Teratogens and SGA Flashcards
What abnormalities occur in infants exposed to ACE inhibitors in utero?
Exposure to ACE inhibitors in the 2nd and 3rd trimesters increases the risk of renal dysgenesis, oligohydramnios, and skull ossification defects.
What is the most common overall cause of intellectual disability?
Fetal alcohol syndrome
What complications are associated with the presence of maternal hypertension after the 20th week of gestation?
IUGR, placental insufficiency, and placental abruption or previa.
Define small for gestational age.
Infants who are SGA have birth weights <10th percentile for all fetuses at the same gestational age.
What are some of the (12) perinatal complications that an SGA infant can have?
Perinatal asphyxia, meconium aspiration, persistent pulmonary HTN, necrotizing enterocolitis, respiratory distress syndrome, intracranial hemorrhage, temperature instability, hypoglycemia, polycythemia/hyperviscosity, impaired immune function, impaired protein and lipid metabolism, neurodevelopmental abnormalities.
What abnormality are infants exposed to carbamazepine in utero at risk for?
When exposure occurs between 15 and 29 days after conception, there is an increased risk (<1%) for the development of spina bifida.
What syndrome is seen in infants who were exposed to phenytoin in the 1st trimester of pregnancy?
Fetal hydantoin syndrome (growth deficiency, developmental delays, craniofacial anomalies, and hypoplastic phalanges/nails).
What (6) congenital abnormalities would one expect in an infant exposed to retinoids in utero?
Microcephaly, facial nerve palsies, microtia and external auditory canal anomalies, cardiovascular defects, thymic hypoplasia, and GU anomalies.
Define inrauterine growth restriction.
IUGR refers to a condition in which a fetus is not able to achieve its genetically determined potential size. By definition, this excludes infants who are SGA but are not pathologically small.
How might an infant exposed to mercury in utero present clinically?
Mercury poisoning in the fetus can manifest as cerebral atrophy, seizures, and developmental delay.
What two congenital cardiac abnormalities can be seen as a result of Lithium use before 8 weeks of gestation?
Lithium use results in a <1% chance of Ebstein anomaly. Congenital heart block can also occur.
List three retinoids which should be avoided in pregnancy.
Isotretinoin, etretinate, and megadoses of Vitamin A (retinol). They are used to treat acne and psoriasis and women using these medications should be using reliable forms of birth control.
What is the definition of a low birthweight infant?
< 2,500 g
What are the risks to the fetus of exposure to valproic acid in utero?
Valproic acid use in the first 30 days after conception has a 2% risk of spina bifida. Use during the 1st trimester can result in craniofacial abnormalities and preaxial defects.
How might extensive maternal hyperthermia during pregnancy adversely affect the fetus?
Extensive hyperthermia for prolonged periods (hot tub users and high maternal fever) during days 14-30 postconception increases the risk of neural tube defects.
Lsit five congenital anomalies which may occur due to maternal infection with CMV during pregnancy.
Low birth weight, intellectual disability, microcephaly, periventricular calcifications, and hearing loss.
What is neonatal abstinence syndrome (NAS)?
NAS refers to the withdrawal symptoms in a neonate born to a mother who takes or abuses certain drugs, particularly opiates, during pregnancy. The central and autonomic nervous systems are especially vulnerable.
What are the different congenital anomalies caused by rubella? How are these dependent on the time of infection?
Infection up to 8 weeks gestation: deafness (85% affected). Infection from 9-12 weeks: cataracts (52% affected). Infection from 12-30 weeks: heart defects (16% affected).
What is the risk of malformation in fetuses exposed to anticonvulsants?
The risk is doubled. Polytherapy with anticonvulsants increases the risk even further.
What are the neonatal complications of maternal warfarin use during pregnancy?
Warfarin use during weeks 6-9 of gestation can cause fetal warfarin syndrome (nasal hypoplasia and stippled epiphyses). There may also be CNS effects in the infant or spontaneous abortions.
What (4) risks are associated with maternal SLE during pregnancy?
SLE increases the risk of spontaneous abortion in pregnancy before 20 weeks of gestation. After 20 weeks, it causes increased risk of stillbirth, prematurity, and congenital heart block.
How does maternal hypertension relate to miscarriage?
HTN occurring before the 20th week of gestation increases the risk of miscarriage.
List some (8) symptoms associated with neonatal abstinence syndrome (NAS).
High-pitched cry, irritability, sleep problems, tremors, feeding difficulty, vomiting/diarrhea, seizures, and autonomic symptoms (i.e. sweating, yawning, mottling, fever, and nasal congestion/sneezing).
What is the complication associated with maternal use of tetracycline during pregnancy?
Maternal tetracycline use after 20 weeks of gestation can cause tooth discoloration in the child. Tetracycline can also accumulate in developing bones and affect growth.
What is the most common human teratogenic state?
Diabetes mellitus in the mother.
What are the (6) maternal risk factors for an SGA infant?
Severe malnutrition, hypoxemia, uteroplacental dysfunction, TORCH infections, substance abuse, and toxins.
How might congenital toxoplasmosis present?
Microcephaly, hydrocephalus, diffuse cerebral calcifications, chorioretinitis, hepatosplenomegaly, jaundice, and maculopapular rash/purpura.
What are the 3 distinct categories of findings in children with fetal alcohol syndrome?
Facial abnormalities, pre- or postnatal growth deficiency, and cognitive abnormalities.
How many of the known facial anomalies must be present for a child to qualify for the diagnosis of fetal alcohol syndrome? List the seven possible facial abnormalities.
A child must have 2 of the following facial anomalies to qualify for a diagnosis of FAS: shortened palpebral fissures, epicanthal folds, hypoplastic nasal root, short upturned nose, hypoplastic or absent philtrum, thin upper lip, and midface hypoplasia. ***Image 1-12
What are the most commonly described abnormalities in infants with congenital syphilis?
Abnormal teeth and bones, intellectual disability, and proteinuria.
What (5) risks are associated with cocaine use during pregnancy?
Increased risk of miscarriage, stillbirth, premature delivery, placental abruption, and intracranial hemorrhage.
When is it most effective for a woman with diabetes to get her blood sugar under control in order to decrease her child’s risk for birth defects?
Prior to conception.
List 5 complications of maternal cigarette smoking during pregnancy.
There is a high association with low birth weight. Heavy smoking can lead to miscarriage, premature birth, and stillbirth. Maternal smoking is also a risk factor for SIDS.
List five malformations which might be seen in an infant exposed to anticonvulsants in utero.
Neural tube defects, cleft palate, congenital heart defects, urinary tract defects, and skeletal abnormalities.
What findings would you expect in a symptomatic infant of a mother who used cocaine during the pregnancy?
Infants born to chronic users during pregnancy are frequently jittery, irritable, tremulous, and have muscle rigidity. These findings usually occur several days after birth and resolve without known long-term effects.
List seven fetal abnormalities which may occur due to maternal varicella infection during pregnancy.
Limb reduction defects, IUGR, microphthalmia, chorioretinitis, skin scarring, developmental delay, and microcephaly.
What supplement should women taking antiseizure medications be taking if they are pregnant or may become pregnant?
Antiseizure medications are folate antagonists, so women taking antiepileptics should also be taking a folate supplement.
List four congenital defects which can occur due to maternal diabetes mellitus.
Sacral agenesis (caudal regression syndrome), situs inversus, holoprosencephaly, and congenital heart disease.
Why was thalidomide initially pulled from the market in many countries?
It was used as an antinausea medication during pregnancy, but if fetal exposure occurs between 34-50 days of gestation, there is a 20% risk for limb defects, including missing arms and/or legs and ear malformations with deafness.
What factors must be present for a child to qualify for pre- or postnatal growth deficiency as part of the diagnostic evaluation of fetal alcohol syndrome?
A child must have at least one of the following: Weight < 10th percentile, microcephaly, or length/height ratio < 10th percentile.
What is the definition of a very low birthweight infant?
< 1,500 g
What is the congenital abnormality associated with use of streptomycin during the 3rd trimester?
Streptomycin use during the 3rd trimester can result in hearing loss in the infant.
What is the definition of an extremely low birthweight infant?
< 1,000 g
What abnormalities occur in infants exposed to methotrexate between 6 and 9 weeks of gestation?
Methotrexate exposure in utero can result in an increased risk of craniosynostosis, craniofacial abnormalities, and limb defects.
What risks are associated with the use of SSRIs during pregnancy?
SSRI use in the 1st trimester increases the risk of cardiovascular and/or other congenital malformations. Neonates exposed late in the 3rd trimester can present with neonatal abstinence syndrome and/or persistent pulmonary HTN.
What is the risk of maternal infection with parvovirus B19 during pregnancy?
Infection between the 10th and 24th weeks of pregnancy can result in a 7-10% fetal risk of severe anemia, heart failure, hydrops fetalis, and death.
What anomalies are seen in children whose mothers used DES?
Diethylstilbestrol use before 12 weeks of gestation increases the risk of vaginal adenocarcinoma in female offspring at a later age. There are also reports of uterine abnormalities, vaginal adenosis, and male infertility.
