Botulinum toxin and pregnancy-a cautionary tale.

A 17-year-old female was treated with botulinum toxin (botulinum toxin type A, Allergan) for a left convergent squint. She returned 1 week after her second injection and informed us that she found out she was pregnant 3 days after the second injection. After a long worrying 9 months, her pregnancy fortunately proceeded to term with no adverse effect on both mother and baby. A literature review reassuringly suggests that it is a relatively safe treatment with no adverse effects on the expectant mother or the fetus. Up to 300 units of botulinum toxin have been used at various stages of pregnancy without adverse effects.