PATRICK DUFF, M.D. - University of Florida OF TERATOGENS Medications Thalidomide Environmental...
Transcript of PATRICK DUFF, M.D. - University of Florida OF TERATOGENS Medications Thalidomide Environmental...
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PATRICK DUFF, M.D.
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POWEROFTHEM.D.
May 2016
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POTENTIALFORHARM
Thalidomide
Valproic acidTopiramate
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MECHANISMSOFPLACENTALTRANSFER�Simple diffusion�Facilitated
diffusion�Active transport�Pinocytosis
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POSSIBLETERATOGENICEFFECTS�Anatomic abnormality
�Impaired growth
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TYPESOFTERATOGENS�Medications
�Thalidomide� Environmental agents
� Irradiation�Heat�Chemicals� Smoking�Microorganisms�Maternal diabetes
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TRIMESTEROFGREATESTFETALVULNERABILITY
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MOSTLIKELYORGANSYSTEMSAFFECTED
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ANIMALMODELSTOASSESSTERATOGENECITY
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ORIGINALFDACLASSIFICATIONOFDRUGSINPREGNANCYFDA CLASS EXPLANATIONA No harmB No harm but limited
human studiesC Animal studies suggest
riskD HarmfulX Absolutely
contraindicatedDiscontinued in the summer of 2015
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ACEINHIBITORSANDARBs�Most likely adverse
fetal effect?� Is the effect
reversible?� Is there a safe
period in pregnancy to use these drugs?
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BETABLOCKERS�Usual
indications?�Adverse fetal
effects?
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CARBEMAZEPINE�Possible
indications in the mother?
�Most likely harmful effects in the baby?
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COUMADIN�Most likely
adverse effect in the fetus?
�Alternative agents for anticoagulation in pregnancy?
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HEAT�How does the
fetus dissipate heat?
�Critical time of exposure?
�Most likely adverse fetal effect?
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ISOTRETINOIN�Most likely
prescriber?�Indication?�Adverse fetal
effects?
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LITHIUM�Usual
indication in the mother?
�Most likely harmful effect in the fetus?
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METHAMPHETAMINE�Most likely
adverse fetal effect?
�Most likely adverse neonatal effect?
�Effect on breast feeding?
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NARCOTICS�Two most likely
sources of exposure?
�Most likely adverse fetal effects?
�Most likely adverse neonatal effect?
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NSAIDS�Usual
indications?�Adverse maternal
effects?�Adverse fetal
effects?
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PHENYTOIN�Usual
indication?�Most likely
adverse fetal effects?
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QUINOLONES�Usual
indications?�Most likely
harmful effect in the fetus?
�Acceptable indications in pregnancy?
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RADIATION�Dose threshold?�Most likely
adverse fetal effect?
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SSRIs�Usual indication?�Most dangerous
of the SSRIs in pregnancy?
�Most likely adverse fetal effect?
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TETRACYCLINE/DOXYCYCLINE�Possible harmful
effect in the mother?
�Most likely adverse effect in the fetus?
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THALIDOMIDE�Original
indication?�Adverse fetal
effects?
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TOBACCO�Most likely adverse fetal effects?
�Most serious maternal complication?
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TOPIRAMATE�Possible
indications?�Newly described
adverse fetal effect?
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TRIMETHOPRIM-SULFAMETHOXAZOLE�Most likely adverse
fetal effect with first trimester exposure?
�Potential neonatal effect with exposure just prior to delivery?
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VALPROICACID�Usual
indications?�Most likely
adverse fetal effect?
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MICROORGANISMSMICROBE TERATOGENIC
EFFECTSRubellaVaricellaCMVParvovirusToxoplasmosis
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EXPOSURETOTERATOGENSCONCLUSIONS�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