Narrative Review of the Safety of Botulinum Toxin Type A During Pregnancy in Aesthetic Medicine

Abstract

     This survey research aimed to review the available evidence regarding maternal and fetal outcomes following BoNT-A exposure during pregnancy, evaluate the biological plausibility of fetal risk, and provide practical recommendations for clinicians practicing aesthetic medicine. A narrative review was conducted using PubMed, Scopus, Web of Science, and Google Scholar. Relevant publications reporting maternal exposure to BoNT-A during pregnancy or prior to pregnancy recognition were identified and synthesized. Eligible evidence included case reports, case series, retrospective surveys, pharmacovigilance databases, post-marketing safety registries, and review articles.

     Results: Several hundred pregnancies exposed to BoNT-A have been reported in the literature, with the largest pharmacovigilance database including 913 documented exposures. Most exposures occurred in women receiving treatment for neurological disorders, whereas evidence related to aesthetic indications remains limited and primarily consists of inadvertent first-trimester exposure. Current evidence does not demonstrate an increased risk of spontaneous abortion, congenital anomalies, preterm birth, or adverse neonatal outcomes compared with expected background population rates. Furthermore, the pharmacological characteristics of BoNT-A, including its large molecular size, minimal systemic absorption, and lack of confirmed placental transfer in humans, support a low biological plausibility for fetal toxicity.