Botulism in pregnancy: A clinical review

Abstract

Botulism is a rare but potentially life-threatening neuroparalytic condition caused by Clostridium botulinum toxin, which has significant maternal and fetal health consequences during pregnancy, necessitating a careful review of existing literature. We conducted a comprehensive literature review, searching databases such as PubMed, Scopus, and Embase for studies published through June 2025. This search was supplemented by hand-searching and the translation of foreign articles. We included studies describing clinical cases of botulism in pregnant patients or reporting on botulinum antitoxin safety. After applying strict criteria, we identified 20 cases from 17 distinct articles. Our analysis shows that although botulinum antitoxin remains the only available antidote for botulism, information on its safety, efficacy, and impact on both mother and fetus during pregnancy is limited. Review findings suggest that early administration of antitoxin is associated with positive maternal outcomes, and there is no evidence that the toxin or antitoxin crosses the placental barrier. However, data on fetal and neonatal effects remain sparse. Current evidence supports prompt antitoxin treatment for pregnant individuals with botulism, but further research is needed to understand the full implications, optimize management, and clarify remaining uncertainties regarding maternal and fetal safety.