Can I treat this pregnant patient with botulinum toxin?

Botulinum toxin type A (BoNT-A) is used to treat dystonia. The commonest form, cervical dystonia, is more common in women; since many are still of childbearing age,1 some women on botulinum toxin treatment inevitably will either be planning to become pregnant or may wish to be treated while pregnant. The use of BoNT-A for chronic migraine—a female-predominant disorder—will make botulinum treatment an increasingly common issue for women,2 leaving aside the use of BoNT-A in a cosmetic setting. To inform discussions with patients, clinicians need to understand the known risks of botulinum toxin.