Scorpion sting during pregnancy: a systematic review

Scorpion envenomation is a significant public health problem in tropical and subtropical regions, and there are only limited data on scorpion stings during pregnancy and their outcomes.

To systematically synthesize published human evidence on envenomation severity, maternal and fetal/neonatal outcomes, and reported experiences of scorpion antivenom administration during pregnancy.

A systematic search of PubMed, Embase and Scopus was conducted from inception to June 2025 (PROSPERO: CRD420251070831) in accordance with the PRISMA 2020 statement and the Synthesis Without Meta-analysis (SWiM) reporting guideline.

All human studies reporting scorpion envenomation during pregnancy (case reports, case series, and observational studies) were eligible. Because of marked clinical and methodological heterogeneity and the lack of comparable quantitative data, we combined findings using a structured narrative synthesis (SWiM) and grouped them by study design and envenomation severity.

Fourteen studies were included. One was a national poison-center dataset that reported no extractable individual outcomes and is summarised separately; the remaining 13 studies provided individual pregnancy-level data on 138 women. Envenomation was mild, with local effects only, in most cases; moderate systemic features occurred in a minority, and severe envenomation was uncommon. The scorpion species was identified in only 4/14 studies. Maternal outcomes were reported for 132/138 women: 131/132 survived without reported sequelae, and 1/132 died, following critical envenomation with disseminated intravascular coagulation and delayed treatment. Fetal or neonatal outcomes were reported for 115/138 women and included eight pregnancy losses - three miscarriages (before 20 weeks) and five stillbirths (fetal death at or after 20 weeks), one of which accompanied the maternal death - together with seven preterm births, all arising within a single cohort (7/62 pregnancies in that cohort reaching a recorded birth). Antivenom was administered to 85/138 women, but the product, dose, route, and timing were rarely reported. Individual-level data were dominated by one Iranian cohort (n = 66).

Scorpion envenomation during pregnancy is predominantly mild, although severe systemic envenomation can pose serious maternal and fetal risks. The certainty of the evidence is very low for every outcome, and the published data are too limited, heterogeneous, and uncontrolled to establish either the safety or the effectiveness of antivenom in pregnancy. This review identifies evidence gaps and can inform clinical reasoning, but it cannot by itself determine obstetric or toxicological management.