EXPOSURE TO BREVETOXIN IN PREGNANCY

Brevetoxins are cyclic polyether neurotoxic compounds produced by marine organisms such as the dinoflagellate Karenia brevis that bioaccumulate in filter feeding molluscs. Brevetoxins bind to the sodium channels in nerve cells leading to disruption of neurological processes resulting in neurotoxic shellfish poisoning. Aerosolisaton of brevetoxin is also possible during algal blooms.

There are no data regarding brevetoxin exposure in human pregnancy. Animal studies have demonstrated placental transfer of the toxin in pregnant rats, and direct fish embryo culture with the toxin produced CNS, spinal and skull malformations. However, these data may not be relevant to human exposure scenarios.

Owing to the potential severity of brevetoxin exposure, treatment during pregnancy should be the same as for the non-pregnant patient. Due to a lack of human exposure data, it is not possible to state that maternal exposure which does not result in toxicity would not pose a risk to the developing fetus. However, maternal toxicity is likely to be a major determinant of risk to the fetus after maternal brevetoxin exposure.

Due to a lack of data following exposure in human pregnancy, it is not currently possible to offer an evidence-based assessment of the risk that maternal brevetoxin exposure poses to a developing fetus. Where exposure to brevetoxin has occurred, even in cases which did not result in maternal toxicity, enhanced fetal monitoring may be warranted. Discussion with UKTIS is recommended in all cases.