Teratogens

Question 1

What is a teratogen?

Answer 1

• Any medication, chemical, infectious disease, or environmental agent that might interfere with normal development of a fetus
• Result in loss of pregnancy, birth defect, or other adverse pregnancy outcomes
• Outcome is highly dependent on timing of exposure (embryology) and dosage

Question 2

Accutane (Isotrentinoin)

Answer 2

• Severe anomalies
• CNS anomalies, ear anomalies, cardiovascular defects, thymus anomalies, intellectual disability
• Affects neural crest migration

Question 3

ACE Inhibitors

Answer 3

Critical period: 2nd and 3rd trimester (NOT 1st trimester)

Symptoms: Renal tubular dysplasia, oligohydramnios/Potter sequence, pulmonary hypoplasia, IUGR, large anterior fontanelle

Question 4

Fetal Alcohol Syndrome

Answer 4

• CNS involvement, learning problems and behavioral problems

- Ptosis, short palpebral fissures, smooth philtrum, thin upper lip vermilion

Question 5

Cytomegalovirus (CMV)

Answer 5

• Most are asymptomatic

- May see: Growth restriction, Cerebral calcifications, Ocular abnormalities, Hepatosplenomegaly, Hearing loss

Question 6

Maternal Diabetes

Answer 6

• Caudal regression
• CHDs – coarctation of the aorta
• CNS – NTDs and holoprosencephaly
• Duodenal atresia
• Limb defects
• Single umbilical artery
• Macrosomia
• Polyhydramnios
• Miscarriage

Question 7

Infections

Answer 7

• Almost all infections can have an impact on CNS development
• Important to stay up to date on vaccines

Question 8

Maternal PKU

Answer 8

• Microcephaly
• Intellectual disability
• Dysmorphic features
• CHDs

Question 9

Mercury

Answer 9

• Dose-dependent
• Leads to congenital Minamata disease – severe CNS impairment
• Pregnant women should avoid fish high in mercury

Question 10

Maternal Obesity

Answer 10

• Growth abnormalities
• Congenital abnormalities
• NTDs
• Hydrocephalus
• CHDs
• Gastroschisis
• Miscarriage
• Higher risk for child to have diabetes

Question 11

SSRIs

Answer 11

Critical period: All trimesters

Symptoms:

• Congenital heart defects, anencephaly, craniosynostosis, omphalocele
• Possible association with persistent pulmonary hypertension
• Potential effects on gross motor function and language development

Question 12

Thalidomide

Answer 12

• First known medical teratogen
• Prescribed for morning sickness
• Severe limb reduction defects

Question 13

Maternal Thyroid Dysfunction

Answer 13

• Goiter
• Growth delay
• Developmental delay

Question 14

Valproic acid/Anti-convulsants

Answer 14

• 6-15% risk for major malformations
• Myelomeningocele
• Oral clefting
• CHDs
• Limb defects
• Dysmorphic features: hypertelorism, broad flat nasal bridge with upturned nose, fingernail hypoplasia
• Developmental delay

Question 15

Warfarin/Blood Thinners

Answer 15

• Critical period: 6-9 post conception, 8-11 weeks LMP

- Symptoms: Nasal and limb hypoplasia, stippled epiphyses