Teratology

Question 1

Most common fetal anomaly from cyclophosphamide?

Answer 1

Missing or hypoplastic digits

Question 2

What are the fetal effects of ACE inhibitors?

Answer 2

No structural malformations from first trimester exposure have been noted.
Most commonly there is late-onset growth restriction and oligo followed by profound and prolonged neonatal hypotension and anuria.
The most severe consequence is renal tubular dysgenesis which causes early onset oligo, pulmonary hypoplasia and limb contractures.
Hypocalvaria is also strongly linked to ACE inhibitor exposure.

Question 3

Which of the following medications are contraindicated in breastfeeding?

Answer 3

Cyclosporine, PTU - ok, Warfarin, Phenytoin

Question 4

Anticonvulsants that should be avoided in pregnancy, at least in first trimester

Answer 4

Valproic acidPhenytoinCarbamazepinePhenobarbitalTopiramatePrimidoneTrimethadione

Question 5

Overall rate of major fetal malformations with phenobarbital

Answer 5

6.00%

Question 6

Overall rate of major fetal malformations with lamotrigine

Answer 6

3.00%

Question 7

Overall rate of major fetal malformations with carbamazepine

Answer 7

3.00%

Question 8

Fetal malformations associated with carbamazepine

Answer 8

CraniofacialFingernail hypoplasiaDevelopmental delayNeural tube defects

Question 9

Overall rate of major fetal malformations with valproic acid

Answer 9

10.00%

Question 10

Fetal malformations associated with valproic acid

Answer 10

Neural tube defects (1-2%)Cleft lip/palateDevelopmental delayHypospadiasCardiac malformationsEndocrine disorders

Question 11

Fetal malformations associated with phenytoin

Answer 11

Fetal hydantoin syndrome:Prenatal & postnatal growth deficiencyMicrocephalyDysmorphic faciesMental deficiencyCleft lip/palate

Question 12

How common is fetal hydantoin syndrome

Answer 12

May be seen in 11% of infants exposed to phenytoin in utero, but 30% may have lesser degrees of impairment

Question 13

Fetal malformations associated with topiramate

Answer 13

Oral cleftsIncreased risk of low birth weight

Question 14

Fetal malformations associated with lamotrigine

Answer 14

Facial clefts

Question 15

Which is more teratogenic: valproic acid or carbamazepine?

Answer 15

Valproic acid

Question 16

Valproic acid + ___ is particularly teratogenic.

Answer 16

Lamotrigine

Question 17

Is breastfeeding contraindicated in women taking anticonvulsants?

Answer 17

No. Monitor infants for sedation. Valproic acid, phenobarbital, phenytoin, and carbamazepine may be considered as not transferring into breast milk as much as levetiracetam, gabapentin, lamotrigine, and topiramate.