Toluene abuse during pregnancy: obstetric complications and perinatal outcomes.

Toxic vapor abuse during pregnancy was found to be associated with increased maternal and fetal morbidity. Toluene-induced renal tubular acidosis occurred in over half of these women and was clustered among long-duration abusers. The renal acidosis placed the mother at risk for hypokalemia, with associated cardiac dysrhythmias and rhabdomyolysis. Beta-mimetics and intravenous fluid for preterm labor therapy potentially exacerbated the electrolyte abnormalities. Among 21 newborns exposed to toluene in utero, preterm delivery, perinatal death, and growth retardation were significantly increased. Delivery during uncorrected maternal acidosis further compromised these infants. As children, growth retardation and developmental delay were common findings. Recognition of the unique obstetric and medical characteristics of the toluene-abusing woman is needed if complications are to be averted and perinatal outcomes improved.