W11_11 teratogens and therapeutics in pregnancy Flashcards
define teratogen
any agent that may have harmful effects on the fetus
what’s the baseline risk of a major malformation in the general population?
1-3%
when’s the “all-or-none” period?
12 days following ovulation
when’s the major time period of organogenesis?
first 8 or 9 weeks
when does the placenta first become significant?
about 5 weeks gestation
note: uncontrolled diabetes prior to pregnancy increases risk of major malformations to 5-9%
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how does maternal hypothyroidism affect the fetus?
severe maternal hypothyroidism can affect the baby’s IQ
what’s the TORCH infections?
toxoplasmosis;
other (syphillis, varicella);
rubella;
cytomegalovirus;
herpes simplex
what is isotretinoin (accutane) used for and what teratogenic effects does it have?
used for acne treatment;
micrognathia;
microtia;
cardiac issues;
neurologic issues
recall thalidomide
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what’s fetal warfarin syndrome?
nasal hypoplasia;
stippled epiphyses;
IUGR?;
CNS damage?;
eye defects and hearing loss
which two drugs can cause risk of neural tube defects?
carbamazepine;
valproic acid
note: dilantin can cause craniofacial abnormalities
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why do ACE inhibitors have teratogenic effects (note only in 2nd,3rd trimesters)?
decrease baby blood pressure.
Damage kidneys;
oligouria
hypocalvaria (thinning of skull plate bones)
what does lithium cause in the fetus?
ebstein’s anomaly
what’s ebstein’s anomaly?
insertion of the tricuspid valve is displaced, affecting right ventricular function
what’s the number 1 cause of maternal death in pregnant women in the UK?
cardiac disease; then
infection;
indirection neurological conditions
what’s the safest drug for anticoagulation in pregnant women
heparin (low molecular weight)
note: bronchodilators (beta2 agonists) and inhaled steroids are safe in pregnancy
systemic steroids po, IV - might be more risky of growth and cleft lip/palate
what’s the teratogenic amount of radiation?
5-15 rad (50-150 mSv)
which is the biggest radioactive risky test that you cannot do in a pregnant woman?
radioactive thyroid uptake scan (collects in the fetal thyroid)
note: organic solvents MAY be associated with neurological and colour vision defects
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note: mercury can cause disease in the fetus
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what’s the triad of fetal alcohol syndrome?
growth retardation;
dysmorphic facies;
decreased IQ/behavioural abnormalities
who should be taking 5mg of folic acid?
people with history of NTD;
BMI > 35, epilepsy, diabetes, certain ethnic groups, suspected poor complicance
