Effects of maternal and prenatal history

Question 1

Maternal rubella

Answer 1

IUGR, postnatal growth retardation, cardiac and great vessel abnormalities, microcephaly, sensorineural deafness, cataracts, microphthalmos, glaucoma, pigmented retinopathy, mental deficiency, neonatal bleeding, hepatosplenomegaly, osteopathy, tooth defects
35% chance of cardiac defects (PDA, PPS, septal defect)

Question 2

maternal diabetes

Answer 2

Common anomalies include holoprosencephaly (failure of the forebrain to divide into hemispheres), meroencephaly (partial absence of the brain), sacral agenesis, vertebral anomalies, congenital heart defects, limb defects, and renal anomalies.
3-5% chance of cardiac defect (VSD, coarc, TGA)

Question 3

maternal PKU

Answer 3

25-30% cardiac defects (TET)

Question 4

Lupus

Answer 4

20-40% chance of cardiac defect (complete heart block)

Question 5

Alcohol abuse

Answer 5

25-30% risk CHD (septal defects)

IUGR; mental deficiency, microcephaly; ocular anomalies; joint abnormalities; short palpebral fissures

Question 6

Hydantoin

Answer 6

2-3% chance CHD (pulm and aortic stenosis, PDA, coarc)

Question 7

lithium

Answer 7

10-20% chance of CHD (Ebstein’s, TA, ASD)

Question 8

Methotrexate

Answer 8

Multiple defects, especially skeletal, involving the face, cranium, limbs, and vertebral column

Question 9

drugs known to cause heart defects

Answer 9

amphetamines, alcohol, anticonvulsants (hydantoins, trimethadione, valproic acid, carbamazepine), lithium, retinoic acid, thalidomide, and warfarin (Coumadin)

Question 10

isotretinoin (accutane)

Answer 10

Microcephaly, absence of the cerebellar vermis, hydrocephalus, Arnold–Chiari malformation, Dandy–Walker syndrome.
Hypotonicity, decreased reflexes, feeding problems, facial nerve paralysis, lack of visual responsiveness, seizures
Craniofacial abnormalities
CHD (Defects of ventricular outflow tracts)
Cleft palate
Thymic aplasia

Question 11

Phenytoin

Answer 11

Characterized by a typical facies (broad, low nasal bridge, hypertelorism, epicanthal folds, ptosis, and prominent, malformed ears), low-set hairline, and nail hypoplasia.
Associated: Cleft lip and palate, umbilical and inguinal hernias, Microencephaly, anencephaly, myelomeningocele, hydrocephalus

Question 12

primidone (mysoline)

Answer 12

Microcephaly, hydrocephalus, spina bifida, anencephaly

Question 13

cocaine

Answer 13

Cocaine alters the norepinephrine, dopamine, and serotonin neurotransmitter pathways.
Exposure to cocaine can result in tachycardia, arrhythmias, hypertension, vasoconstriction, diaphoresis, and mild tremors.
Microcephaly, cerebral infarction, encephalocele.
Depressed interactive behavior, poor organizational responses to environmental stimuli, hyperirritability, altered sleep.
SGA, due to decreased placental blood flow from vasoconstriction
Increased incidence of genitourinary tract anomalies.
Placental abruption, intestinal atresia, and necrotizing enterocolitis d/t vasoconstriction

Question 14

narcotics

Answer 14

microcephaly, strabismus.

Withdrawal symptoms; increased activity, tone, and arousal to stimulation

Question 15

warfarin

Answer 15

Nasal hypoplasia, stippled epiphyses, hypoplastic phalanges; eye anomalies; mental deficiency
Microcephaly, hydrocephalus, brain atrophy, Dandy–Walker syndrome

Question 16

phencyclidine

Answer 16

Hypertonicity, decreased reflexes, bursts of agitation, rapid changes in level of consciousness

Question 17

congenital CMV

Answer 17

microcephaly, petechiae, purpura, and jaundice on physical examination.
Microcephaly, chorioretinitis, sensorineural hearing loss, delayed psychomotor/mental development, hepatosplenomegaly, hydrocephaly, cerebral palsy, brain (periventricular) calcification

Question 18

maternal Zika

Answer 18

seizures, severe microcephaly, contractures, significant early hypotonia, craniosynostosis, and may be small for gestational age

Question 19

Valproic acid

Answer 19

prominent or fused metopic suture, epicanthal folds, mid-face hypoplasia, and broad, low nasal bridge with short nose and long philtrum. Congenital heart defects, genitourinary anomalies, and club feet are associated anomalies

Question 20

Aminopterin

Answer 20

IUGR; skeletal defects; malformations of the CNS, notably meroanencephaly (most of the brain is absent)

Question 21

Androgens and high dose progestogens

Answer 21

Varying degrees of masculinization of female fetuses: ambiguous external genitalia resulting in labial fusion and clitoral hypertrophy

Question 22

Misoprostol

Answer 22

Limb abnormalities, ocular and cranial nerve defects, autism spectrum disorder

Question 23

thalidomide

Answer 23

Abnormal development of limbs (e.g., meromelia [partial absence] and amelia [complete absence]), facial defects, systemic anomalies (e.g., cardiac, kidney, and ocular defects)

Question 24

congenital HSV

Answer 24

Skin vesicles and scarring, chorioretinitis, hepatomegaly, thrombocytopenia, petechiae, hemolytic anemia, hydranencephaly

Question 25

Human parvovirus

Answer 25

Fetal anemia, nonimmune hydrops fetalis, fetal death

Question 26

Toxoplasma gondii

Answer 26

Microcephaly, mental deficiency, microphthalmia, hydrocephaly, chorioretinitis, cerebral calcifications, hearing loss, neurologic disturbances

Question 27

varicella

Answer 27

Cutaneous scars (dermatome distribution), neurologic anomalies (limb paresis [incomplete paralysis], hydrocephaly, seizures, etc.), cataracts, microphthalmia, Horner syndrome, optic atrophy, nystagmus, chorioretinitis, microcephaly, mental deficiency, skeletal anomalies (hypoplasia of limbs, fingers, toes, etc.), urogenital abnormalities

Question 28

TORCH infections

Answer 28

toxoplasmosis, other agents (including syphilis), rubella, cytomegalovirus, and herpes simplex. TORCH infections may present with similar clinical findings: IUGR; hepatosplenomegaly; rash; CNS manifestations such as microcephaly, chorioretinitis, and intracranial calcifications; jaundice; and low platelet

Question 29

Maternal smoking

Answer 29

intrauterine growth restriction and preterm birth
jitteriness and hypertonicity from exposure to nicotine. Potential long-term morbidities related to fetal exposure to nicotine and toxins from cigarette smoke include decreased cognitive functioning, auditory processing deficits, impulsivity, anxiety, depression, attention deficit hyperactivity disorder, reduced lung function, and asthma in offspring

Question 30

methamphetamines

Answer 30

premature birth, growth restriction, placental abruption, and fetal distress. Maybe reduced long-term mental dexterity

Question 31

marijuana

Answer 31

may be associated with fetal growth restriction, prematurity, and stillbirth. Mothers more anemic.
Newborns exposed to marijuana prenatally have an association with decreased executive functioning skills, including poor impulse control, visual memory, and attention deficit.

Question 32

NAS

Answer 32

Causes:
Opioids
Opioid treatment like methadone or buprenorphine
SSRIs, SNRIs, TCAs
benzodiazepines
Clinical signs and symptoms of NAS include tremors, jitteriness, myoclonic jerks, irritability, poor sleep patterns, excessive crying, high-pitched crying, poor feeding, poor weight gain, hyperphagia (excessive desire to eat), emesis, diarrhea, sneezing, mottling, tachypnea, tachycardia, temperature instability, and skin excoriation. Perianal excoriation is secondary to gastrointestinal disturbances, whereas excoriation of face and body is secondary to excessive irritation and movements.