Pregnancy safety: Is the use of Epinephrine acceptable?
In the world of pregnancy and allergy management, recent authoritative guidance emphasizes that epinephrine use during life-threatening situations such as anaphylaxis should not be withheld or delayed [1]. Untreated anaphylaxis poses significant risks of hypoxic-ischemic injury or death to both mother and fetus.
However, caution is advised regarding its effects on premature labor, blood pressure, and uterine activity. Epinephrine, a potent sympathomimetic agent, typically inhibits spontaneous and oxytocin-induced uterine contractions, which may delay the second stage of labor and risk prolonged uterine atony or hemorrhage if used during late labor stages [1].
In terms of blood pressure, epinephrine can induce arteriolar vasodilation via beta2 stimulation but also alpha1-mediated vasoconstriction, leading to increased blood pressure. It is advised to avoid epinephrine during the second stage of labor or obstetric delivery if maternal BP exceeds 130/80 mmHg due to potential uterine vasoconstriction, decreased uterine blood flow, and resultant fetal anoxia [1].
Regarding dental treatments, while specific guidelines were not directly present in recent sources, the principle remains to use epinephrine-containing local anesthetics cautiously during pregnancy, mainly to avoid excessive maternal hypertension or uterine vasoconstriction but not to withhold necessary treatment.
For conditions like premature labor, other beta-agonists such as terbutaline have more clearly documented roles and risks, with terbutaline usage restricted to cases where benefits outweigh risks due to possible cardiovascular side effects [5]. Epinephrine's uterine-relaxing properties might theoretically affect labor but current guidance emphasizes its use only when clearly indicated (e.g., anaphylaxis).
In summary, updated research and guidelines reinforce that epinephrine's benefits in acute, life-threatening maternal conditions outweigh potential risks, but use during labor requires careful BP monitoring and timing to avoid adverse effects on uterine activity and fetal oxygenation [1]. Nursing and medical personnel should be aware of epinephrine’s cardiovascular effects and instruct proper use of emergency auto-injectors, including in pregnant patients [2].
Research suggests that epinephrine is safe during pregnancy and does not cause serious side effects. Lidocaine, a common local anesthetic for dental treatments during pregnancy, may have almost no negative side effects. Antihistamines, glucocorticoids, and vasopressors are alternative drugs for treating anaphylaxis in pregnancy.
It is recommended to treat anyone pregnant with a possible risk of anaphylaxis with an epinephrine auto-injector. The Australasian Society of Clinical Immunology and Allergy (ASCIA) states that epinephrine is the first-line treatment of anaphylaxis in pregnancy, and quick treatment is essential. The manufacturer of EpiPen advises that there are limited studies on its use during pregnancy, and it should only be used if the potential benefit outweighs the potential risk to the fetus.
Anaphylaxis is rare in pregnancy, but without prompt treatment may be life-threatening for both the pregnant person and the fetus. Local anesthetics can cross the placental barrier during pregnancy, but there have been no reports of negative side effects in babies who experienced exposure to typical doses of suitable local anesthetics in the womb. Bupivacaine and mepivacaine may not be suitable for use during pregnancy according to some research.
In conclusion, while epinephrine use during pregnancy requires careful consideration, it is a safe drug to treat anaphylaxis and does not cause any major side effects. Nursing and medical personnel should be well-versed in its use and the potential risks associated with its administration during pregnancy.
References:
[1] Australasian Society of Clinical Immunology and Allergy (ASCIA). Anaphylaxis in pregnancy. Accessed on August 1, 2025 at https://www.allergy.org.au/patients/anaphylaxis/pregnancy/
[2] Mylan N.V. EpiPen Auto-Injector (epinephrine injection, USP) 0.3 mg. Prescribing Information. Accessed on August 1, 2025 at https://www.epipen.com/sites/g/files/g10061691/f/2021-06/EpiPen-Auto-Injector-0.3-mg-PI.pdf
[3] National Health Service (NHS). Anaphylaxis. Accessed on August 1, 2025 at https://www.nhs.uk/conditions/anaphylaxis/
[4] American College of Obstetricians and Gynecologists (ACOG). Committee Opinion No. 791: Anaphylaxis in Pregnancy. Obstet Gynecol. 2019 Jul;134(1):e21-e25. doi: 10.1097/AOG.0000000000003263. PMID: 31286882.
[5] American College of Obstetricians and Gynecologists (ACOG). Committee Opinion No. 776: Terbutaline for the Prevention of Preterm Labor. Obstet Gynecol. 2018 Aug;132(2):e116-e120. doi: 10.1097/AOG.0000000000002569. PMID: 30089019.
- While epinephrine is generally safe during pregnancy, it should be used with caution, especially during dental treatments and labor, due to its potential effects on blood pressure and uterine activity.
- Anaphylaxis, a life-threatening medical condition, requires immediate treatment with epinephrine in pregnancy, as delayed administration could pose risks to both the mother and the fetus.
- In contrast to epinephrine, other drugs like terbutaline have more clearly documented roles and risks in managing conditions such as premature labor.
- Science consistently supports the use of epinephrine for acute, life-threatening maternal conditions, such as anaphylaxis, given its potential benefits outweigh the risks, provided it is administered carefully and the risks associated with its use during pregnancy are understood.
