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McCall SJ, Bonnet MP, Äyräs O, Vandenberghe G, Gissler M, Zhang WH, Van Leeuw V, Deneux-Tharaux C, Kurinczuk JJ, Knight M. Anaphylaxis in pregnancy: a population-based multinational European study. Anaesthesia 2020; 75:1469-1475. [PMID: 32463487 DOI: 10.1111/anae.15069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2020] [Indexed: 02/06/2023]
Abstract
Anaphylaxis in pregnancy is a rare but severe complication for both mother and infant. Population-based data on anaphylaxis in pregnancy are lacking from mainland European countries. This multinational study presents the incidence, causative agents, management and maternal and infant outcomes of anaphylaxis in pregnancy. This descriptive multinational study used a combination of retrospective (Finnish medical registries) and prospective population-based studies (UK, France, Belgium and the Netherlands) to identify cases of anaphylaxis. Sixty-five cases were identified among 4,446,120 maternities (1.5 per 100,000 maternities; 95%CI 1.1-1.9). The incidence did not vary between countries. Approximately three-quarters of reactions occurred at the time of delivery. The most common causes were antibiotics in 27 women (43%), and anaesthetic agents in 11 women (17%; including neuromuscular blocking drugs, 7), which varied between countries. Anaphylaxis had very poor outcomes for one in seven mothers and one in seven babies; the maternal case fatality rate was 3.2% (95%CI 0.4-11.0) and the neonatal encephalopathy rate was 14.3% (95%CI 4.8-30.3). Across Europe, anaphylaxis related to pregnancy is rare despite having a multitude of causative agents and different antibiotic prophylaxis protocols.
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Affiliation(s)
- S J McCall
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK.,Center for Research on Population and Health, American University of Beirut, Lebanon
| | - M-P Bonnet
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team EPOPé, INSERM U1153, Paris, France.,Department of Anesthesiology and Critical Care, Hôpital Armand Trousseau, Assistance Publique des Hôpitaux de Paris, France.,Société Française d'Anesthésie et de Réanimation Research Network, Paris, France
| | - O Äyräs
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
| | - G Vandenberghe
- Department of Obstetrics, Ghent University Hospital, Ghent, Belgium
| | - M Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - W-H Zhang
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Research Laboratory for Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
| | - V Van Leeuw
- Perinatal Epidemiology Center (CEpiP), Brussels, Belgium
| | - C Deneux-Tharaux
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team EPOPé, INSERM U1153, Paris, France
| | - J J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - M Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
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