Teratogenic side effects

Question 1

Congenital malformations of children exposed to sodium valproate in utero

Answer 1

Neural tube defects
Facial dysmorphism
Cleft lip and palate
Craniostenosis
Cardiac defects
Renal and urogenital defects including hypospadias
Limb defects - bilateral aplasia of the radius

Question 2

Neurodevelopmental effects of exposure to sodium valproate in utero

Answer 2

Dose dependent relationship with developmental delay
30-40% of children have early developmental delay
3x increased rate of autism

Question 3

Main teratogenic effects of carbamazepine

Answer 3

Spina bifida

Fingernail hypoplasia

Question 4

Teratogenic effects of phenytoin

Answer 4

Cleft palate
Congenital heart disease
Fingernail hypoplasia
Craniofacial defects
Intellectual disability
Limb defects

Question 5

Most teratogenic mood stabiliser

Answer 5

Valproate

Question 6

Medication associated with floppy baby syndrome when used in the third trimester

Answer 6

Benzodiazepines

Question 7

Congenital anomaly associated with maternal lithium use during pregnancy

Answer 7

Ebstein’s anomaly

Question 8

Risk of Ebstein’s anomaly in the general population

Answer 8

1 in 20000

Question 9

Risk of Ebstein’s anomaly when exposed to lithium in utero

Answer 9

1 in 1000

Question 10

Structural abnormality in Ebstein’s anomaly

Answer 10

Prolapse of the tricuspid valve into the right ventricle

Question 11

Risk for Ebstein’s anomaly among patients taking lithium in pregnancy but which does not relate to lithium use

Answer 11

Increased risk associated with maternal mental health problems

Question 12

Time frame for maximum risk of Ebstein’s anomaly if taking lithium in pregnancy

Answer 12

2-6 weeks

Question 13

Mood stabilisers which can synergistically increase the risks of teratogenic side effects

Answer 13

Valproate and carbamazepine

Question 14

Class of antidepressants which can increase the risk of cleft lip/palate when used in pregnancy

Answer 14

SSRIs

Question 15

Percentage chance of an infant having a major congenital malformation if exposed to valproate in utero

Answer 15

7-10%

Question 16

Percentage change of a child exposed to valproate in utero showing delays in early development

Answer 16

30-40%

Question 17

Likely effect of exposure to venlafaxine or SSRIs with a short half life in utero

Answer 17

Neonatal irritability due to discontinuation syndrome

Question 18

Psychiatric medications which most often cause orofacial clefts when used in pregnancy

Answer 18

Benzodiazepines

Question 19

Teratogenic effect of lamotrigine

Answer 19

Cleft palate

Question 20

Percentage chance of foetal death in a foetus exposed to valproate

Answer 20

1%