April 5th, 2020

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Use of Botulinum Toxin Type A in the Reproductive-Aged Female: A Case Report
Authors:  Alyssa M. Larish, M.D., and Charles C. Coddington, M.D.
BACKGROUND: Botulinum toxin works by preventing synaptic level neuromuscular transmission, and thus muscle contraction. With an increasing number of FDA-approved indications, gestational exposure may become more common. Evidence is limited to animal studies, case reports, and industry-sponsored databases. We present a case outlining the management of a patient using botulinum toxin prepregnancy and suggest management after assessing the available evidence.

CASE: A 34-year-old woman with a history of diminished ovarian reserve was seen in clinic prior to her third frozen embryo transfer. She was contemplating botulinum toxin injection for the treatment of a refractory anal fissure 1 week prior to her scheduled frozen embryo transfer. Colorectal Surgery sought our recommendation on the safety of botulinum toxin in pregnancy and the periconceptual time period.

CONCLUSION: Limited data in humans do not suggest detrimental effects at or below FDA-approved doses. Consideration could be given to administering the lowest effective dose as far from the critical time periods of preconception and organogenesis as possible. However, additional prospective data on exposed gestations are needed before any final conclusions can be made. In our patient we affirm that the decision to defer injection immediately prior to frozen embryo transfer was in her best interest.
Keywords:  botox, botulinum A toxin, botulinum neurotoxin A, botulinum toxin, botulinum toxin type A, clostridium botulinum A toxin, clostridium botulinum toxin type A, maternal exposure, pregnancy, reproduction, safety
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