PATRICK DUFF, M.D.
Teratogenic risks in pregnancy are crucial to comprehend for the safety of the fetus. Explore potential harms of medications like Thalidomide, Topiramate, and Valproic acid. Understand the mechanisms of placental transfer and possible teratogenic effects such as anatomic abnormalities and impaired growth. Learn about different types of teratogens, trimester vulnerability, organ systems affected, FDA drug classifications in pregnancy, and more. Discover the effects of ACE inhibitors, ARBs, beta blockers, and Carbemazepine on fetal development.
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Presentation Transcript
POTENTIAL FOR HARM Thalidomide Topiramate Valproic acid
MECHANISMS OF PLACENTAL TRANSFER Simple diffusion Facilitated diffusion Active transport Pinocytosis
POSSIBLE TERATOGENIC EFFECTS Anatomic abnormality Impaired growth
TYPES OF TERATOGENS Medications Thalidomide Environmental agents Irradiation Heat Chemicals Smoking Microorganisms Maternal diabetes
TRIMESTER OF GREATEST FETAL VULNERABILITY
MOST LIKELY ORGAN SYSTEMS AFFECTED
ANIMAL MODELS TO ASSESS TERATOGENECITY
ORIGINAL FDA CLASSIFICATION OF DRUGS IN PREGNANCY FDA CLASS A B EXPLANATION No harm No harm but limited human studies Animal studies suggest risk Harmful Absolutely contraindicated C D X Discontinued in the summer of 2015
ACE INHIBITORS AND ARBs Most likely adverse fetal effect? Is the effect reversible? Is there a safe period in pregnancy to use these drugs?
BETA BLOCKERS Usual indications? Adverse fetal effects?
CARBEMAZEPINE Possible indications in the mother? Most likely harmful effects in the baby?
COUMADIN Most likely adverse effect in the fetus? Alternative agents for anticoagulation in pregnancy?
DOLUTEGRAVIR What is the usual indication for use of this drug? What is the mechanism of action of this drug? What is the newly described fetal anomaly associated with use of this drug in early pregnancy?
HEAT How does the fetus dissipate heat? Critical time of exposure? Most likely adverse fetal effect?
ISOTRETINOIN Most likely prescriber? Indication? Adverse fetal effects?
LITHIUM Usual indication in the mother? Most likely harmful effect in the fetus?
METHAMPHETAMINE Most likely adverse fetal effect? Most likely adverse neonatal effect? Effect on breast feeding?
NARCOTICS Two most likely sources of exposure? Most likely adverse fetal effects? Most likely adverse neonatal effect?
NSAIDS Usual indications? Adverse maternal effects? Adverse fetal effects?
PHENYTOIN Usual indication? Most likely adverse fetal effects?
QUINOLONES Usual indications? Most likely harmful effect in the fetus? Acceptable indications in pregnancy?
RADIATION Dose threshold? Most likely adverse fetal effect?
SSRIs Usual indication? Most dangerous of the SSRIs in pregnancy? Most likely adverse fetal effect?
TETRACYCLINE/DOXYCYCLINE Possible harmful effect in the mother? Most likely adverse effect in the fetus?
THALIDOMIDE Original indication? Adverse fetal effects?
TOBACCO Most likely adverse fetal effects? Most serious maternal complication?
TOPIRAMATE Possible indications? Newly described adverse fetal effect?
TRIMETHOPRIM- SULFAMETHOXAZOLE Most likely adverse fetal effect with first trimester exposure? Potential neonatal effect with exposure just prior to delivery?
VALPROIC ACID Usual indications? Most likely adverse fetal effect?
ZIDOVUDINE Most common indication ? Most likely adverse fetal effect ?
MICROORGANISMS MICROBE TERATOGENIC EFFECTS Rubella Varicella CMV
MICROORGANISMS MICROBE TERATOGENIC EFFECTS Parvovirus Toxoplasmosis Zika virus
EXPOSURE TO TERATOGENS CONCLUSIONS Think carefully before prescribing any drug in pregnancy, especially in the first trimester If you are unsure about the safety of a drug, ask for consultation from your obstetric colleague
