Teratogens

Question 1

ACEi and ARBS (no angiotensin II)

Answer 1

Renal dysgenesis/agenesis, oligohydramnios, hypocalvaria in fetus –> potter’s sequence

Question 2

Alkylating agents

Answer 2

Absence of digits, multiple anomalies

Question 3

Aminoglycosides (neomycin, gentamycin)

Answer 3

Ototoxicity

Question 4

Antiepileptic drugs (esp. valproate, carbamazepine, phenytoin, phenobarbital)

Answer 4

High- dose folic acid recommended with all others

Causes: neural tube defects, cardiac defects, cleft palate, skeletal abn (phalynx/nail hypoplasia, facial dysmorphism)

Question 5

Diethylsilbestrol (DES)

Answer 5

Vaginal clear cell adenocarcinoma, congenital müllerian anomalies (uterus, fallopian tubes, upper vagina, cervix)

Question 6

Fluoroquinolones

Answer 6

Cartilage damage

Question 7

Folate antagonists (antiepileptics, trimethoprim, methotrexate)

Answer 7

Neural tube defects

Question 8

Isotretinoin

Answer 8

Contraception is mandatory
Multiple severe birth defects
microcephaly
thymic hypoplasia
small ears
hydrocephalus

Question 9

Lithium

Answer 9

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

Question 10

Methimazole

Answer 10

Use only in second and third trimesters
Aplasia cutis in fetus
Use PTU in first trimester

Question 11

PTU (propylthiouracil)

Answer 11

Use only in first trimester

Hepatotoxicity in utero

Question 12

Tetracyclines

Answer 12

Discolored teeth, inhibited bone growth

Question 13

Thalidomide

Answer 13

Limb defects (phocomelia, micromelia “flipper hands”)

Question 14

Warfarin

Answer 14

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

Question 15

Alcohol

Answer 15

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)

Question 16

Cocaine

Answer 16

Causes vasoconsriction

• low birth weight
• preterm birth
• IUGR
• placental abruption

Question 17

Smoking

Answer 17

Nicotine causes vasoconstriction
CO causes impaired oxygen delivery

• low birth weight (leading cause in developed countries)
• preterm labor
• Placental problems
• IUGR
• SIDS
• ADHD

Question 18

Iodine excess

Answer 18

Congenital goiter

Question 19

Iodine deficiency

Answer 19

Hypothyroidism (cretinism) - intellectual disability

Question 20

Maternal diabetes (GDM)

Answer 20

• Caudal regression syndrome
• cardiac defects (vsd)
• neural tube defects
• macrosomia —> shoulder dystocia
• neonatal hypoglycemia (due to islet cell hyperplasia)
• polycythemia

Question 21

Methylmercury

Answer 21

Neurotoxicity

Highest in: swordfish, shark, tilefish, king mackerel

Question 22

Vit A excess

Answer 22

Extremely high risk for spontaneous abortion and birth defects (cleft palate, cardiac)

Question 23

X rays

Answer 23

Microcephaly, intellectual disability. Minimized by lead shielding

Question 24

Opoids

Answer 24

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

Question 25

phenytoin

Answer 25

neural tube defects
microcephaly
orofacial clefts
dysmorphic facial features
distal digit/nail hypoplasia

Question 26

valproate

Answer 26

neural tube defects

Question 27

methotrexate

Answer 27

limb and craniofacial abnormalities, neural tube defects, abortion