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Repro Week 3 > LM 14.6: TORCH/Teratogens > Flashcards

LM 14.6: TORCH/Teratogens Flashcards

1
Q

what are the complications associated with teratogens?

A
  1. pregnancy loss
  2. birth defects
  3. growth restriction
  4. impaired neurologic function
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2
Q

what types of exposures can women have?

A
  1. infections
  2. mechanical

amniotic bands, umbilical cord, uterine size

  1. environmental
  2. maternal habits
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3
Q

when is the most impactful weeks when it comes to teratogen effect on the embryo?

A

first 12 weeks

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4
Q

what is the all or none effect?

A

within the first 2 weeks after conception there is an all or none effect

so if something effects the embryo you’ll have a spontaneous abortion/miscarriage or the baby will be totally fine

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5
Q

what is the major effect of teratogens on a baby in the first 8 weeks of gestation?

A

it will effect organogenesis and lead to structural defects

neural tube, heart, limbs, facial structures etc. are all being formed at this time and if mom is effected by teratogens at this time it will effect these thigns

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6
Q

what is the major effect of teratogens on a baby after the first 8 weeks of gestation?

A

growth and CNS development are effected

this can effect the fetus into childhood and adulthood

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7
Q

what are the drug categories for teratogens?

A

A = safe; like prenatal medications

B = they’re probably fine

C = most; don’t have enough info to say they’re technically safe

D = we know can be teratogenic in fetuses and we know there’s some risk; there isn’t a good alternative to this medication though and they must be used during pregnancy; must discuss risk/benefit ration

X = absolutely contraindicated in pregnancy; usually an alternative exists or they’re not essential medications

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8
Q

what is the mnemonic for teratogenic pharmaceuticals

A

TERATOWAMM

Ⓣhalidomide

Ⓔpileptic medications (valproic acid, phenytoin, phenobarbital, carbamazepine)

Ⓡetinoids

ⒶCE inhbitors/ARBs

Ⓣhird element (lithium)

Ⓞral contraceptives/other hormones

Ⓦarfarin

Ⓐntibiotics (ahminoglycosides, tetracyclines, fluoroquinolone, trimethoprim, sulfonamides

Ⓜethimazole

Ⓜmethotrexate

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9
Q

how does thalidomide effect the fetus?

A

class X drug; orphan drug aka you have to have special permission to even use it

FDA approved for use for MM and Hansen’s disease

initially used for morning sickness and insomnia in pregnancy

  1. phocomelia (abnormal limbs)
  2. micromelia (abnormally small limbs)
  3. amelia (absence of limbs)
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10
Q

how do epileptic medications effect the fetus?

A

valproic acid, phenytoin, phenobarbital, carbamazepine

  1. neural tube defects
  2. cardiac defects
  3. cleft palate
  4. facial and finer abnormalities

mostly related to decreased folic acid…so high dose folic acid supplementation is indicated if use is absolutely necessary during pregnancy

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11
Q

how does valproic acid effect the fetus?

A

neural tube defects

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12
Q

how does phenytoin effect the fetus?

A

fetal hydantoin syndrome:

  1. cleft lip/palate
  2. microcephaly
  3. mental retardation
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13
Q

how does phenobarbital effect the fetus?

A
  1. IUGR (intrauterine growth restriction)
  2. cleft lip/palate
  3. facial abnormalities
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14
Q

how does carbamazepine effect the fetus?

A

neural tube defects

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15
Q

how do retinoids effect the fetus?

A

FDA approved fro acne but category X drug

20% risk of spontaneous abortion

20-30% risk of abnormal facial features, congenital heart disease, hydrocephalus in live births

there is a mandatory birth control as part of prescribing this!!

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16
Q

how do ACEI/ARBs effect the fetus?

A

commonly used for HTN but use with caution in reproductive age women

leads to decline in renal function and ultimately renal failure in the fetus….this will manifest as oligohydramnios in the 2nd/3rd trimester….this could result as pulmonary hypoplasia and limb/skeletal deformities (Potter syndrome)

17
Q

why does oligohydrmanios lead to pulmonary hypoplasia and limb/skeletal defects?

A

amniotic fluid is needed to cushion the limbs and give room to grow so without it there could be limb hypoplasia

in tuero, the fetus drinks amniotic fluid to help them fill and grow and so without it, you’d get pulmonary hypoplasia

18
Q

how does lithium effect the fetus?

A

category D drug

risk of Ebstein’s anomaly aka tricuspid displaced toward RV apex

19
Q

how do OCPs effect the fetus?

A

unclear evidence showing craniofacial defects, cardiac defects, limb defects

also effects on sexual differentiation in early pregnancy….

20
Q

how does warfarin effect the fetus?

A

fetal warfarin syndrome:
1. stippled epiphysies in bones

  1. nasal and limb hypoplasia
  2. bleeding
  3. optic atrophy

contraindicated in pregnancy; there are other options like heparin because this doesn’t cross the placenta

21
Q

how do antibiotics effect the fetus?

A
  1. aminoglycosides = deafness
  2. tetracyclines = discolored teeth
  3. fluoroquinolone = cartilage damage
  4. trimethoprim = disrupts folate metabolism in 1st trimester –> can use in 3rd trimester to treat UTIs
  5. sulfonamides = displace bilirubin from albumin which can lead to kernicterusin 3rd trimester –> can use in the 2nd trimester though for infections

all of these effect kids too so we dont usually give them to kids unless we have to

22
Q

how does methimazole effect the fetus?

A

used for hyperthyroidism but can cause:

  1. aplasia cutis = missing hair patch on scalp

dont use in the 1st trimester because high risk of this happening; lower likelihood in 2nd and 3rd trimester

  1. propylthiouracil (PTU) is better treatment for hyperthyroidism in pregnancy during the 1st trimester
23
Q

how does methotrexate effect the fetus?

A

category X drug…

inhibits folate metabolism so can cause neural tube defects

used for RA and other autoimmune mechanisms

24
Q

how do chemotherapeutic agents effect the fetus?

A
  1. spontaneous abortions
  2. missing digits
  3. many other defects

1st trimester chemo results in 15% fetal malformations so ideally defer till at least 2nd trimester if possible

25
Q

how does diethylstilbestrol effect the fetus?

A

DES is a nonsteroidal estrogen prescribed to prevent miscarriage and preterm labor but it causes:

  1. increased breast cancer risk
  2. hypoplastic uterus and cervix in infants
  3. vaginal adenomas, vaginal clear cell adenocarcinoma, and infertility in children

this is no longer on the marker..

26
Q

how do opioids effect the fetus

A
  1. poor fetal growth
  2. preterm birth
  3. stillbirth
  4. neonatal abstinence syndrome (neonatal withdrawal once delivered)
27
Q

how does alcohol effect the fetus?

A
  1. it’s a neurotoxin so it can cause cell death or failed cell migration
  2. fetal alcohol syndrome

Ⓕissures (eye openings shortened)

Ⓐnatomically thin vermillion border (upper lip)

Ⓢmooth philthrum under nose

  1. skeletal deformities
  2. heart deformities (ASD, VSD, tetralogy of Fallot
  3. microcephaly with small corpus callous, basal ganglia, and cerebellum
  4. MRDD
  5. holoprosencephaly, hypotonia, CNS deficits if severe
28
Q

when is alcohol most teratogenic to the fetus?

A

1st trimester

but in the 3rd trimester it can cause poor growth

no amount of alcohol is safe while pregnant!

29
Q

how does nicotine effect pregnancy?

A
  1. nicotine causes vasoconstriction
  2. CO produced competes for oxygen binding

these two combined lead to decreased oxygen flow which can result in intrauterine growth restriction

can also cause:
1. placental abruptiosn

  1. placenta previa
  2. premature rupture of membranes
  3. preterm labor
  4. increased sudden infant death syndrome (SIDS) risk**
30
Q

how does cocaine effect the fetus?

A

very potent vasoconstriction so can cause IUGR or placental abruptions

31
Q

how does mercury effect the fetus?

A

present in seafood and the fetal brain is HIGHLY sensitive to this

can caused delayed milestones, cerebral palsy, blindness, and deafness

32
Q

how does radiation effect the fetus?

A

ideally avoid any radiation during pregnancy; we are unsure about the threshold of how many rads is “safe’”

use lead shielding of abdomen if necessary

8-15 weeks is most sensitive time and can result in IUGR, MRDD and microcephaly

33
Q

which infections are TORCH infections?

A

Ⓣoxoplasma gondii

Ⓞther: treponema pallidum, listeria, varicella zoster virus, and parvovirus B19

Ⓡubella

ⒸMV

Ⓗerpes

34
Q

how does maternal DM effect the fetus?

A

increased fetal insulin levels

even though maternal insulin doesn’t cross the placenta, maternal glucose does which causes high fetal glucose and then the fetal pancreas makes more insulin

then since insulin is a fat storage hormone, it encourages storage of energy and fat resulting in fetal growth aka giant babies!! –> this can ultimately result in neonatal hypoglycemia since the fetus has super high levels of insulin but not as much glucose since the umbilical cord is no longer transferring maternal glucose

all of this can cause:

  1. caudal recession defects
  2. neural tube defects
  3. mermaid syndrome
  4. cardiac defects
  5. transposition of the great vessels**
35
Q

what is maternal PKU?

A

high levels of PKU are teratogenic because it’s similar to alcohol

can cause:
1. IUGR

  1. micorcephaly
  2. MRDD
  3. cardiac defects: coarctation of the aorta*, hypo plastic left heart

Repro Week 3 (26 decks)

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