Teratogens Flashcards
ACEi and ARBS (no angiotensin II)
Renal dysgenesis/agenesis, oligohydramnios, hypocalvaria in fetus –> potter’s sequence
Alkylating agents
Absence of digits, multiple anomalies
Aminoglycosides (neomycin, gentamycin)
Ototoxicity
Antiepileptic drugs (esp. valproate, carbamazepine, phenytoin, phenobarbital)
High- dose folic acid recommended with all others
Causes: neural tube defects, cardiac defects, cleft palate, skeletal abn (phalynx/nail hypoplasia, facial dysmorphism)
Diethylsilbestrol (DES)
Vaginal clear cell adenocarcinoma, congenital müllerian anomalies (uterus, fallopian tubes, upper vagina, cervix)
Fluoroquinolones
Cartilage damage
Folate antagonists (antiepileptics, trimethoprim, methotrexate)
Neural tube defects
Isotretinoin
Contraception is mandatory Multiple severe birth defects microcephaly thymic hypoplasia small ears hydrocephalus
Lithium
Epstein anomaly -cyanotic cardiac anomaly -displacement of tricuspid valve leaflets into RV (atrialization of the RV) - tricuspid regurgitation -accessory conduction pathways - RHF hypothyroidism -nephrogenic diabetes insipidus
Methimazole
Use only in second and third trimesters
Aplasia cutis in fetus
Use PTU in first trimester
PTU (propylthiouracil)
Use only in first trimester
Hepatotoxicity in utero
Tetracyclines
Discolored teeth, inhibited bone growth
Thalidomide
Limb defects (phocomelia, micromelia “flipper hands”)
Warfarin
Use LMWH instead “keep the baby HEPpy with Heparin”
- Bone and cartilage deformities (stippled epiphyses, nasal and limb hypoplasia)
- optic nerve atrophy
- fetal cerebral hemorrhage
Alcohol
Fetal alcohol syndrome: impaired migration of neuronal and glial cells
- intellectual disability
- microcephaly (holoprosencephaly if severe)
- facial abnormalities (smooth philtrum, thin vermillion border, small palpebral fissures)
- limb dislocation
- heart defects (heart-lung fistulas if severe)
Cocaine
Causes vasoconsriction
- low birth weight
- preterm birth
- IUGR
- placental abruption
Smoking
Nicotine causes vasoconstriction
CO causes impaired oxygen delivery
- low birth weight (leading cause in developed countries)
- preterm labor
- Placental problems
- IUGR
- SIDS
- ADHD
Iodine excess
Congenital goiter
Iodine deficiency
Hypothyroidism (cretinism) - intellectual disability
Maternal diabetes (GDM)
- Caudal regression syndrome
- cardiac defects (vsd)
- neural tube defects
- macrosomia —> shoulder dystocia
- neonatal hypoglycemia (due to islet cell hyperplasia)
- polycythemia
Methylmercury
Neurotoxicity
Highest in: swordfish, shark, tilefish, king mackerel
Vit A excess
Extremely high risk for spontaneous abortion and birth defects (cleft palate, cardiac)
X rays
Microcephaly, intellectual disability. Minimized by lead shielding
Opoids
Involves CNS, ANS, GI
Universal screening in all pregnant patients
Neonatal abstinence/ withdrawal syndrome:
- uncoordinated sucking reflexes
- irritability
- high- pitched crying
- tremors
- tachypnea
- sneezing
- diarrhea
- possibly seizures
Tx for opiate abuse: methadone, morphine, buprenorphine
phenytoin
neural tube defects microcephaly orofacial clefts dysmorphic facial features distal digit/nail hypoplasia
valproate
neural tube defects
methotrexate
limb and craniofacial abnormalities, neural tube defects, abortion
