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The Safety of Epinephrine in Pregnancy : Debunking Myths and Understanding the Facts

Epinephrine is a drug that has several effects on the body, including increasing blood pressure and widening airways. It is used as a local anesthetic and to treat severe allergic reactions.

Is it Safe to Use Epinephrine During Pregnancy?

Epinephrine is a safe drug and can be used during pregnancy. It is known to have no side effects on the health of the mother and fetus. Still, it is important to use it under the guidance of a healthcare professional who can weigh the benefits and risks of its usage.

The Safety of Epinephrine in Pregnancy : Debunking Myths and  Facts

A case study done in 2017 reported that epinephrine is a safe drug to be used during pregnancy without major side effects.(1) However, an article published in 2019 reported a theoretical risk of epinephrine causing uterine spasms during pregnancy leading to premature labor.(2) At present, there is no evidence to support this.

It is important that healthcare professionals use epinephrine with caution if the female’s blood pressure is 130/80 mmHg or higher.(3) Epinephrine may delay labor by affecting the action of oxytocin. A review and meta-analysis also indicated that epinephrine may prolong the effects of local anesthesia.(4)

Epinephrine for Dental Treatment During Pregnancy

According to the American Dental Association, it’s safe to use epinephrine as an anesthetic for dental treatment during pregnancy.(5) Research shows that bupivacaine and mepivacaine should not be used during pregnancy.(6) Delaying dental treatment is not recommended even during pregnancy. A person can avoid it in the first trimester if not an emergency.

Anaphylaxis and Pregnancy

There is a theoretical risk reported on the usage of epinephrine during pregnancy causing premature delivery.

Untreated anaphylaxis can also be dangerous for the pregnant female and the fetus. It may lead to low blood pressure and low level of oxygen in the blood, thereby lowering the levels of oxygen reaching the fetus and increasing the risk of severe fetal brain damage. This can also increase the risk of cesarean delivery with anaphylaxis.

A 2017 case report suggested epinephrine to be a safe drug for anaphylaxis during pregnancy as it does not cause any major side effects.(1) It recommended treatment with an epinephrine autoinjector for anyone pregnant with a possible risk of anaphylaxis.

Other drugs suitable for treatment for anaphylaxis during pregnancy are:

  • Antihistamines
  • Glucocorticoids
  • Vasopressors

As there are no specific guidelines on managing anaphylaxis during pregnancy, therefore it is managed in the same way it is done in those not pregnant.(7)

Can Epinephrine Cause Pregnancy Loss?

No evidence suggests the role of epinephrine in causing pregnancy loss.

A 2019 article suggests the theoretical risk of preterm labor on using epinephrine during pregnancy, but there is no evidence supporting it. Research suggests epinephrine is safe to be used during pregnancy as it does not cause any serious side effects.(1)

Anaphylaxis is rare during pregnancy, but without prompt treatment, it can prove to be life-threatening for the pregnant female and the fetus. Epinephrine can be used in pregnancy but under the guidance of a healthcare professional. Some studies reported its usage with preterm labor, but more research is needed to prove this. A healthcare professional may also recommend additional medications or treatments that may be suitable to be used during pregnancy.

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:February 3, 2023

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