USE OF INSECT REPELLENTS IN PREGNANCY

Insect repellents are applied to the skin and clothing to deter biting insects, such as mosquitos and ticks. They are important in the prevention of mosquito-borne infections, such as malaria, Zika virus, dengue fever and yellow fever, and tick-borne infections including Lyme disease and tick-borne encephalitis.

Pregnant women should be advised against travel to areas where there is a risk of mosquito-borne infection and should be aware that transmission of Lyme disease and other tick-borne illnesses vary locally and globally.

When exposure to environments where insect bites may lead to serious illness is unavoidable, non-pharmacological preventative measures are important. These include staying indoors at the times of day when mosquitos are most active, using bed nets impregnated with insecticide, and minimising skin exposure when outdoors by wearing long sleeves and trousers (including tucking trousers into socks where there is a risk of mosquito/tick exposure). Insect repellent should be applied to clothing and exposed skin according to the manufacturer’s instructions and washed off once returning indoors. Ticks should be removed from the skin intact as soon as possible to reduce the risk of transmission of tick-borne disease.

The use of diethyl-m-toluamide (DEET) 50% is recommended first-line for all pregnant women, at any stage of pregnancy, travelling to a malarial area. The available data on the use of DEET in human pregnancy do not raise concern of adverse effects but are too limited to formally rule these out. However, the benefits of using DEET to prevent malaria and other insect-borne disease are likely to outweigh any risk of harm.

If DEET is not tolerated, an icaridin (20%), or hydrated, cyclized eucalyptus citriodora oil, or 3-ethlyaminopropionate (also called IR3535)-containing repellent can be considered as possible alternatives. There are no data relating to exposure to these agents in human pregnancy; however, animal studies have not demonstrated any features of developmental toxicity.

Exposure to insect repellents, according to the manufacturer’s instructions, at any stage of pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

Note: Where travel to a malarial area during pregnancy is unavoidable, additional prophylaxis will be necessary. Please consult the Malaria Prophylaxis monograph or contact UKTIS on 0344 892 0909 for more information.