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Chronic Ayurvedic medicine use associated with major and fatal congenital abnormalities

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Although there are potential associations between lead exposure during pregnancy and adverse pregnancy outcomes, there are limited data on whether in-utero lead exposure is associated with major congenital abnormalities. We describe a case of a major congenital renal abnormality, which resulted in severe pulmonary hypoplasia and neonatal death, that was potentially associated with maternal chronic lead ingestion via an Ayurvedic medicine throughout pregnancy.

Clinical record

A 28-year-old primigravida was referred to a maternal–fetal specialist because a fetal ultrasound at 20 weeks showed oligohydramnios, absence of the right kidney and a small echogenic left kidney with poor corticomedullary differentiation, and intrauterine growth restriction. She had a history of lethargy throughout her pregnancy and a normocytic anaemia with a haemoglobin level of 95 g/L (reference interval [RI], 97–148 g/L) at 24 weeks’ gestation and 88 g/L (RI, 95–150 g/L) at 30 weeks’ gestation. Her white cell count and platelet count were normal at 24 weeks’ and 30 weeks’ gestation. Liver and renal function test results, and serum vitamin B12, folate and ferritin levels were also within normal limits at both 24 weeks’ and 30 weeks’ gestation. Chorionic venous sampling performed at 24 weeks did not detect any significant genomic abnormalities. At 30 weeks’ gestation, the maternal blood film…