EPSDT Care for Kids Newsletter

EPSDT Care for Kids Newsletter

___________________________________________________________

Teratogens that can affect brain development
Spring 1998

Maternal health conditions
Diabetes mellitus, insulin-dependent	Congenital heart defect, caudal deficiency, neural tube defect.
Hypertension	Intrauterine growth retardation.
Hyperthermia	Neural tube defect.
Maternal infection
Arbovirus (arthropod-borne viruses)	Encephalitis, CNS disease.
Coxsackie virus	Myocarditis, neonatal death.
Cytomegalo virus (CMV)	Microcephaly, hepatosplenomegaly, chorioretinitis, hearing impairment, ocular abnormalities, mental retardation.
Herpes	Fetal death, skin lesions, encephalitis, disseminated disease involving CNS, lungs, liver, adrenals, eyes, mouth.
HIV	HIV in infants: Hepatosplenomegaly, lymphadenopathy, failure to thrive, encephalopathy, infection.
Mumps	Increased risk of miscarriage; risk of endocardial fibroelastosis.
Parvovirus (fifth disease)	Non-immune fetal hydrops.
Rubella (German measles)	Congenital heart defect, cataracts, hearing impairment, mental deficiency.
Syphilis	Abnormal teeth, bones; mental deficiency.
Toxoplasmosis	Hydrocephalus, blindness, mental deficiency.
Varicella (chicken pox)	Limb reduction defects, muscle atrophy, mental deficiency.
Medications
Anticholesterol Lovastatin	Congenital heart defects, VATER syndrome, spina bifida, holoprosencephaly.
Anticoagulants Coumadin Warfarin Dicoumarol	Fetal death, growth deficiency, CNS malformation, mental deficiency, microcephaly, craniofacial abnormalities.
Anticonvulsants: Carbamazepine	Neural tube defect, craniofacial defects, developmental delay.
Hydantoin, phenytoin	Fetal hydantoin syndrome, growth and developmental retardation, facial dysmorphia.
Valproic acid	Neural tube defects, facial dysmorphia, growth deficiency, microcephaly, hydrocephaly.
Antihypertensives ACE inhibitors, such as Captopril, Enalapril	ACEI fetopathy: Neonatal death, renal dysgenesis, oligohydramnios sequence, skull defect, hypotension, hypocalvaria, intrauterine growth retardation, patent ductus arteriosus (PDA).
Methotrexate	Fetal death, skull and rib defects, cleft palate, spina bifida, absent digits.
Anti-neoplastics Aminopterin	Miscarriage, hydrocephalus, small stature, facial dysmorphia.
Barbiturates Secobarbitol (Seconal) Phenobarbital	Cardiac and brain defects.
Chlorpropamide (for diabetes)	Hypoglycemia if medication not discontinued one month before delivery.
Etretinate, isotretinoin (for skin disorders)	Miscarriage; major malformations: hydrocephalus, CNS defect, small/absent thymus, microtia/anotia, heart defect.
Lithium (psychotropic)	8% risk of serious cardiovascular anomaly, 2.7% risk of Ebstein anomaly, hypotonia, bradycardia.
Narcotics meperidine methadone morphine oxycodone, etc.	With prolonged use, all narcotics may produce withdrawal syndrome in neonates.
Streptomycin	Hearing loss due to ototoxicity.
Thyroid therapy methimazole propylthiouracil	Altered thyroid function, hypothyroidism, goiter, mental retardation.
Tranquilizers Alprazolam Diazepam	Withdrawal, respiratory problems.
Lorazepam meprobamate	Withdrawal, risk of fetal malformation.
Vitamins Overdose, Vitamin A	Craniofacial, CNS, cardiac and thymic malformations with maternal dosage in excess of 10,000 IU daily.
Overdose, Vitamin K	Anemia with Heinz bodies, hyperbilirubinemia, kernicterus.
Overdose, Vitamin D	Mental and physical retardation, aortic stenosis, idiopathic hypercalcemia, facial dysmorphia, strabismus, cranial synostosis, inguinal hernia, cryptorchidism.
Radiation therapy	Growth retardation, developmental retardation, microcephaly.
Reproductive Toxins
Lead	Miscarriage, CNS damage.
Methylmercury	Cerebral atrophy, spasticity, mental retardation.
Polychlorobiphenyls (PCBs)	Low birth weight, skin discoloration.
Substance abuse	.
Alcoholism, chronic	Fetal alcohol syndrome (FAS) -- developmental delay, microcephaly, craniofacial dysmorphia.
Cocaine abuse	Placental abruption, cerebral infarct (stroke), seizures, apnea.
Nicotine (smoking)	Miscarriage, low birth weight.
Toluene abuse ("glue sniffing")	Signs similar to fetal alcohol syndrome.

Sources:
Briggs, GG et al. Drugs in Pregnancy and Lactation, 3rd ed., 1990
Cunningham, GF et al. Williams Obstetrics, 19th ed., 1993
Genetic Drift Newsletter, Mountain State Regional Genetic Services Network, Fall 1995
Physicians' Desk Reference, 1998
Shephard, TH. Catalog of Teratogenic Agents (1992)

_______________________________________________________________________________

EPSDT Care for Kids Newsletter | EPSDT Care for Kids Provider Web Site