Teratogens

ACE Inhibitors (-pril)

• Use

  • Hypertension, congestive heart failure

• Effect

  • Fetal renal failure → oligohydramnios → pulmonary hypoplasia

• ACE = “Amniotic fluid Can Empty”

Methimazole

• Use

  • Hyperthyroidism (eg. Graves disease)

• Effect

  • Esophageal atresia, aplasia cutis, omphalocele

• Substitute with propylthiouracil

• Think

  • Methimazole leaves a hole in your skin and abdomen

Warfarin

• Use

  • Anticoagulant (eg. if history of DVT)

• Effect

  • Nasal hypoplasia, limb hypoplasia (affects bone and cartilage formation)

• Substitute with heparin (does not cross placenta)

• The W in Warfarin looks like limbs

Isotretinoin

• Use

  • Severe acne

• Effect

  • Affects cranial neural crest cells → cleft palate, ear anomalies, microphthalmia, cardiac and thymic malformations

• Face acne treatment = disrupt face and head

Lithium

• Use

  • Mood stabilizer for bipolar disorder

• Effect

  • Ebstein anomaly (apical displacement of tricuspid valve)

• Lithium Loves the Heart

Aminoglycosides (-mycin)

• Use

  • Antibiotics (end in -mycin)

• Effect

  • Deafness (m. 1555A>G), renal toxicity

• AminOglycoside = Ototoxic

Valproate

• Use

  • Antiepilectic

• Effect

  • VALProate

  • Vertebral tube (NTD), Alimentary issues (cleft palate), Limb anomalies, Pump anomalies

    
    

Phenytoin

• Use

  • Seizures

• Effect

  • Cleft lip / palate, growth deficiency, digital anomalies, nail hypoplasia

• Phenytoin has phunny toenails

Griseofulvin

• Use

  • Fungal infections

• Effect

  • Spontaneous abortion

• Meds that prevent cell division or DNA synthesis is usually teratogenic

Methotrexate

• Use

  • Cancer, rheumatic disease

• Effect

  • NTD, cranial anomalies, limb anomalies

• Methotrexate Ate the folate

Tetracyclines (-cycline)

• Use

  • Antibiotics

• Effect

  • Discolored teeth, inhibit bone growth

• Teethracyclines

Diethylstillbestrol (DES)

• Use

  • Synthetic estrogen (no longer used)

• Effect

  • Vaginal clear cell adenocarcinoma, uterine malformations

• DES = daughters have endometrial sequela

• Estrol = estrogen

Thalidomide

• Use

  • Previously used for nausea

• Effect

  • Limb defects like phocomelia, micromelia

• Tha limb domide

Alcohol

• Effect

  • Number 1 cause of intellectual disability

  • Fetal alcohol spectrum disorder

  • F - facial differences (short palpebral fissures , epicanthal folds, thin upper lip, smooth philtrum)

  • A - Altered CNS development

  • S - Small size

• Presents similarity to Down Syndrome

Cigarettes

• Effect

  • Preterm birth, cleft lip / palate, fetal growth restriction, jejunoilial atresia

Cocaine

• Effect

  • Placenral abruption

  • Vascular accidents (jejunoileal atresia) in fetus

  • Duodenal atresia associated with Down Syndrome

Maternal infections

Treatment of infection may not stop symptoms in fetus

Skin rashes, hepatomegaly, lyphadenopathy in Newport may be signs of congenital infection

TORCHES

Toxoplasmosis

• Effect

  • Intracranial calcifications, hydrocephalus, chorioretinitis

Rubella

• Effect

  • Triad of

    • Cardiac defects

    • Cataracts (rub your eye)

    • Deafness (can’t hear bell)

Cytomegalovirus (CMV)

• Effect

  • Macrocephaly, peri ventricular calcification, cataracts, chorioretinitis, hearing loss

• CMV (Calcify my ventricles)

Herpes simplex virus (HSV)

• Effect

  • Vesicular skin lesions and temporal lobe encephalitis (heroes affects your head)

• Acquired upon passage through birth canal

Syphilis

• Effect

  • Rhinorrhea (syphilitic snuffles), anemia, thrombocytopenia, heptomegaly, skin rash, skeletal anomalies in fetus

• 
  

Zika

• Effect

  • Severe microcephaly, brain calcifications

Varicella (chicken pox)

• Effect

  • Limb hypoplasia, scar tissue, low birth weight

Pregestational diabetes

• Type 1 or Type 2

• Effect

  • Congenital heart disease, lower extremity anomalies (eg. caudal regression syndrome) and holoprosencephaly

  • Risk associated with maternal glucose control

Gestational diabetes

• Diabetes after 20 weeks

• Effect

  • Macrosomia, neonatal hypoglycemia after delivery

  • Low risk of major congenital anomies (vs. pre gestational diabetes)

Maternal PKU (phenylketonuria)

• Effect

  • Cardiac defects, fetal growth restriction, microcephaly

Maternal obesity

• Effect

  • Risk of cleft lip palate, heart defect, NTD

  • CHiN

Hyperthermia (Maternal fever)

• Effect

  • Increased risk for neural tube defects when closure at 6 weeks

Iodine deficiency

• Effect

  • Congenital hypothyroidism (cretinism), goiter

  • Developmental delay, coarse facial features, macrohlossia, hypotonia, jaundice

• Iodine is vital for thyroid hormone

X-rays

• Effect

  • Microcephaly, intellectual disability

  • Minimize by lead shielding

  • Avoid CT scans

• MRI are safe