Xylazine Use in Pregnancy: A Case Report and Narrative Review

Area of Science:

• Obstetrics and Gynecology
• Pharmacology
• Toxicology

Background:

• Xylazine, an alpha-2 adrenergic agonist, is a veterinary sedative frequently adulterating illicit opioids, leading to the 'tranq dope' crisis.
• Its impact on human pregnancy is largely unknown, creating significant challenges in obstetric addiction medicine.

Purpose of the Study:

• To present a case of maternal and neonatal complications from xylazine exposure during pregnancy.
• To review existing human and animal data on xylazine's effects during gestation.
• To discuss clinical management strategies for pregnant individuals exposed to xylazine-adulterated opioids.

Main Methods:

• Case report of a pregnant patient with opioid use disorder unknowingly exposed to fentanyl adulterated with xylazine.
• Review of sparse human literature and relevant animal studies on xylazine exposure in pregnancy.
• Discussion of clinical management and harm-reduction strategies.

Main Results:

• The patient developed preeclampsia with HELLP syndrome, necessitating preterm delivery; the neonate required treatment for neonatal abstinence syndrome.
• Postpartum, the patient experienced severe withdrawal, leading to Mallory-Weiss tear, hemorrhage, and cardiac arrest.
• Human data indicate placental transfer of xylazine, potential maternal CNS depression, and neonatal sedation; animal models show uterine vasoconstriction and fetal growth restriction.

Conclusions:

• Xylazine exposure in pregnancy poses significant risks, including severe maternal complications and adverse neonatal outcomes.
• Effective management requires early diagnosis, tailored withdrawal protocols, and expanded harm-reduction strategies.
• Urgent need for surveillance and evidence-based guidelines for xylazine in the perinatal setting.