Teratogens Flashcards
def. teratogen
an agent that may have a negative effect on the baby
5 possible teratogen effects
- preg. loss
- congenital malformations
- neurobehavioral
- IUGR
- long term carcinogen
2 classes of malformation
- major - require intervention
2. minor - traits with no serious or cosmetic consequence
** what is baseline risk of malformation
1-3%
2 major risk for malformation
- unknown
- genetic
drugs are 1%
what is all or none period
time after fert and before implantation (12 days after ovulation)
- either kills or is fine
when is are most structures developed by and 2 exception
done by end of T1 except brain and eye
when does placenta play a role
5 weeks
- won;t let some drugs through
4 mechs. of teratology
- control of cell division
- apop
- gene expression
- cell metabolism
6 mech of toxicity
- hyperthermia
- hypoxia
- acid base
- reduced uterine flow
- elevated cortisol
- def. of zinc
4 maternal conditions that are teratologic
- diabetes - hyperglycemia - cardiac, neural tube, macrosomia
- hypothyroidism - decrease IQ
- chronic renal failure - oligohydro
- conditions with antibodies -SLE, graves
5 major maternal infections
Toxoplasmosis Other (syph, varicella) Rubella Cytomegalovirus Herpes simplex
6 bad drugs
- accutane - miscarriage and malformations
- thalidomide - flippers (phocomegaly)
- warfarin 6-9 weeks
- anticonvulsants
- ACEi
- lithium
when is warfarin risk
6-9 weeks - facial defects
4 anticonvulsants and their risks
- carbamazepin - 1% risk of NTD
- lamotragine - no effects
- valproic acid - 2% risk of NTD, others possible
- phenytoin (dilantin) - craniofacial, impaired growth - 10%
when is ACEi effect and what
back in T2-3
- oligouria, low BP - polyhydramnios
what is effect of lithium
ebsteins abnormality
5 classes of FDA
A - no risk human studies
B - no risk in human studies, but yes in animals
C- animals studies bad - no human studies
D- poor quality studies
x- contraindicated
2 probs with FDA
- not always updated
2. need RCTs which preg women are excluded from
how to anticoagulate a preg. woman
heparin - large and can’t pass
what to use for asthma
- bronchdilator - safe
- inhaled steroids - safe
- systemic steroid - some probs
what is radiation principle
ALARA - need 5-15rads to cause prob- all are way below 5
2 env. exposures
- organic solvents
2. mercury - avoid big fish and 1 can tuna/week
traid of FAS
- growth retard
- dysmorphic features
- decreased IQ and behav issues
3 prevention strategies
- folic acid before preg - high dose if high risk
- multivitamin throughout
- US at 18 weeks
what is breastfeeding reccomendation
generally safe - keep to 10% of maternal dose
