Teratogenicity

Question 1

tetracyclines

Answer 1

yellow-brown discoloration of deciduous teeth

Question 2

sulfonamides

Answer 2

avoid near delivery due to 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 a G6-PD deficiency
for infants younger than age 1 month and those with a known G6PD deficiency, nitrofurantoin is contraindicated because of potential hemolysis

Question 4

quinolones

Answer 4

associated with irreversible arthropathies and cartilage erosion in animal studies
no teratogenic effects 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 ability to easily cross placental barrier
if exposed between weeks 6 and 9 - fetus at risk for developing a warfarin 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 pregnancy because the large, polar molecules do not cross the placenta

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 carbamazapine

Answer 9

exposure during embryogenesis is associated with risk of spina bifida and neural tube defects

Question 10

SSRIs

Answer 10

paroxetine - increased risk of ventral and atrial septal cardiac defects
all SSRIs - exposure late in pregnancy associated with a neonatal behavioral syndrome (increased muscle tone, irritability, jitteriness, and respiratory distress)

Question 11

ACE inhibitors

Answer 11

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

Question 12

diuretics

Answer 12

thiazides - when given near delivery, fetus may experience thrombocytopenia with associated bleeding and electrolyte disturbances
all - may interfere with breast milk production

Question 13

ß-blockers

Answer 13

reported association with fetal growth restriction and neonatal hypoglycemia
neonates may experience transient mild hypotension with symptomatic ß-blockade

Question 14

calcium channel blockers

Answer 14

generally considered safe

Question 15

methyldopa and hydralazine

Answer 15

generally considered safe

Question 16

alkylating agents

Answer 16

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

Question 17

methotrexate

Answer 17

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

Question 18

androgens

Answer 18

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

Question 19

testosterone and anabolic steroids

Answer 19

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

Question 20

danazol

Answer 20

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

Question 21

aspirin and acetaminophen

Answer 21

aspirin - theoretical risk of premature closure of ductus arteriosus
acetaminophen - not associated with an increased risk of defect

Question 22

NSAIDs

Answer 22

in general, not teratogenic and can be used short term in the third trimester, with reversible fetal effects
indamethacin - used as a tocolytic agent; constriction of the fetal ductus arteriosus and neonatal pulmonary hypertension have been associated with use of indomethacin near delivery

Question 23

pseudoephedrine

Answer 23

retrospective study found an increased risk of gastroschisis
should be avoided in first trimester

Question 24

benzodiazepines

Answer 24

teratogenicity not clearly defined

exposed neonates should be monitored for transient withdrawal symptoms

Question 25

lithium

Answer 25

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

Question 26

vitamin A

Answer 26

extremely high doses of vitamin A are associated with congenital anomalies, but categorization is limited by the small number of confirmed cases

Question 27

isotretinoin

Answer 27

potent teratogen

associated with significant fetal loss and malformations with first-trimester use

Question 28

tretinoin

Answer 28

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

Question 29

alcohol congenital syndrome

Answer 29

growth restriction
facial abnormalities, including shortened palpebral fissures, low-set ears, midfacial hypoplasia, smooth philtrum, and thin upper lip
CNS dysfunction, including microcephaly, mental retardation, and behavioral disorders such as attention deficit disorder

Question 30

smoking

Answer 30

IUGR
low birth weight
fetal mortality