W11_11 teratogens and therapeutics in pregnancy

Question 1

define teratogen

Answer 1

any agent that may have harmful effects on the fetus

Question 2

what’s the baseline risk of a major malformation in the general population?

Answer 2

1-3%

Question 3

when’s the “all-or-none” period?

Answer 3

12 days following ovulation

Question 4

when’s the major time period of organogenesis?

Answer 4

first 8 or 9 weeks

Question 5

when does the placenta first become significant?

Answer 5

about 5 weeks gestation

Question 6

note: uncontrolled diabetes prior to pregnancy increases risk of major malformations to 5-9%

Answer 6

ok

Question 7

how does maternal hypothyroidism affect the fetus?

Answer 7

severe maternal hypothyroidism can affect the baby’s IQ

Question 8

what’s the TORCH infections?

Answer 8

toxoplasmosis;
other (syphillis, varicella);
rubella;
cytomegalovirus;
herpes simplex

Question 9

what is isotretinoin (accutane) used for and what teratogenic effects does it have?

Answer 9

used for acne treatment;
micrognathia;
microtia;
cardiac issues;
neurologic issues

Question 10

recall thalidomide

Answer 10

ok

Question 11

what’s fetal warfarin syndrome?

Answer 11

nasal hypoplasia;
stippled epiphyses;
IUGR?;
CNS damage?;
eye defects and hearing loss

Question 12

which two drugs can cause risk of neural tube defects?

Answer 12

carbamazepine;
valproic acid

Question 13

note: dilantin can cause craniofacial abnormalities

Answer 13

ok

Question 14

why do ACE inhibitors have teratogenic effects (note only in 2nd,3rd trimesters)?

Answer 14

decrease baby blood pressure.
Damage kidneys;
oligouria
hypocalvaria (thinning of skull plate bones)

Question 15

what does lithium cause in the fetus?

Answer 15

ebstein’s anomaly

Question 16

what’s ebstein’s anomaly?

Answer 16

insertion of the tricuspid valve is displaced, affecting right ventricular function

Question 17

what’s the number 1 cause of maternal death in pregnant women in the UK?

Answer 17

cardiac disease; then
infection;
indirection neurological conditions

Question 18

what’s the safest drug for anticoagulation in pregnant women

Answer 18

heparin (low molecular weight)

Question 19

note: bronchodilators (beta2 agonists) and inhaled steroids are safe in pregnancy

Answer 19

systemic steroids po, IV - might be more risky of growth and cleft lip/palate

Question 20

what’s the teratogenic amount of radiation?

Answer 20

5-15 rad (50-150 mSv)

Question 21

which is the biggest radioactive risky test that you cannot do in a pregnant woman?

Answer 21

radioactive thyroid uptake scan (collects in the fetal thyroid)

Question 22

note: organic solvents MAY be associated with neurological and colour vision defects

Answer 22

ok

Question 23

note: mercury can cause disease in the fetus

Answer 23

ok

Question 24

what’s the triad of fetal alcohol syndrome?

Answer 24

growth retardation;
dysmorphic facies;
decreased IQ/behavioural abnormalities

Question 25

who should be taking 5mg of folic acid?

Answer 25

people with history of NTD;
BMI > 35, epilepsy, diabetes, certain ethnic groups, suspected poor complicance