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.
Highlights
Anaphylaxis is a severe immune hypersensitivity disorder that is rapid in onset and occurs without premonitory signs
The majority of the literature on anaphylaxis in pregnancy consists of case series and case reports, with limited high quality studies [1, 2]
As anaphylaxis in pregnancy is very rare, national studies from small populations may not accrue sufficient cases unless they are conducted for long periods; on the other hand, multinational studies are able to provide larger numbers that enable more precise estimates of incidence [5]
Summary
Anaphylaxis is a severe immune hypersensitivity disorder that is rapid in onset and occurs without premonitory signs. The majority of the literature on anaphylaxis in pregnancy consists of case series and case reports, with limited high quality studies [1, 2]. There are no population-based studies examining anaphylaxis in pregnancy in continental European countries. As anaphylaxis in pregnancy is very rare, national studies from small populations may not accrue sufficient cases unless they are conducted for long periods; on the other hand, multinational studies are able to provide larger numbers that enable more precise estimates of incidence [5]. This study aimed to estimate the incidence, causative agents, management and outcomes of anaphylaxis in pregnancy across Europe using both prospective and retrospective data collection methods
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