COMMENTARY

Anthrax in Pregnancy: Protecting Mother and Baby

Dana M. Meaney Delman, MD, MPH

Disclosures

May 27, 2014

Editorial Collaboration

Medscape &

In This Article

Prevention and Treatment

Pregnant, postpartum, and lactating women generally should receive the same postexposure prophylaxis (PEP) and treatment regimen as nonpregnant adults.

Prevention. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B anthracis spores, pregnant, postpartum, and lactating women should receive PEP in the form of a 60-day course of oral antimicrobials and 3 doses of anthrax vaccine adsorbed (AVA) at 0, 2, and 4 weeks post-exposure. Pregnant women should receive both vaccine and antimicrobials regardless of trimester.

Exposed pregnant, postpartum, and lactating women should receive a full 60-day course of antimicrobials -- whether they are unvaccinated, partially vaccinated, or fully vaccinated.

Ciprofloxacin is a first-line drug for PEP in pregnant women and is preferred over doxycycline and other fluoroquinolones. Amoxicillin is acceptable if the B anthracis strain is determined to be penicillin-sensitive according to the same criteria as in nonpregnant adults.

Antimicrobial prophylactic dosing should remain the same for pregnant, postpartum, and lactating women as for nonpregnant adults.

Treatment. Pregnant, postpartum, and lactating women requiring treatment for anthrax should receive combination antimicrobial therapy. The criteria for the use of antitoxins should be the same as for nonpregnant adults:

Because of concerns for transplacental transmission of anthrax, at least one antimicrobial agent used to treat pregnant women should cross the placenta. The most data are available for ciprofloxacin, levofloxacin, amoxicillin, and penicillin.

Antitoxin dosing for infected pregnant, postpartum, and lactating women is the same as for nonpregnant adults. Antitoxin options include raxibacumab (pregnancy category B) and anthrax immune globulin (AIG), an investigational product.

Diagnosis. A diagnosis of anthrax during pregnancy may be difficult, particularly because abnormal laboratory values and clinical findings can mimic those of common obstetrical conditions such as preeclampsia, HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, fatty liver of pregnancy, and thrombotic thrombocytopenia purpura. Similar to other infectious processes, such complications as preterm labor, fetal distress, or fetal loss may be initial clinical indicators of infection or signs of worsening status. Suggested radiologic testing for inhalation anthrax includes chest radiography and chest CT. Given the limitations of interpreting chest radiographs in pregnant women in later stages of pregnancy, thoracic ultrasound may also be useful.

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