Aluminium Phosphide Poisoning in Pregnancy: A Systematic Review of Maternal and Fetal Outcomes without Meta-Analysis (SWiM Approach).

Abstract

Background: Aluminium phosphide (ALP) is a widely used agricultural fumigant and a leading agent of suicidal self-poisoning across South Asia, including India. Poisoning during pregnancy poses a dual clinical and medicolegal challenge, since maternal resuscitation must be balanced against fetal viability, and no validated management protocol exists for the gravid patient. This review synthesises the available evidence on maternal and fetal outcomes following ALP poisoning in pregnancy. Objective: To systematically identify, appraise, and narratively synthesise published case reports, case series, and observational data on ALP poisoning during pregnancy, describing maternal survival, fetal/neonatal outcome, and management approaches, using the Synthesis Without Meta-analysis (SWiM) framework. Methods: PubMed, Scopus, Embase, and Google Scholar were searched for reports of ALP poisoning in pregnant patients, supplemented by hand-searching of forensic and obstetric toxicology literature. Data were extracted on gestational age, dose/route, management, maternal outcome, and fetal/neonatal outcome. Given the exclusively case-report/case-series nature of the evidence base, findings were synthesised narratively by outcome domain (vote-counting by direction of effect), in accordance with SWiM reporting guidance, without pooled meta-analysis. Results: Fifteen studies met inclusion criteria. Maternal case-fatality remained high overall, though survival was consistently associated with early decontamination and aggressive intensive care. Fetal and neonatal outcomes were poor in the majority of reports, including intrauterine death and preterm delivery, even in mothers who survived. No uniform obstetric management protocol emerged across the included reports. Conclusion: Evidence on ALP poisoning in pregnancy remains confined to low-certainty case-level data. Early recognition, rapid decontamination, multidisciplinary obstetric–toxicology–critical care management, and forensic documentation are central to outcome, pending larger prospective data.