Teratogens

Question 1

ACE/ARB

Answer 1

Increase risk of oligohydramnios and fetal kidney damage, decreased skull ossification

Question 2

Tetracyclines (Doxycycline)

Answer 2

Interfere w/ fetal bone and tooth development

Gray/yellow discoloration of teeth

Question 3

Fluoroquinolones (Ciprofloxacin)

Answer 3

Associated w/ bone/cartilage deformaties and arthropathy

Question 4

Sulfonamides (TMP-SMX)

Answer 4

Class C
First trimester - interferes with folic acid metabolism
Third trimester - increases risk of kernicterus (possibly)

Question 5

Retinoids (isotretinoin)

Answer 5

CNS abnl, cardiovascular abnl, facial abnl, spontaneous abortion

Question 6

Lithium

Answer 6

Congenital heart disease, esp Ebstein’s anomaly

Question 7

NSAIDs

Answer 7

Increase risk of miscarriage

May promote premature closure of fetal ductus arteriosus

Question 8

Mycophenolate

Answer 8

(Immunosuppressant)
Ear/face congenital malformations
Increases risk of first trimester miscarriages

Question 9

Thalidomide

Answer 9

(Immunosuppressant)
Flipper limbs (phocomelia)

Question 10

Warfarin

Answer 10

Spontaneous abortion, IUgR, CNS abnl, facial abnl, MR, Dandy-Walker malformation (use heparin or LMWH)

Question 11

Efavirenz

Answer 11

NNRTI (teratogenic)

Question 12

Finasteride

Answer 12

Blocks testosterone -> DHEA

Femininization / genitalia abnl in male fetus

Question 13

Aminoglycosides (gentamicin, etc)

Answer 13

CN VIII damage (deafness)

Skeletal abnormalities, renal defects

Question 14

Anti-seizure medications in general

Answer 14

NTD, facial abnormalities (clefting)

Question 15

Carbamazepine

Answer 15

Facial abnl, NTD

Fingernail hypoplasia

Question 16

Chemotherapeutics (all classes)

Answer 16

Intrauterine fetal demise (30%)

Severe IUGR, multiple anatomic abnl, MR, spontaneous abortion, secondary neoplasms

Question 17

Diazepam

Answer 17

Cleft palate

Question 18

Diethylstilbestrol (DES)

Answer 18

Anatomic genital tract abnl +

Vaginal and cervical adenocarcinoma later in life

Question 19

Heparin

Answer 19

Mild prematurity, IUFD (much safer than warfarin)

Question 20

OCPs

Answer 20

Spontaneous abortion, ectopic pregnancy (overall fairly safe)

Question 21

Phenobarbital

Answer 21

Neonatal withdrawal

Question 22

Phenytoin

Answer 22

Facial abnl (cleft)

Question 23

Valproic acid

Answer 23

NTD (1%), facial abnl (cleft)

Question 24

Cocaine

Answer 24

Abruptio placentae

Arrythmia, MI, stroke in mother

Question 25

Ethanol

Answer 25

FAS (MR, IUGR, facial abnl, fetal demise)

Question 26

Opioids

Answer 26

Narcotic withdrawal

Question 27

Tobacco

Answer 27

IUGR, prematurity

Question 28

Radiation

Answer 28

> 10 rads risk of fetal malformation, small increased risk of childhood leukemias