Epinephrine

 Risk Factor: C
 Class: AUTONOMICS / Sympathomimetics (Adrenergics)

Contents of this page:

Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers

Fetal Risk Summary

Epinephrine is a sympathomimetic that is widely used for conditions such as shock, glaucoma, allergic reactions, bronchial asthma, and nasal congestion. Because it occurs naturally in all humans, it is difficult to separate the effects of its administration from effects on the fetus induced by endogenous epinephrine, other drugs, disease states, and viruses.

The drug readily crosses the placenta (1). Epinephrine is teratogenic in some animal species, but human teratogenicity has not been suspected (2,3). The Collaborative Perinatal Project monitored 50,282 mother-child pairs, 189 of whom had 1st trimester exposure to epinephrine (4, pp. 34556). For use anytime during pregnancy, 508 exposures were recorded (4, p. 439). A statistically significant association was found between 1st trimester use of epinephrine and major and minor malformations. An association was also found with inguinal hernia after both 1st trimester and anytime use (4, pp. 477, 492). Although not specified, these data may reflect the potentially severe maternal status for which epinephrine administration is indicated.

In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 35 newborns had been exposed to epinephrine (route not specified) during the 1st trimester (F. Rosa, personal communication, FDA, 1993). No major birth defects were observed (1.5 expected).

Theoretically, epinephrine's a-adrenergic properties might lead to a decreased in uterine blood flow. A large intravenous dose of epinephrine, 1.5 mL of a 1:1000 solution during a 1-hour period to reverse severe hypotension secondary to an allergic reaction, may have contributed to intrauterine anoxic insult to a 28-week-old fetus (5). Decreased fetal movements occurred after treatment and the infant, delivered at 34 weeks' gestation, had evidence of intracranial hemorrhage at birth and died 4 days later. Thus, in situations such as maternal hypotension where a pressor agent is required, use of ephedrine may be a better choice.

Breast Feeding Summary

No data are available.

References

1. Morgan CD, Sandler M, Panigel M. Placental transfer of catecholamines in vitro and in vivo. Am J Obstet Gynecol 1972;112:106875.
2. Nishimura H, Tanimura T. Clinical Aspects of The Teratogenicity of Drugs. New York, NY:American Elsevier, 1976:231.
3. Shepard TH. Catalog of Teratogenic Agents. 3rd ed. Baltimore, MD:Johns Hopkins University Press, 1980:1345.
4. Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton, MA:Publishing Sciences Group, 1977.
5. Entman SS, Moise KJ. Anaphylaxis in pregnancy. S Med J 1984;77:402.