Teratogens Flashcards
What are some of the effects of ACEi in pregnancy?
1st trimester numerous congenital malformations
- Hypocalvaria (absent skull bones)
2/3rd trimester: Oligohydramnios
- Decreased fetal kidney function
- Fetal renal failure
- Potter’s syndrome
- Pulmonary hypoplasia, limb/skeletal deformities
What time period is the fetus most susceptible to teratogens?
Weeks 2 - 8
What are some of the teratogenic effects of antiepileptic drugs (Valproate, carbamazepine, phenytoin, phenobarbital) cause?
- Neural tube defects
- Cardiac defects
- Cleft palate
- Skeletal abnormalities (phalynx/nail hypoplasia, facial dysmorphism)
What are the teratogenic effects of alkylating agents?
- Multiple anomalies
- Absence of digits
What are the teratogenic effects of aminoglycosides?
Ototoxicity
What are the teratogenic effects of diethylstillbesterol?
- Hypoplastic uterus, cervical hypoplasia, vaginal adenosis + metaplasia
- Vaginal clear cell adenocarcinoma
- Congenital Mullerian anomalies
- Infertility
What are the teratogenic effects of fluoroquinolones?
Cartilage damage
What are examples of folate antagonists which may cause NT defects?
- Antiepileptics
- Trimethoprim
- Methotrexate (can induce abortion in ectopic)
What is a drug which is a folate antagonist that may also induce abortion in ectopic pregnancy?
Methotrexate
What might sulfonamides cause in the newborn?
Kernicterus
What acne medication may have teratogenic effects?
Isotretinoin
What are the teratogenic effects of Isotretinoin (or large amounts of Vit A)?
Craniofacial
- Microtia (missing ear)
- Dysmorphism
CNS, cardiac, thymic defects
What defect may be present in the baby of a mother taking lithium?
Ebstein anomaly
What are the teratogenic effects of Methimazole (used to treat hyperthyroidism)?
- Aplasia cutis congenita (congenital absence of skin, particularly on the scalp)
- Propylthiouracil (PTU) used instead
What are the teratogenic effects of tetracyclines?
- Discoloured teeth
- Inhibited bone growth
What are the teratogenic effects of thalidomide?
Limb defects (phocomelia, micromelia - ‘flipper’ limbs)
What are the teratogenic effects of Warfarin?
- Bone and cartilage abnormalities
- Stippled epiphyses (small white dots on X-ray)
- Nasal and limb hypoplasia
- Optic nerve atrophy
- Fetal cerebral hemorrhage
What is used instead of warfarin in pregnant mothers?
Heparin
What are the characteristic facial features in fetal alcohol syndrome?
- Smooth philtrum
- Thin vermillion border (upper lip)
- Short palpebral fissures (small opening of eyes)
What is one of the hypotheses for fetal alcohol syndrome’s features?
Impaired migration of neuronal and glial cells
What are possible features of fetal alcohol syndrome?
- Developmental delay
- Microcephaly, holoprosencephaly (severe)
- Heart defects (ASD, VSD, tetralogy of fallot)
- Heart-lung fistulas (severe)
- Limb defects (fingers, hip)
- Facial abnormalities
What are the teratogenic effects of cocaine?
- Preterm birth, low birth weight (vasoconstriction), IUGR
- Placental abruption
What are the teratogenic effects of smoking?
- Low birth weight, preterm labor (vasoconstriction)
- Placental problems
- IUGR
- ADHD
- SIDS (sudden infant death syndrome)
What are the teratogenic effects of iodine?
- Congenital hypothyroidism (cretinism)
- Congenital goiter
What are the effects on the fetus/neonate of maternal diabetes?
- Large baby (macrosomia) -> shoulder dystocia
- Neonatal hypoglycemia (islet cell hyperplasia)
- Heart defects (VSD, transposition)
- Polycythemia
- Neural tube defects
- Neonatal respiratory distress syndrome
- Caudal regression syndrome (sacral agenesis, sirenomelia/mermaid legs)
What are teratogenic effects of methylmercury (fish)?
- Neurotoxicity -> delayed milestones
What are teratogenic effects of X-rays?
- Microcephaly
- Intellectual disability
Minimised by lead shielding
Describe neonatal abstinence syndrome?
Secondary to usually opioids
- Uncoordinated sucking reflexes
- Irritability, high-pitched crying
- Tremors
- Tachypnea
- Sneezing
- Diarrhea
- Seizures
What is neonatal abstinence syndrome treated with?
- Methadone
- Morphine
- Buprenorphine
What are the effects of phenylalanine (mother w. PKU) on the baby?
- IUGR
- Retardation
- Microcephaly
- Cocarc of aorta, hypoplastic L heart
