Carbon monoxide (CO), poses a serious threat to expectant mothers and their unborn babies. It's a colourless, odourless, tasteless gas which is a leading cause of accidental poisoning worldwide.

Understanding the Impact

CO is a by-product of incomplete combustion of carbon-based fuels due to insufficient oxygen. According to the Cross Government Group on Gas Safety and Carbon Monoxide (Annual Report 2020-21), approximately 20 deaths occur each year due to CO exposure, likely an underestimate due to diagnostic difficulties.

Moreover, many individuals, especially vulnerable groups like pregnant women may be unknowingly exposed to lower levels of CO, negatively impacting their health.

A recent project funded by the CO Research Trust, "Identifying and Protecting Women from CO Exposure," highlighted a significant public health concern regarding the lack of awareness of CO exposure's risks to unborn children. It reported a lack of guidance and information for health professionals and emphasised the lack of data concerning the scale of the problem.

Challenges in Detection and Management

The foetus in utero is extremely vulnerable to CO exposure. Chronic exposure can cause disproportionate harm to the foetus, placing them at greater risk than the mother due to foetal blood's higher CO uptake.

Studies indicate severe maternal exposure to CO can lead to adverse outcomes such as foetal death, developmental issues, and neurological problems, even at low exposure levels.

Despite these risks, pregnant women and midwives often lack awareness and resources to identify CO poisoning. Symptoms of CO poisoning, like headache and fatigue, can mimic pregnancy signs, complicating diagnosis. Furthermore, difficulties in diagnosing CO poisoning persist, as levels may drop by the time of antenatal appointments, making detection challenging.

Recent research highlights challenges in CO exposure diagnosis and treatment. While high-flow oxygen is the standard treatment, recent work at UCL, funded by the CO Research Trust, highlights potential neural damage concerns. Moreover, changes in treatment recommendations, such as the removal of Hyperbaric Oxygen Therapy (HBOT) by NHS England, underscore the need for improved diagnostic tools and treatment options.

What can be done?

Addressing CO exposure during pregnancy requires a holistic approach. Healthcare professionals, including midwives, need education and resources to identify and address CO exposure risks in pregnant women. Moreover, standardised protocols and pathways for identifying and treating CO poisoning are essential to ensure timely interventions.

Campaigning efforts should focus on raising awareness among pregnant women, healthcare professionals, and policymakers. This improved education, guidance, and resources are necessary to mitigate CO exposure risks and protect pregnant women and unborn children.

What is the CO Research Trust doing?

The CO Research Trust is concerned about the significant health risk carbon monoxide exposure during pregnancy poses to both mothers and unborn children.

In addition to funding research projects with Improving Performance in Practice to look at midwifery services and behaviours amongst pregnant women, and the UK Health Security Agency to test the CO and maternity algorithm, the CO Research Trust will be dedicating an afternoon to better understanding the risks and challenges from a clinical and developmental point of view at our CO Research Conference which will take place in Edgbaston, Birmingham on 18 and 19 June 2024. You can sign up for the conference here.

Addressing these risks requires collaborative efforts from healthcare professionals, policymakers, and communities.

By raising awareness, improving education and resources, and implementing standardised protocols, we can mitigate CO exposure risks and ensure healthier outcomes for expectant mothers and their babies.