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EXPOSURE TO TETRODOTOXIN IN PREGNANCY

Date of issue: October 2023, Version: 1.4

Tetrodotoxin is a potent neurotoxin produced by symbiotic bacteria (typically Vibrio alginolyticus) found in certain species of fish belonging to the order Tetraodontiformes (e.g. puffer fish) and less commonly in other animals including the blue-ringed octopus and rough-skinned newt.

Tetrodotoxin binds to voltage-gated, fast sodium channels in neuronal membranes, thereby blocking the action potential in the nerve cell thus preventing signal transmission and leading to paralysis that can be fatal if respiratory muscles are affected.

Owing to the potential severity of tetrodotoxin exposure, treatment of the pregnant patient should be the same as for the non-pregnant patient. Maternal toxicity leading to subsequent fetal anoxia is likely to be a major determinant of risk to the fetus after maternal tetrodotoxin 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 maternal tetrodotoxin exposure poses to a developing fetus. Where exposure to tetrodotoxin has occurred, even in cases which did not result in maternal toxicity, enhanced fetal monitoring may be warranted. Discussion with UKTIS is recommended.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to NHS health care professionals who are logged in.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from UKTIS.org to ensure you are using the most up-to-date version.