Anaphylaxis in pregnancy: a population-based multinational European study

S.J. McCall* (Corresponding Author), M.-P. Bonnet, O. Äyräs, G. Vandenberghe, M. Gissler, W.-H. Zhang, V. Van Leeuw, C. Deneux-Tharaux, Jennifer J Kurinczuk, Marian Knight

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)
17 Downloads (Pure)


Anaphylaxis in pregnancy is a rare but severe complication for both mother and infant. Population-based data on anaphylaxis in pregnancy are lacking from mainland European countries. This multinational study presents the incidence, causative agents, management and maternal and infant outcomes of anaphylaxis in pregnancy. This descriptive multinational study used a combination of retrospective (Finnish medical registries) and prospective population-based studies (UK, France, Belgium and the Netherlands) to identify cases of anaphylaxis. Sixty-five cases were identified among 4,446,120 maternities (1.5 per 100,000 maternities; 95%CI 1.1–1.9). The incidence did not vary between countries. Approximately three-quarters of reactions occurred at the time of delivery. The most common causes were antibiotics in 27 women (43%), and anaesthetic agents in 11 women (17%; including neuromuscular blocking drugs, 7), which varied between countries. Anaphylaxis had very poor outcomes for one in seven mothers and one in seven babies; the maternal case fatality rate was 3.2% (95%CI 0.4–11.0) and the neonatal encephalopathy rate was 14.3% (95%CI 4.8–30.3). Across Europe, anaphylaxis related to pregnancy is rare despite having a multitude of causative agents and different antibiotic prophylaxis protocols.

Original languageEnglish
Pages (from-to)1469-1475
Number of pages7
Issue number11
Early online date28 May 2020
Publication statusPublished - Nov 2020

Bibliographical note

Funding Information:
M‐P B, OA, and GV had equal contributions to this study. We thank T. Schapp, J. Zwart and E. Overtoom in the NethOSS team; C. Daoui from the French SFAR Research Network; the B.OSS team and Belgian maternity units involved in this study. The work was funded by the Medical Research Council (MRC) and the Nuffield Department of Population Health. The views expressed in this publication are those of the authors and not necessarily those of the MRC. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the article. Permission for the use and sharing of registry and medical records was obtained from the National Institute for Health and Welfare (THL), Finland. Approval was acquired from the B.OSS and NethOSS steering committee for the data collection and sharing of anonymous data for this anaphylaxis study. The French Data Protection Authority approved the collection of the data (CNIL 1985389). All the women in France were informed of anonymised data collection during the study. B.oSS gained approval for data collection from the Ghent University Ethics Committee as central EC (2015/1470, amendment 23/06/2016, B670201526875), and gained informed consent of all women included in the study. The Central University Research Ethics Committee, University of Oxford gave approval to complete this prospective observational study (Reference R46400/RE001). Data sharing statement: Data cannot be shared publicly due to confidentiality issues arising from small numbers of cases in mainland European countries. Requests for access to the UK dataset will be considered by the National Perinatal Epidemiology Unit Data Sharing committee. Access to the data can be requested from . No other external funding or competing interests declared.

Publisher Copyright:
© 2020 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists

Copyright 2020 Elsevier B.V., All rights reserved.


  • anaphylaxis causative agents
  • anaphylaxis in pregnancy
  • anaphylaxis management
  • maternal morbidity
  • neonatal encephalopathy
  • neuromuscular blocking drugs


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