MEDICATION EXPOSURES DURING PREGNANCY AND LACTATION

MEDICATION EXPOSURES DURING PREGNANCY  AND LACTATION

 

            Every woman in the general population has a 3–5% risk of having a child with a birth defect or mental retardation. Birth defects are the leading cause of infant mortality in the United States. Two important factors to consider when assessing the teratogenic potential of a medication are the stage of pregnancy at which the exposure occurred and the amount of medication taken. It is critical to evaluate each exposure on a case-by-case basis in order to give an accurate risk assessment. Some of the known, possible, and unlikely human teratogens are listed below.

            If you have a pregnant or breast feeding patient who is currently taking, or considering taking, a medication, the patient needs to be counselled about potential adverse effects the medication could have on her fetus or infant.

 

Some Known Teratogens

 

• Radiation

Atomic weapons

Radioiodine

Therapeutic radiation

 

• Infections

Cytomegalovirus

Herpes simplex virus I and II

Parvovirus B-19 (Erythema

infectiosum)

Rubella virus

Syphilis

Toxoplasmosis

Varicella virus

Venezuelan equine encephalitis virus

 

• Maternal & Metabolic Imbalance

Alcoholism

Amniocentesis, early

(before day 70 post conception)

Chorionic villus sampling

(before day 60 post conception)

Cretinism, endemic

Diabetes

Folic acid deficiency

Hyperthermia

Myasthenia gravis

Phenylketonuria

Rheumatic disease

Sjögren’s syndrome

Virilizing tumors

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Drugs and Environmental Chemicals

ACE inhibitors (benazepril,

captopril, enalapril, fosinopril,

lisinopril, moexipril, quinapril,

ramipril, trandolapril)

Aminopterin

Androgenic hormones

Busulfan

Chlorobiphenyls

Cigarette Smoking

Cocaine

Coumarin anticoagulants

Cyclophosphamide

Diethylstilbestrol

Etretinate

Fluconazole (high doses)

Iodides

Isotretinoin (Accutane®)

Lithium

Mercury, organic

Methimazole

Methotrexate (methylaminopterin)

Methylene blue (via intraamniotic

injection)

Misoprostol

Penicillamine

Phenytoin

Tetracyclines

Thalidomide

Toluene (abuse)

Trimethadione

Valproic acid

 

Possible Teratogens

Binge drinking

Carbamazepine

Colchicine

Disulfiram

Ergotamine

Glucocorticoids

Lead

Primidone

Quinine (suicidal doses)

Streptomycin

Vitamin A (high doses)

Zidovudine (AZT)

Zinc deficiency

 

Unlikely Teratogens

Agent Orange

Anesthetics

Aspartame

Aspirin (but aspirin in the 2nd half of

pregnancy may increase cerebral

hemorrhage during delivery)

Bendectin® (antinauseant)

Electromagnetic waves

Hydroxyprogesterone

LSD

Marijuana

Medroxyprogesterone

Metronidazole

Oral contraceptives

Progesterone

Rubella vaccine

Spermicides

Video display terminals

Ultr