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Teratogens Flashcards

1
Q

Infection can be required through:

A

venereal transmission, respiratory spread, contact with infected blood products, cat litter or uncooked meat

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2
Q

Venereal transmission can cause:

A

syphilis gonorrhea, herpes virus, CMV, HIV
therefore can be in vagina and passed to baby during birth (may consider a C-section is infection is diagnosed and active)

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3
Q

Respiratory spread can cause:

A

rubella, varicella, coxsackie

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4
Q

contact with infected blood products can cause:

A

HIV, hepatitis, malaria

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5
Q

cat litter or uncooked meat can cause:

A

toxoplasmosis

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6
Q

classic teratogenic time period during pregnancy

A

weeks 7-10 from last menstrual period (most women don’t know they are pregnant yet)

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7
Q

prenatal infection can cause:

A
  • embryonic death and reabsorption (extremely early infections);
  • spontaneous abortion (SAB) and stillbirth (after pregnancy is recognized);
  • prematurity, IUGR, low birth weight (usually infection in 3rd trimester);
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8
Q

the majority of children exposed to infection are:

A

normal infants!

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9
Q

general signs of infection post-delivery:

A

purpura (red rash), jaundice, hepatosplenomegaly, pneumonitis (inflammation of lungs), meningoencephalitis (inflammation of brain)

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10
Q

IgG antibody

A

antibody associated with lifelong immunity, forms 3-4 weeks after IgM

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11
Q

IgM antibody

A

initial antibody formed following viral infection - goes away after 6 months

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12
Q

CMV symptoms

A
  • Mom is typically ASYMTPOMATIC
  • high risk of intellectual disability/developmental delay
  • pneumonia
  • hepatosplenomegaly
  • jaundice
  • thrombocytopenia
  • microcephaly
  • deafness
  • blindness (optic nerve atrophy)
  • brain calcifications
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13
Q

Individuals at higher risk for CMV:

A

health care workers

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14
Q

Treatment for CMV

A

NONE

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15
Q

CMV ultrasound findings

A

hepatic calcifications, fetal ascites

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16
Q

Congenital Rubella Syndrome features

A
  • ocular concerns: cataracts, glaucoma (10-30%)
  • CNS: deafness (60-70%), intellectual disability, microcephaly (10-25%)
  • cardiac: PDA (10-20%)
  • low birth weight
  • prematurity
  • blueberry muffin purpura
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17
Q

Toxoplasmosis maternal symptoms

A

flu-like illness or mono, but most are asymptomatic. 1/3 chance of fetal infection if mom has it

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18
Q

Individuals at higher risk for Toxo

A

exposure to raw or undercooked mutton or lamb, direct contact with cat shit

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19
Q

Some factors that affect tetratogenicity:

A

developmental phase, genotype, dose effect

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20
Q

How to evaluate whether an agent is a teratogen:

A

phenotypic effect, animal model, dose-response relationship, plausible biological explanation (present during critical periods of development)

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21
Q

categories of teratogens

A

deficiency/excess of endogenous agents, medications, industrial chemicals, environmental contaminants, physical agents (trauma, hyperthermia, radiation), infections, maternal disease

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22
Q

Medications that are classic known teratogens

A

Warfarin, Streptomycin, Valproid Acid (and basically every other seizure medication), ACE inhibitors, Lithium

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23
Q

Maternal diseases that have teratogenic effects

A

Insulin dependent diabetes, hypo/hyperthyroidism, PKU, hypertension, autoimmune disorders

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24
Q

Most common psychosocial reaction to teratogens

A

guilt

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25
Thalidomide
- can treat leprosy, multiple myeloma, hyperemesis & pregnancy related nausea - can cause limb reduction defects, ear anomalies
26
Diethylstilbestrol (DES)
- was used from 1940 and 1971 to prevent miscarriage, premature labor, and related complications of pregnancy (didn't work) - can cause vaginal adenosis/adenocarcinoma, cervical erosion and ridges
27
Warfarin
- blood thinner to treat clotting d/o | - can cause nasal hypoplasia, stippled epiphyses, CS defects
28
Hydantoin
- can treat epilepsy | - can cause dysmorphic facial features, hypoplastic nails, growth and developmental delay
29
Aminopterin and methotrexate
- chemotherapy | - pregnancy loss, hydrocephalus, low birth weight, dysmorphic facial features
30
Streptomycin
- can treat TB | - can cause hearing loss
31
Tetracycline
- can treat acne and skin infections | - can cause stained teeth, enamel hypoplasia
32
Valproic acid
- can treat seizures and bipolar disorder | - can cause neural tube defects, dysmorphic facial features
33
Isotretinoin
- can treat severe acne - can cause pregnancy loss, hydrocephalus, other CNS defects, small or absent thymus, microtia/anotia, conotruncal heart defects
34
Antithyroid drugs
- can cause hypothyroidism, goiter
35
Penicillamine
- medication is immunosuppression to treat rheumatoid arthritis, Wilson's disease, cystinuria - can cause cutis laxa
36
ACE Inhibitors
- can treat hypertension, congestive heart failure - can cause renal dysgenesis, oligohydramnios sequence, skull ossification defects - in contrast to most teratogens, critical period is second & third trimester
37
Carbamazepine (Tegretol anticonvulsant)
- can treat epileptic seizures and nerve pain | - can cause neural tube defects
38
Cocaine
- can cause pregnancy loss, placental abruption, growth retardation, microcephaly
39
Lithium
- can treat bipolar disorder | - can cause Ebstein anomaly
40
Methylmercury
- primarily occurs through the consumption of contaminated food such as fish - can cause cerebral atrophy, spasticity, mental retardation
41
Lead
- can cause pregnancy loss, CNS damage
42
Polychlorobiphenyls (PCBs - ingested)
- exposure through food | - can cause low birth weight, skin discoloration
43
Cigarette smoking during pregnancy
can cause pregnancy loss, low birth weight
44
Hyperthermia during pregnancy
can cause neural tube defects
45
Chronic alcoholism during pregnancy
- classic triad of FAS involves a pattern of growth deficiency, CNS involvement and facial dysmorphology.
46
Therapeutic Radiation during pregnancy
can cause growth and developmental delay, microcephaly
47
Maternal Insulin Dependent Diabetes Mellitus
can cause congenital heart defects, caudal deficiency, neural tube defects, limb defects, holoprosencephaly, pregnancy loss
48
Maternal Hypo/Hyperthyroidism
can cause goiter, growth and developmental | retardation
49
Maternal Phenylketonuria
can cause pregnancy loss, microcephaly, mental retardation, facial dysmorphism, congenital heart defects
50
Maternal Hypertension
can cause intrauterine growth retardation
51
Maternal autoimmune disorders
can cause congenital heart block, pregnancy | loss
52
Potential teratogenic effects
- spontaneous abortion - growth retardation - microcephaly - patterns of major and minor malformations - metabolic dysfunction - cognitive dysfunction or mental deficiency - altered social behavior - malignancy
53
Recreational drugs with known teratogenic effects
- alcohol - cigarette smoke - cocaine - toluene
54
Methadone
- can treat pain & drug addiction - can cause developmental problems, behavioral problems, adverse effects on fetal growth, increased risk of stillbirth, premature birth, decreased fetal movements, neonatal withdrawal
55
Buprenorphine/Subutex
- can treat pain & drug addiction - DOES NOT significantly increase risk for birth defects - 60% neonatal withdrawal
56
Naloxone/Suboxone
- can treat pain & drug addiction - no human data but animal data is reassuring - neonatal withdrawal is possible
57
Naltrexone
- can help prevent relapses into drug & alcohol abuse - limited human data, but does not significantly increase risk for birth defects - theoretical risk for behavioral abnormalities
58
Toluene
- aromatic hydrocarbon found in some spray paints, glues and lacquers - inhaled to cause acute intoxication - can cause microcephaly, intellectual disability, growth deficiency, craniofacial abnormalities similar to fetal alcohol syndrome
59
Isotrentinoin (Accutane)
- can treat severe acne | - can cause CNS anomalies, ear anomalies, cardiac defects, thymus anomalies, intellectual disability
60
Etretinate
- can treat psoriasis - stored in the body for long time (years) - can cause same as isotrentinoin: CNS anomalies, ear anomalies, cardiac defects, thymus anomalies, intellectual disability
61
Trentinoin (Retin A)
- can treat acne, wrinkles - theoretical risk b/c of relation to isotrentinoid, but likely to be low risk - generally administered topically
62
Dietary Vitamin A
- can cause CNS defects, urinary tract defects, face, palate, heart, ear deformities
63
Beta carotene
- provitamin A compound provided by vegetables - NOT teratogenic - found in prenatal supplements
64
Diagnostic X-ray during pregnancy
NOT believed to be teratogenic (<5 rads & serious risk to fetus occurs when absorbed dose is 10 rads or more)
65
Lead exposure during pregnancy
- NO increased risk for structural malformations - Inconsistent data re: IUGR - greatest concern for neurobehavioral development
66
Theoretical effects of paternal exposure to teratogens
- DNA mutations in sperm (ex: radiation) - Alterations to fertility - Presence of agent in sperm directly affects fetal development - NO PATERNAL EXPOSURE HAS EVER ACTUALLY BEEN SHOWN TO BE TERATOGENIC
67
Phenytoin
- can treat seizures (anti-convulsant) | - can cause IUGR, microcephaly, hypoplastic nails and distal phalanges

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