Teratogenicity Caused by Drugs in Pregnancy
Teratology is the study of environmentally and medicine induced congenital anomalies or abnormality in developing fetus. Under the teratogenicity various functional abnormalities like- CNS function, death, prenatal onset growth deficiency, specific effects like carcinogenesis and recognizable syndromes, magnitude of risk are included .
If any drug which is high lipid soluble and of low molecular weight is given to mother during pregnancy then there is strong chances that those drugs may cross the defensive barrier of BPB that is blood placental barrier. Large molecules with molecular weights greater than 1,000 do not easily cross the placenta into the embryonic-fetal bloodstream to exert potential teratogenic effect. Using ethanol during pregnancy may cause severe dysfunction in organ development and it is totally discontinue as soon as pregnancy confirms.
There are a number of medicine which my cause teratogenic effect. Anticonvulsant drugs taken by pregnant women to prevent seizures are among the most common causes of potential harm to the fetus. The frequency of major malformations, growth retardation, and hypoplasia of the midface and fingers, known as anticonvulsant embryopathy, is increased in infants exposed to anticonvulsant drugs. Fetal valproate syndrome (FVS) results from prenatal exposure to valproic acid (VPA) It is characterized by a distinctive facial appearance, a cluster of minor and major anomalies, and central nervous system dysfunction.
Phenytoin is another most commonly used antiepileptic medications, Exposure during pregnancy is also associated with hydantoin syndrome that includes abnormalities like short nose, low or broad nasal bridge, epicanthic folds, hypertelorism, microcephaly, abnormal ears, wide mouth, oral clefts, hypoplasia of distal phalanges, short/webbed neck, low hairline, abnormal mental development and abnormal motor development
Agents with their Teratogenic Effects
|Drug/ Agents||Teratogenic Effects|
|Tobacco and Nicotine
||Increased risk of developing attention-deficit/ hyperactivity disorder (ADHD).|
|Alcohol (In Large Dose)||Microcephaly, Developmental delay, Dysmorphic facies consisting of low nasal bridge, Midfacehypoplasia, Long featureless philtrum, Small palpebral fissures, Thin upper lip|
|Anxiolytics||BZD may produce the benzodiazepine syndrome. This syndrome consists of facial dysmorphism, hypotonia and delayed motor development, polycystic kidney, sub mucous clef hard palate, microcephaly, varying degrees of mental retardation, convulsions, and neonate abstinence syndrome|
|Anticonvulsants||The use of valproic acid in the first trimester of pregnancy is associated with an increased risk of spina|
|Antibacterial||Administration of norfloxacin during pregnancy especially in early stage and at high doses could induce some fetal defects and abnormalities so it is advisable to avoid using this drug during pregnancy. , birth defects with methotrexate include skeletal defects, low birth weight, and a wide range of developmental abnormalities. Chloroquine, an antimalarial drug, has been associated with an
increased risk of auditory and optic abnormalities. Yellow-brown discoloration of teeth may occur due to deposition of the antibiotic in calcifying teeth with tetracycline use in late pregnancy
|ACE Inhibitors||The administration of these drugs during the second and third trimesters of pregnancy causes high fetal and perinatal mortality|
|Folic Acid Antagonist||Aminopterin is a folic acid antagonist, it leads to fetal aminopterin syndrome some malformations, facial anomalies such as cleft palate, high arched palate, micrognathia, ocular hypertelorism, external ear anomalies, abnormal cranial ossification, abnormalities in first branchial arch derivatives, intrauterine growth retardation and mental retardation and include central nervous system defects such as hydrocephalus.|
|Warfarin||Warfarin therapy during pregnancy has been associated with spontaneous abortion, stillbirth, nasal hypoplasia, stippled epiphyses, distal limb hypoplasia and malformations of the CNS, eye, jaw and urinary tract|
|Thalidomide||Thalidomide was used clinically in the 1960s. The limb deformities produced by thalidomide is known as phocomelia and amelia that are characterized by severe shortening or complete absence of legs and or arms, whereas the ear malformations include anotia, microtia and hearing loss.|
|Cytomegalovirus||Infection of viruses like congenital CMV is a major public health concern. CMV causes serious neurodevelopmental sequelae, including mental retardation, cerebral palsy and sensorineural hearing loss|
Source:- KD Tripathi- Essential of Medical Pharmacology- 8th Edition.
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