teratogens Flashcards
teratogens effects according to period
before week 3 –> all-or-none
3-8 weeks (embryonic period - most suscpetible)
after 8 weeks –> growth and function affected
Antibiotics to avoid in pregnancy (and why)
- Sulfonamides –> Kernicterus
- Amniglycosides –> Ototoxicity
- Fluoroquinolones –> Cartilage damage
- macrolides –> embryotoxic
- tetracyclines –> DIscolored teeth, inhibiton of growth
- Chloramphenicol –> Gray babe syndrome
- Griseofluvin –> teratogenic
- Ribavirin (antiviral)
drugs and substance that affect pregnancy (beside antibiotics) (14)
- ACE inhibitors 2. Alkylating agents 3. Antiepileptics
- Diethylstibestrol 5. Folate antagonists
- Isotretinoin 7. Lithium 8. Methimazol
- Thalidomide 10. Warfarin 11. Alcohol 12. Cocaine
- Smoking (nicotine, CO) 14. others factors
Alkylating agents - effects on fetus
- absence of digits
2. multiple anomalies
Warfarin - effects on fetus
- bone deformities
- fetal hemorrhage
- abortion
- opthalmologic abnormalities
Methimazole - effects on fetus
aplasia cutis congenita
thalidomide - effects on fetus
limb defects (phocomelia, micromelia - flipper limbs)
phocomelia
a rare congenital deformity in which the hands or feet are attached close to the trunk, the limbs being grossly underdeveloped or absent.
micromelia
limb is abnormally shortened
isotretinoin (13-cis retinoic acid) - effects on fetus
multiple severe birth defects (contraception mandatory)
Folate antagonists - effects on fetus / drugs?
neural tube defects
- TMP
- Methotrexate
- antiepileptic drugs
Complications of DES daughters
- clear cell adeno of vagina + cervic
- stractureal anomalies of the reproductive syystem
- pregnancy problems
- infertility
antiepileptic drugs - effects on fetus
- neural tube defects
- cardiac defects
- cleft palate
- skeletal abnormalities (phalanx/nail) hypoplasia, facial dysmorphism)
antiepileptic drugs that affect fetus - which drugs Most commonly
- carbamazepine
- phenobarbital
- phenytoin
- valproate
antiepileptic drugs - co-administration with
high dose of follate acid
substance abuse that affects fetus
- Alcohol
- cocaine
- Smoking (nicotine, CO)
alchohol abuse - effects on fetus
- common cause of birth defects and intellectual disability
- fetal alcohol syndrome
cocaine abuse - effects on fetus
- low birth weight
- preterm birth
- Intrauterine growth restriction (IUGR)
- placental abruption
smoking - effects on fetus
- Low birth weight (leading cause in developed countries)
- preterm labor
- placental problems
- Intrauterine growth restriction (IUGR)
- SIDS
iodine (lack or excess) - effect on fetus
congenital goiter or hypothiroidism (cretinism)
Methylmercury - effect on fetus / found
NEUROTOXICITY
- swordfish
- shark
- tilefish
- king mackerel
Vitamin A excess - effect on fetus
Extremely high risk for spontaneous abortions and birth defects (cleft palate, cardiac)
X-rays - effect on fetus
- Microcephaly
2. intellectual disability
Leading cause of low body weight in in developed countries
smoking
Leading cause of intellectual disability in USA / mechanism
Fetal alcohol syndrome –> failure of cell migration
newborns of alcohol consumption mothers have increased incidence of congenital abnormalities, including
- pre and postnatal developmental retardation 2
- microcephaly
- facial abnormalities
- limb disolocation
- heart defects
- heart-lung fistulas
- holoprosencephaly
Fetal alcohol syndrome - Most severe form
- heart-lung fistulas
2. holoprosnecephaly
Fetal alcohol syndrome - facial abnormalities
- smooth philtrum
- thin vermilion border (upper lip)
- small palpebras fissures
drugs that affect bone/limbs of fetus (and how)
- Warfarin (bone deformities)
- tetracyclines (inhibited bone growth)
- thalidomide (limb defects (phocomelia, micromelia - flipper limbs))
- alcohol (limb disolocation)
- antiepileptics (skeletal abnormalities (phalanx/nail) hypoplasia, facial dysmorphism)
Males exposed to DES in the utero - complciations
cryptorchidism
microphallus
hyposadias
testicular hypoplasia
azathiprine in pregnancy
safe
lithium exposure during pregnancy
1st trimester: Ebstein anomaly
2nd and 3rd trimester: goiter and neonatal neuromuscular dysfunction
woman under lithium becomes pregnant –> ….
slow tapering lithium
no abrupt stopping
inhale steroids during pregnancy
ok
fetal hydantion syndrome
small body size, microcephali, digital hypoplasia, nail hypoplasia, hirsutism, cleft palate, rib abnormalities
- phenytoin, carbamazepine
