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Teratogens Flashcards

1
Q

Infection can be required through:

A

venereal transmission, respiratory spread, contact with infected blood products, cat litter or uncooked meat

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2
Q

Venereal transmission can cause:

A

syphilis gonorrhea, herpes virus, CMV, HIV
therefore can be in vagina and passed to baby during birth (may consider a C-section is infection is diagnosed and active)

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3
Q

Respiratory spread can cause:

A

rubella, varicella, coxsackie

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4
Q

contact with infected blood products can cause:

A

HIV, hepatitis, malaria

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5
Q

cat litter or uncooked meat can cause:

A

toxoplasmosis

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6
Q

classic teratogenic time period during pregnancy

A

weeks 7-10 from last menstrual period (most women don’t know they are pregnant yet)

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7
Q

prenatal infection can cause:

A
  • embryonic death and reabsorption (extremely early infections);
  • spontaneous abortion (SAB) and stillbirth (after pregnancy is recognized);
  • prematurity, IUGR, low birth weight (usually infection in 3rd trimester);
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8
Q

the majority of children exposed to infection are:

A

normal infants!

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9
Q

general signs of infection post-delivery:

A

purpura (red rash), jaundice, hepatosplenomegaly, pneumonitis (inflammation of lungs), meningoencephalitis (inflammation of brain)

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10
Q

IgG antibody

A

antibody associated with lifelong immunity, forms 3-4 weeks after IgM

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11
Q

IgM antibody

A

initial antibody formed following viral infection - goes away after 6 months

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12
Q

CMV symptoms

A
  • Mom is typically ASYMTPOMATIC
  • high risk of intellectual disability/developmental delay
  • pneumonia
  • hepatosplenomegaly
  • jaundice
  • thrombocytopenia
  • microcephaly
  • deafness
  • blindness (optic nerve atrophy)
  • brain calcifications
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13
Q

Individuals at higher risk for CMV:

A

health care workers

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14
Q

Treatment for CMV

A

NONE

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15
Q

CMV ultrasound findings

A

hepatic calcifications, fetal ascites

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16
Q

Congenital Rubella Syndrome features

A
  • ocular concerns: cataracts, glaucoma (10-30%)
  • CNS: deafness (60-70%), intellectual disability, microcephaly (10-25%)
  • cardiac: PDA (10-20%)
  • low birth weight
  • prematurity
  • blueberry muffin purpura
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17
Q

Toxoplasmosis maternal symptoms

A

flu-like illness or mono, but most are asymptomatic. 1/3 chance of fetal infection if mom has it

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18
Q

Individuals at higher risk for Toxo

A

exposure to raw or undercooked mutton or lamb, direct contact with cat shit

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19
Q

Some factors that affect tetratogenicity:

A

developmental phase, genotype, dose effect

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20
Q

How to evaluate whether an agent is a teratogen:

A

phenotypic effect, animal model, dose-response relationship, plausible biological explanation (present during critical periods of development)

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21
Q

categories of teratogens

A

deficiency/excess of endogenous agents, medications, industrial chemicals, environmental contaminants, physical agents (trauma, hyperthermia, radiation), infections, maternal disease

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22
Q

Medications that are classic known teratogens

A

Warfarin, Streptomycin, Valproid Acid (and basically every other seizure medication), ACE inhibitors, Lithium

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23
Q

Maternal diseases that have teratogenic effects

A

Insulin dependent diabetes, hypo/hyperthyroidism, PKU, hypertension, autoimmune disorders

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24
Q

Most common psychosocial reaction to teratogens

A

guilt

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25
Q

Thalidomide

A
  • can treat leprosy, multiple myeloma, hyperemesis & pregnancy related nausea
  • can cause limb reduction defects, ear anomalies
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26
Q

Diethylstilbestrol (DES)

A
  • was used from 1940 and 1971 to prevent miscarriage, premature labor, and related complications of pregnancy (didn’t work)
  • can cause vaginal adenosis/adenocarcinoma, cervical erosion and ridges
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27
Q

Warfarin

A
  • blood thinner to treat clotting d/o

- can cause nasal hypoplasia, stippled epiphyses, CS defects

28
Q

Hydantoin

A
  • can treat epilepsy

- can cause dysmorphic facial features, hypoplastic nails, growth and developmental delay

29
Q

Aminopterin and methotrexate

A
  • chemotherapy

- pregnancy loss, hydrocephalus, low birth weight, dysmorphic facial features

30
Q

Streptomycin

A
  • can treat TB

- can cause hearing loss

31
Q

Tetracycline

A
  • can treat acne and skin infections

- can cause stained teeth, enamel hypoplasia

32
Q

Valproic acid

A
  • can treat seizures and bipolar disorder

- can cause neural tube defects, dysmorphic facial features

33
Q

Isotretinoin

A
  • can treat severe acne
  • can cause pregnancy loss, hydrocephalus, other CNS defects, small or absent thymus, microtia/anotia, conotruncal heart defects
34
Q

Antithyroid drugs

A
  • can cause hypothyroidism, goiter
35
Q

Penicillamine

A
  • medication is immunosuppression to treat rheumatoid arthritis, Wilson’s disease, cystinuria
  • can cause cutis laxa
36
Q

ACE Inhibitors

A
  • can treat hypertension, congestive heart failure
  • can cause renal dysgenesis, oligohydramnios sequence, skull ossification defects
  • in contrast to most teratogens, critical period is second & third trimester
37
Q

Carbamazepine (Tegretol anticonvulsant)

A
  • can treat epileptic seizures and nerve pain

- can cause neural tube defects

38
Q

Cocaine

A
  • can cause pregnancy loss, placental abruption, growth retardation, microcephaly
39
Q

Lithium

A
  • can treat bipolar disorder

- can cause Ebstein anomaly

40
Q

Methylmercury

A
  • primarily occurs through the consumption of contaminated food such as fish
  • can cause cerebral atrophy, spasticity, mental retardation
41
Q

Lead

A
  • can cause pregnancy loss, CNS damage
42
Q

Polychlorobiphenyls (PCBs - ingested)

A
  • exposure through food

- can cause low birth weight, skin discoloration

43
Q

Cigarette smoking during pregnancy

A

can cause pregnancy loss, low birth weight

44
Q

Hyperthermia during pregnancy

A

can cause neural tube defects

45
Q

Chronic alcoholism during pregnancy

A
  • classic triad of FAS involves a pattern of growth deficiency, CNS involvement and facial dysmorphology.
46
Q

Therapeutic Radiation during pregnancy

A

can cause growth and developmental delay, microcephaly

47
Q

Maternal Insulin Dependent Diabetes Mellitus

A

can cause congenital heart defects, caudal
deficiency, neural tube defects,
limb defects, holoprosencephaly, pregnancy loss

48
Q

Maternal Hypo/Hyperthyroidism

A

can cause goiter, growth and developmental

retardation

49
Q

Maternal Phenylketonuria

A

can cause pregnancy loss, microcephaly, mental retardation, facial dysmorphism, congenital heart defects

50
Q

Maternal Hypertension

A

can cause intrauterine growth retardation

51
Q

Maternal autoimmune disorders

A

can cause congenital heart block, pregnancy

loss

52
Q

Potential teratogenic effects

A
  • spontaneous abortion
  • growth retardation
  • microcephaly
  • patterns of major and minor malformations
  • metabolic dysfunction
  • cognitive dysfunction or mental deficiency
  • altered social behavior
  • malignancy
53
Q

Recreational drugs with known teratogenic effects

A
  • alcohol
  • cigarette smoke
  • cocaine
  • toluene
54
Q

Methadone

A
  • can treat pain & drug addiction
  • can cause developmental problems, behavioral problems, adverse effects on fetal growth, increased risk of stillbirth, premature birth, decreased fetal movements, neonatal withdrawal
55
Q

Buprenorphine/Subutex

A
  • can treat pain & drug addiction
  • DOES NOT significantly increase risk for birth defects
  • 60% neonatal withdrawal
56
Q

Naloxone/Suboxone

A
  • can treat pain & drug addiction
  • no human data but animal data is reassuring
  • neonatal withdrawal is possible
57
Q

Naltrexone

A
  • can help prevent relapses into drug & alcohol abuse
  • limited human data, but does not significantly increase risk for birth defects
  • theoretical risk for behavioral abnormalities
58
Q

Toluene

A
  • aromatic hydrocarbon found in some spray paints, glues and lacquers
  • inhaled to cause acute intoxication
  • can cause microcephaly, intellectual disability, growth deficiency, craniofacial abnormalities similar to fetal alcohol syndrome
59
Q

Isotrentinoin (Accutane)

A
  • can treat severe acne

- can cause CNS anomalies, ear anomalies, cardiac defects, thymus anomalies, intellectual disability

60
Q

Etretinate

A
  • can treat psoriasis
  • stored in the body for long time (years)
  • can cause same as isotrentinoin: CNS anomalies, ear anomalies, cardiac defects, thymus anomalies, intellectual disability
61
Q

Trentinoin (Retin A)

A
  • can treat acne, wrinkles
  • theoretical risk b/c of relation to isotrentinoid, but likely to be low risk
  • generally administered topically
62
Q

Dietary Vitamin A

A
  • can cause CNS defects, urinary tract defects, face, palate, heart, ear deformities
63
Q

Beta carotene

A
  • provitamin A compound provided by vegetables
  • NOT teratogenic
  • found in prenatal supplements
64
Q

Diagnostic X-ray during pregnancy

A

NOT believed to be teratogenic (<5 rads & serious risk to fetus occurs when absorbed dose is 10 rads or more)

65
Q

Lead exposure during pregnancy

A
  • NO increased risk for structural malformations
  • Inconsistent data re: IUGR
  • greatest concern for neurobehavioral development
66
Q

Theoretical effects of paternal exposure to teratogens

A
  • DNA mutations in sperm (ex: radiation)
  • Alterations to fertility
  • Presence of agent in sperm directly affects fetal development
  • NO PATERNAL EXPOSURE HAS EVER ACTUALLY BEEN SHOWN TO BE TERATOGENIC
67
Q

Phenytoin

A
  • can treat seizures (anti-convulsant)

- can cause IUGR, microcephaly, hypoplastic nails and distal phalanges

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