Effects of Maternal Medication

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During pregnancy, the average fetus is exposed to four physician-prescribed and five self-prescribed drugs. Every drug administered or taken by a pregnant woman presents the mother with both risks and benefits. The risks include the drug's potential as a teratogen or as a cause of toxicity in the fetus. Most human teratogens affect the embryo during a very narrow period of early development as illustrated by the time (24 to 33 days gestation) during which the fetus is susceptible to limb reduction defects caused by thalidomide. Several human teratogens, such as alcohol, androgens, cocaine, diphenylhydantoin, radiation, tetracycline, valproic acid, and warfarin have serious side effects beyond the period of organogenesis. These effects may include cell deletion, vascular disruption, necrosis, physiologic decompensation, organ pathology, and intrauterine growth retardation. Drugs taken in the third trimester may not have teratogenic effects, but may be toxic to the fetus. Some examples include indomethacin (causing oligohydramnios), propylthiouracil (causing fetal goiter), and erythromycin (causing cholestatic hepatitis). A detailed history of maternal drug use and abuse is essential in evaluating most malformations and diseases in the neonatal period.

Figure 3.1. This illustration contrasts the craniofacial features of a healthy child on the right to those of a child with fetal alcohol syndrome on the left. Note the microcephaly, short palpebral fissure, flat maxillary area, poorly developed philtrum and thin upper lip (Peter Shvartsman, Canadian Medical Association Journal, July 15, 1981 cover).

Thin Vermilion Border The Upper Lip

Figure 3.2. This infant, age 6 weeks, was born to a mother with severe, chronic alcoholism. There was failure to thrive and hypotonia. Note the microcephaly (head circumference less than the third percentile), short nose, absence of philtrum and thin vermilion border of the upper lip.

Findings in fetal alcohol syndrome include intrauterine growth retardation, microcephaly, dysplastic facial features, hypoplasia of the midface, and a hypoplastic philtrum with a thin vermilion border of the upper lip. Later there may be continued failure to thrive and developmental and behavioral disorders.

Figure 3.2. This infant, age 6 weeks, was born to a mother with severe, chronic alcoholism. There was failure to thrive and hypotonia. Note the microcephaly (head circumference less than the third percentile), short nose, absence of philtrum and thin vermilion border of the upper lip.

Findings in fetal alcohol syndrome include intrauterine growth retardation, microcephaly, dysplastic facial features, hypoplasia of the midface, and a hypoplastic philtrum with a thin vermilion border of the upper lip. Later there may be continued failure to thrive and developmental and behavioral disorders.

Hypoplastic Philtrum

Figure 3.3. Close-up of the face of the same infant shows the short nose, absence of the philtrum, and thin vermilion border of the upper lip. Many other findings in fetal alcohol syndrome have been reported, including epican-thic folds, ptosis, hypoplastic maxilla, deep or accentuated palmar creases, and clinodactyly.

Figure 3.3. Close-up of the face of the same infant shows the short nose, absence of the philtrum, and thin vermilion border of the upper lip. Many other findings in fetal alcohol syndrome have been reported, including epican-thic folds, ptosis, hypoplastic maxilla, deep or accentuated palmar creases, and clinodactyly.

Figure 3.4. Soon after birth, this infant of a narcotic addict shows hypotonia. Note die concavity of the inner aspect of the thighs and the position of the lower extremities. This has resulted from a postural deformation in which the fetus has had its thighs flexed over its abdomen in utero. Because of the mother's narcotic habit there was minimal fetal movement in utero.

Figure 3.4. Soon after birth, this infant of a narcotic addict shows hypotonia. Note die concavity of the inner aspect of the thighs and the position of the lower extremities. This has resulted from a postural deformation in which the fetus has had its thighs flexed over its abdomen in utero. Because of the mother's narcotic habit there was minimal fetal movement in utero.

Figure 3.5. Drug withdrawal is a major problem in neonates delivered of narcotic addicted mothers. This figure stresses the fact that one should always check for signs of drug addiction in the mother. This figure shows needle tracks at both elbows of a mother.

Figure 3.5. Drug withdrawal is a major problem in neonates delivered of narcotic addicted mothers. This figure stresses the fact that one should always check for signs of drug addiction in the mother. This figure shows needle tracks at both elbows of a mother.

Figure 3.6. Infants with retinoic acid embryopathy (Accutane™ embryopathy) may have craniofacial, cardiovascular, and central nervous system abnormalities. In this infant note the narrow sloping forehead, flat depressed nasal bridge, mild micrognathia, and microtia with absence of the external auditory canal. In addition there was congenital heart disease. Affected infants may have hydrocephalus, microcephaly, or thymic abnormalities. This mother was treated with retinoic acid during the first month of pregnancy.

Retinoids Side Effects Children Image
Figure 3.7. Close-up of the ears of the same infant as shown in Figure 3.6 shows the bilateral microtia with absence of the external auditory meatus.

Figure 3.8. In infants with the fetal hydantoin (Dilantin™) syndrome there is moderate growth retardation, usually prenatal, a wide anterior fontanelle and metopic ridging. In this infant, note the growth retardation, profuse scalp hair, and short neck. Other findings included hypopla-sia of the distal phalanges with small nails and a digital thumb.

Figure 3.8. In infants with the fetal hydantoin (Dilantin™) syndrome there is moderate growth retardation, usually prenatal, a wide anterior fontanelle and metopic ridging. In this infant, note the growth retardation, profuse scalp hair, and short neck. Other findings included hypopla-sia of the distal phalanges with small nails and a digital thumb.

Figure 3.9. Close-up of the face of the same infant. Note the marked hirsutism, low hairline, low nasal bridge with a short upturned nose ("pug" nose), and long philtrum.

Figure 3.10. Hypertrichosis in another infant with the fetal hydantoin syndrome. Mother was treated throughout pregnancy with hydantoin. The risk of fetal hydantoin syndrome in infants of treated mothers is about 10%.

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Figure 3.11. Gum hypertrophy in an infant with die fetal hydantoin syndrome. Many other findings have been reported in infants widi fetal hydantoin syndrome, including widely spaced nipples, rib anomalies, abnormal palmar creases, pilonidal sinus, and congenital heart disease.

Figure 3.12. This infant of an epileptic mother on hydantoin developed seizures at the age of 36 hours. He had hypocalcemia with a calcium level of 6.4 mg/dL and a phosphorus level of 11.2 mg/dL. In fetal hydantoin syndrome the digital hypoplasia may be associated with narrow distal phalanges and hypoplastic nails.

Figure 3.11. Gum hypertrophy in an infant with die fetal hydantoin syndrome. Many other findings have been reported in infants widi fetal hydantoin syndrome, including widely spaced nipples, rib anomalies, abnormal palmar creases, pilonidal sinus, and congenital heart disease.

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Pregnancy Diet Plan

Pregnancy Diet Plan

The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.

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Responses

  • mark
    How do a hypotonia gum look like?
    4 years ago

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