmacology consultation service in Izmir, Turkey. J OBSTET GYNAECOL 2018. [PMID: 29537318 DOI: 10.1080/01443615.2017.1419463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Zeynep Ozturk
- a Department of Clinical Pharmacology and Toxicology , Izmir Ataturk Research Hospital , Izmir , Turkey
| | - Kadriye Ugras
- b Turkish Ministry of Health , Doganlar Family Health Center , Izmir , Turkey
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Eyasu M, Dida T, Worku Y, Worku S, Shafie M. Acute poisonings during pregnancy and in other non-pregnant women in emergency departments of four government hospitals, Addis Ababa, Ethiopia: 2010-2015. Trop Med Int Health 2017; 22:1350-1360. [PMID: 28901626 DOI: 10.1111/tmi.12940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To characterise acute poisonings in pregnant and non-pregnant women treated at emergency departments of government hospitals in Addis Ababa, Ethiopia, between 2010 and 2015. METHODS All data for acutely poisoned women were retrospectively collected from patient medical charts at the emergency departments of Saint Paul's Hospital Millennium Medical College, Ras Desta Memorial Hospital, Yekatit 12 Hospital Medical College and Zewditu Memorial Hospital. Data were collected by extraction questionnaire and analysed using SPSSv. 20 statistical software. RESULTS During the study period, 998 cases of acutely poisoned women were listed in the hospital registries. Of these, complete data for inclusion in the study were available for 592. 36.3% of the study participants were in the age group of 20-24, with a mean (±SD) age of 23.03 (±6.3) years. 80.9% were from Addis Ababa; 4.6% were pregnant. The mean arrival time of all cases was 4.14 h. 85.5% of all study cases were due to intentional self-poisoning, of whom 42.1% were discharged without complications. The most common poisons were bleach and organophosphates; 25.9% of pregnant cases and 32.6% of non-pregnant cases were poisoned by bleach; and 18.5% of pregnant cases and 18.9% of non-pregnant cases had organophosphate poisoning. 0.7% had a history of poisoning; all were non-pregnant women. The common route of poison exposure was oral, and the case fatality rate of organophosphate poisoning in pregnant and non-pregnant women was 20 and 1.87%, respectively. The pre-hospital intervention for the majority of the women was milk, in 12.0% of cases. CONCLUSION Acute poisoning remains a public health problem in our community. Bleach is the most common poisons. Our present findings indicate the necessity of educational programmes on preventable reasons of acute poisonings and their outcomes on pregnant and non-pregnant women.
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Affiliation(s)
- Mebrahtu Eyasu
- Department of Pharmacology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tolesa Dida
- Department of Nursing, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Yoseph Worku
- Department of Public Health, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Solomon Worku
- Center for International Reproductive Health Training, University of Michigan, Addis Ababa, Ethiopia
| | - Mensur Shafie
- Department of Pharmacology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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