Medications in pregnancy

Question 1

Tetracyclines (doxycycline and minocycline)

Answer 1

Yellow brown discoloration of deciduous teeth has been associated with the use of these meds

Question 2

Sulfonamides

Answer 2

Avoid near delivery due to the risk of hyperbilirubinemia through the displacement of bilirubin from protein-binding sites

Question 3

Nitrofurantoin

Answer 3

rare theoretic risk of hemolytic anemia in women with G6PD deficiency; for infants younger than age 1 month and those with a known G6PD deficiency, this medication is contraindicated because of potential hemolysis

Question 4

Quinolones

Answer 4

Associated with irreversible arthropathies and cartilage erosion in animal studies; no teratogenic effects have been demonstrated in animal studies

Question 5

Metronidazole

Answer 5

not teratogenic to fetuses exposed in the first trimester

Question 6

Warfarin

Answer 6

Highly teratogenic due to their ability to easily cross the placental barrier; if exposed between weeks 6 and 9, the fetus is at risk for developing a “this med” embryopathy-nasal and midface hypoplasia with stippled vertebral and femoral epiphyses; later exposure is associated with hemorrhage-related fetal abnormalities, such as hydrocephalus

Question 7

Heparin and LMWH

Answer 7

Anticoagulant of choice for use in pregnancy because the large, polar molecules do not cross the placenta; the newer “this med” are not associated with fetal malformations

Question 8

phenytoin

Answer 8

May produce abnormal facies, cleft lip or palate, microcephaly, growth deficiency, and hypoplastic nails and distal phalanges in as many as 10% of exposed offspring

Question 9

Valproic acid and carbamazepine

Answer 9

Exposure during embryogenesis is associated with a 1%-2% risk of spina bifida and neural tube defects

Question 10

SSRIs

Answer 10

Exposure late in pregnancy associated with a neonatal behavior syndrome (increased muscle tone, irritability, jitteriness, and respiratory distress)

Question 11

Paroxetine

Answer 11

increased risk of ventral and atrial septal cardiac defects

Question 12

ACE inhibitors

Answer 12

associated with numerous fetal anomalies, including growth restriction, limb contractures, and abnormalities in cavarum development

Question 13

Diuretics

Answer 13

may interfere with breast milk production

Question 14

Thiazide diuretics

Answer 14

when given near delivery the fetus may experience thrombocytopenia with associated bleeding and electrolyte disturbances

Question 15

Beta Blockers

Answer 15

Reported associations with fetal growth restriction and neonatal hypoglycemia; neonates may experience transient mild hypotension with symptomatic B-blockade

Question 16

calcium-channel blockers

Answer 16

generally considered safe in pregnancy

Question 17

methyldopa and hydralazine

Answer 17

generally considered safe in pregnancy

Question 18

alkylating agents (cyclophosphamide)

Answer 18

associated with missing or hypoplastic digits of the hands and feet when the fetus is exposed in the first trimester; second-semester exposure is not associated with defects

Question 19

methotrexate

Answer 19

alters normal folic acid metabolism; high doses can lead to growth restriction, severe limb abnormalities, posteriorly rotated ears, micrognathia, and hypoplastic supraorbital ridges

Question 20

Androgens

Answer 20

exposure to exogenous androgens between 7 and 12 weeks can cause full masculinization, with later exposure causing partial masculinization

Question 21

Testosterone and anabolic steroids

Answer 21

can result in varying degrees of virilization, including labioscrotal fusion and phallic enlargement, depending on the timing and extent of exposure

Question 22

Danazol

Answer 22

dose-related patterns of clitorimegaly, urogenital sinus malformation, and labioscrotal fusion

Question 23

Aspirin

Answer 23

theoretical risk of premature closure of the ductus arteriosus

Question 24

Acetaminophen

Answer 24

not associated with an increased risk of defects

Question 25

NSAIDS

Answer 25

in general, not teratogenic and can be used short term in the third trimester, with reversible fetal effects

Question 26

indomethacin

Answer 26

used as a tocolytic agent; constriction of the fetal ductus arteriosus and neonatal pulmonary hypertension have been associated with the use of this med near delivery

Question 27

pseudoephedrine

Answer 27

retrospective study found an increased risk of gastroschisis (a congenital defect of anterior abdominal wall characterized by an opening beside the umbilical cord that allows bowl to protrude); should be avoided in 1st trimester

Question 28

Benzodiazepines

Answer 28

teratogenicity is not clearly defined; exposed neonates should be monitored for transient withdrawal symptoms

Question 29

Lithium

Answer 29

associated with an increase in cardiovascular malformations, although evidence for a significant increase has been challenged ; limiting exposure until after 8 weeks gestation to allow the cardiac structures to complete organogenesis is reasonable

Question 30

Vitamin A

Answer 30

Extremely high doses of Vitamin A are associated with congenital anomalies, but catergorization is limited by the small number of confirmed cases

Question 31

Isotrentinoin

Answer 31

A potent teratogen; associated with significant fetal loss and malformations with first-trimester use

Question 32

tretinoin

Answer 32

topical retinoid gel; information about teratogenicity is lacking; women should avoid during pregnancy

Question 33

alcohol

Answer 33

the most common teratogen to which a fetus is exposed

Question 34

fetal alcohol syndrome

Answer 34

1. growth restriction (prenatal, postnatal or both)
2. facial abnormalities, including shortened palpebral fissures, low set ears, midfacial hypoplasia, smooth philtrum, and a thin upper lip
3. central nervous system dysfunction including microcephaly, mental retardation, and behavioral disorders such as ADD

Question 35

smoking/tobacco

Answer 35

IUGR, low birth weight, fetal mortality