Updated: 4/1/2020

Teratogens

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https://upload.medbullets.com/topic/103005/images/aplasia_1.jpg
https://upload.medbullets.com/topic/103005/images/meningo_1.jpg
https://upload.medbullets.com/topic/103005/images/teeth_.jpg
https://upload.medbullets.com/topic/103005/images/03252020vldebstein_sanomaly.jpg
https://upload.medbullets.com/topic/103005/images/meningomy_us.jpg
Snapshot
  • A 35-year-old G1P0 woman gives birth to a baby with the scalp finding seen in the image. A few months prior to her discovery that she was pregnant, she had symptoms of palpitations, heat intolerance, and weight loss. She was diagnosed with Graves disease and prescribed methimazole by her endocrinologist. During her pregnancy, she missed several routine prenatal appointments and inadvertently continued taking many of the same medications that she had been taking prior to her pregnancy, including methimazole. 
Introduction
  • Overview
    • teratogens are agents that can cause abnormal fetal development and birth defects
      • effects vary depending on timing of fetal exposure to the teratogen
        • weeks 1-3 of gestation
          • "all-or-none" effects 
            • the embryo either dies or survives without any complications
        • weeks 3-8 of gestation
          • embryonic period
          • most susceptible time period due to organogenesis
        • week 8 of gestation until birth
          •  growth and function of organs are affected
 
Teratogens
Substance Abuse
Teratogen Effects on Fetus
Alcohol
  • Fetal alcohol sydrome 
Cocaine
  • Low birth weight
  • Preterm birth
  • Intrauterine growth retristriction
  • Placental abruption
Nicotine
  • Low birth weight
  • Preterm labor
  • Placental problems
  • Sudden infant death syndrome
  • ADHD
Medications
ACE inhibitors (i.e., lisinopril)
  • Renal damage
    • renal dysplasia
Alkylating agents (i.e., cyclophosphamide)
  • Absence of digits
  • Cleft palate
  • Renal agenesis
Aminoglycosides (i.e., gentamicin)
  • Ototoxicity
Antiepileptic drugs (i.e., phenytoin)
  • Neural tube defects
  • Cardiac defects
  • Cleft lip and palate
Diethylstilbestrol
  • Vaginal clear cell adenocarcinoma
  • Congenital cervical, ovarian, and uterine abnormalities
Folate antagonists (i.e., methotrexate)
  • Neural tube defects
    • meningomyelocele  
Isotretinoin
  • Multiple severe birth defects (i.e., cleft palate, microphthalmia, and congenital heart defects)
Lithium
  • Ebstein anomaly  
Methimazole
  • Aplasia cutis congenita
Tetracyclines (i.e., doxycycline)
  • Discolored teeth
  • Inhibited bone growth
Thalidomide
  • Limb defects
Warfarin
  • Bone deformities
  • Fetal hemorrhage
  • Abortion
  • Ophthalmologic abnormalities

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Questions (4)
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(M1.EB.14.70) A 5-year-old boy presents for a regularly scheduled check-up. The child is wheelchair bound due to lower extremity paralysis and suffers from urinary incontinence. At birth, it was noted that the child had lower limbs of disproportionately small size in relation to the rest of his body. Radiograph imaging at birth also revealed several abnormalities in the spine, pelvis, and lower limbs. Complete history and physical performed on the child's birth mother during her pregnancy would likely have revealed which of the following?

QID: 106476
1

Maternal hyperthyroidsim

5%

(13/264)

2

Uncontrolled maternal diabetes mellitus

42%

(110/264)

3

Maternal use of tetracyclines

21%

(55/264)

4

Maternal use of lithium

16%

(41/264)

5

Maternal use of nicotine

14%

(36/264)

M 1 E

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Evidence (2)
VIDEOS & PODCASTS (1)
EXPERT COMMENTS (9)
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