Updated: 11/6/2018

Teratogens / Fetal Alcohol Syndrome

Topic
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Questions
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Evidence
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Overview

  • Week 1-3
    • "all-or-none": the embryo either dies or survives without any complications
  • Week 3-8 (Embryonic Period) 
    • most vulnerable time period due to organogenesis
  • Week 8-38
    • growth and function of organ/embryo is affected
    • decreased susceptibility due to organs already formed
Teratogens
 
Examples
Effects on fetus
ACE inhibitors
  • Renal damage
    • renal dysplasia
Alcohol
  • Fetal Alcohol Syndrome
Alkylating agents
  • Absence of digits
  • Cleft palate
  • Renal agenesis
Aminoglycosides
  • CN VIII toxicity
Anticonvulsants
  • Cleft lip and palate
Cocaine
  • Abnormal fetal development
  • Fetal addiction
  • Low-birth weight
  • Placental abruption
Diethylstilbestrol (DES)
  • Vaginal clear cell adenocarcinoma
  • Other cervical, ovarian, and uterine abnormalities
Folate antagonists
  • Neural tube defects
    • myelomeningocele
Lithium
  • Ebstein's anomaly
    • atrialized right ventricle 
Maternal diabetes
  • Caudal regression syndrome 
    • sirenomelia
    • renal dysplasia or aplasia
    • imperforate anus
Phenytoin
  • Cleft lip and palate
  • Congenital heart defects
Potassium iodide
  • Congenital goiter or hypothyroidism
  • Cretinism
Nicotine
  • Premature delivery
  • Low birth weight
  • Intrauterine growth retardation
  • ADHD
Tetracyclines
  • Discolored/stained teeth
Thalidomide
  • Gastrointestinal atresia 
  • Absence or malformation of external ear
  • Phocomelia 
    • "seal" limbs
Valproate
  • Inhibits intestinal folate absorption leading to neural tube defects
  • Cleft lip
  • Renal defects
Vitamin A/isotretinoin
  • Spontaneous abortions
  • Cleft palate
  • Cardiac abormalities
  • Eye and external ear abnormalities
Warfarin
  • Bone deformities
    • femur, vertebral, and calcaneus show stippled appearance on X-ray
  • Fetal hemorrhage
  • Abortion
  • Spasticity and seizures
 
Fetal Alcohol Syndrome
  • Fetal alcohol syndrome (FAS)
    • pregnant mothers who consume alcohol increase their risk of delivering a child with FAS:
      • mental retardation
      • limb dislocation
      • cardiovascular defects such as ventricular septal defects
      • microcephaly
      • holoprosencephaly
      • facial abnormalities: hypertelorism, short palepebral fissures, long philtrum
      • heart and lung fistulas
    • alcohol is leading cause of mental retardation
 

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Questions (4)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
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(M1.EB.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? Review Topic

QID: 106476
1

Maternal hyperthyroidsim

5%

(10/184)

2

Uncontrolled maternal diabetes mellitus

43%

(79/184)

3

Maternal use of tetracyclines

20%

(37/184)

4

Maternal use of lithium

15%

(27/184)

5

Maternal use of nicotine

13%

(24/184)

M1

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