Many afected infants have a pattern of defects termed mycophenolate embyopathy. his includes microtia, auditory canal atresia, clefts, coloboma and other eye anomalies, short ingers with hypoplastic nails, and cardiac defects (Anderka, 2009; Merlob, 2009). A Risk Evaluation and Mitigation Strategy (REMS) has been developed for mycophenolate prescribers who treat women with reproductive potential. REMS are safety strategies mandated by the FDA to help manage known risks associated with a medicine yet still allow patients to have access to the benefits of a given drug.
Radioactive iodine-131 is used for treatment of thyroid cancer and thyrotoxicosis and for diagnostic thyroid scanning. It is also a component of iodine-131 tositumomab therapy, which is employed to treat a type of non-Hodgkin lymphoma. Radioiodine is contraindicated during pregnancy because it readily crosses the placenta and is then concentrated in the fetal thyroid gland by 12 weeks' gestation. It may cause severe or irreversible fetal and neonatal hypothyroidism, which can lead to decreased mental capacity and delayed skeletal maturation Qubilant DraxImage, 2016). Pregnancy testing should be performed before administration of radioiodine-131.
Prenatal lead exposure is associated with fetal-growth abnormalities and with childhood developmental delay and behavioral abnormalities. According to the CDC (2010), no level of lead exposure is considered safe in pregnancy. Care and testing for at-risk pregnancies is discussed in Chapter 9 (p. 170).
Environmental spills of methyl mercury in Minamata Bay, Japan, and rural Iraq demonstrated that the developing nervous system is particularly susceptible to this heavy metal. Prenatal exposure causes disturbances in neuronal cell division and migration. This leads to a range of defects from developmental delay to microcephaly and severe brain damage (Choi, 1978).
he principal concern for prenatal mercury exposure is the consumption of certain species of large fish (Chap. 9, p. 170). The FDA (2017a) advises that pregnant women and breastfeeding mothers avoid consumption of king mackerel, marlin, orange roughy, shark, swordfish, tilefish, and bigeye tuna.
Treatment of psychiatric illness in pregnancy, including a discussion of the risks and benefits of various psychiatric medications, is described in Chapter 61 (p. 1173). Selected birth defects and adverse efects associated with specific medications are presented here.
This medication has been associated with Ebstein anomaly, a rare cardiac abnormality that otherwise complicates only 1 per 20,000 births. Ebstein anomaly is characterized by apical
Teratology, Teratogens, and Fetotoxic Agents 245 displacement of the tricuspid valve, often resulting in severe tri confer signiicant morbidity. A report from the Lithium Baby
Registry initially suggested that the risk for Ebstein anomaly was as high as 3 percent. However, subsequent series have iden right-sided cardiac anomalies of only 1 to 4 per 1000 exposed pregnancies (Patorno, 2017; Yacobi, 2008). In a review of fout case-control studies that included more than 200 infants with
Ebstein anomaly, no cases were attributed to lithium exposure (Cohen, 1994).