Table 1.

Health outcomes of gestational acute OP poisoning

OP Compound	# of Cases	Time of Exposure	Treatments	Outcomes	References
Chlorpyrifos	1	Not reported	Atropine, 2-PAM	Fetal died before treatment initiation; mother survived	Indu et al., 2016
Chlorpyrifos	1	GW 19	Atropine, 2-PAM	Fetus died 2 h post-exposure, before treatment initiation; mother survived	Sebe et al., 2005
Chlorpyrifos	1	GW 29	Atropine	Maternal and fetal death	Solomon and Moodley, 2007
Diazinon	1	GW 21	None reported	Mother and infant survived. In follow-up that lasted 3 years, child presented seizures and severe cognitive deficits	Dahlgren et al., 2004
Diazinon	1	50 h before delivery	Atropine, 2-PAM	Mother died; infant born with clinical signs of OP poisoning, including bradycardia, continued to be treated with atropine and discharged 12 days later	Jajoo et al., 2010
Diazinon	1	GW 26	Atropine, 2-PAM	Mother recovered in 7 days; infant born 12 weeks later	Kamha et al., 2005
Diazinon	1	Close to term	Atropine	Spontaneous labor 28 h after admission; 2.6-kg male infant with normal heart rate, mydriasis and no reaction to light; recovery in 3 days	Shah et al., 1995
Dichlorvos	2	GW 39 GW 22	Atropine, penehyclidine, 2-PAM Penehyclidine, 2-PAM	Stillborn child (3.2 kg) 28 h post-admission; mother survived Live premature infant (320 g) 12 h post-admission, died 1 h post-delivery; mother survived	Sun et al., 2015
Fenthion	1	GW 16	Atropine	Mother recovered; normal delivery	Karalliedde et al., 1988
Methamidophos	1	GW 36	Atropine	Mother recovered; normal delivery	Karalliedde et al., 1988
Oxydemeton-methyl	1	GW 4	Atropine	Infant died at 14 days of age with malformations; mother recovered	Romero et al., 1989
Sarin	110	Various	Not reported	Increased miscarriages (45% in exposed vs. 14% in non-exposed), stillbirths (2.7% in exposed vs. 1.2% in the general population), birth defects (6.4% in exposed vs. 3.0% in general population) some leading to perinatal deaths	Hakeem and Jabri, 2015
UnknownA	21	GW 8 to 36	Atropine	2 mothers and their fetuses died 1 spontaneous abortion 3 patients not followed up 15 patients recovered (2 premature deliveries; 1 mild pre-eclampsia; 2 mild anemia)	Adhikari et al., 2011
UnknownA,B	7	GW 14 to term	Atropine (1) 2-PAM (1) Atropine, 2-PAM (1) No pharmacotreatment (4)	Intrauterine fetal death Perinatal death Vaginal delivery Intrauterine fetal death (2); full-term (1) and premature (1) deliveries	Barhoumi et al., 2016
UnknownC	1	GW 34-35	Atropine	A preterm child (1860 g) was delivered by C-section 11 h after admission of the mother. Infant was resuscitated and admitted to the intensity care unit. Mother and infant survived and were discharged after 1-month hospitalization	Weis et al., 1983

GW: Gestational weeks. Chlorpyrifos, diazinon, dichlorvos, fenthion, methamidophos, and oxydemeton-methyl are OP insecticides. Sarin is an OP nerve agent.

^AOP intoxication was confirmed based on: (i) available information of maternal ingestion of an OP insecticide (note, however, that the identity of the OP compound is not provided in these reports), and (ii) typical clinical signs of a cholinergic crisis, including salivation, lacrimation, vomiting, diarrhea, miosis, tachycardia or bradycardia, and/or respiratory failure, presented by the pregnant women.

^BInhibition of maternal plasma cholinesterase activity correlated with the severity of intoxication.

^COP intoxication was diagnosed based on clinical signs and near full inhibition (that lasted for weeks) of cholinesterase activities in serum and erythrocytes of both mother and infant. Maternal and fetal heart rates at the time of admission were 78 and 140 beats per minute, respectively. While the maternal heart rate was slightly below the normal range of 80 to 90 beats per minute for pregnant women, the fetal heart rate was within the range of 120 to 160 beats per minute considered to be normal (Pildner von Steinburg et al., 2013). Maternal tachycardia has been reported in other cases of gestational OP intoxication (Jajoo et al., 2010; Sun et al., 2015).