This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A prospective follow-up study was conducted on 1, women, and their offspring were sampled from the Danish National Birth Cohort. After adjustment for potential confounders, no significant effects of prenatal exposure to tobacco smoking were found. Considering the indisputable teratogenic effects of tobacco smoking, these findings should be interpreted with caution.
Known fetal and neonatal adverse effects of phenytoin Congenital Malformations The frequency of congenital malformations increases in pregnancies complicated by maternal epilepsy. This increase occurs in pregnancies Teratogen affects on pregnancy which uncontrolled seizures occur frequently during the first and part of the second trimester of pregnancy.
The fetus is most vulnerable to malformations from medication during this time. In the third trimester, seizure activity puts the fetus at risk for hypoxic episodes, which leads to other complications with the pregnancy. Whether the malformations are caused primarily by the maternal epilepsy itself or by exposure to antiepilepsy drugs is controversial.
A recent study, 18 however, suggests that antiepilepsy drugs rather than the epilepsy itself are the major contributor to the development of malformations.
The dosage and timing of exposure to antiepilepsy drugs during pregnancy are considered major contributing factors.
Major signs of this disorder include abnormalities of the skull and facial features, growth deficiencies, and underdeveloped nails on the fingers and toes. These rates are 4-fold greater than the rates in the general population for congenital heart disease and fold greater than the rates for cleft lip or cleft palate.
Phenytoin was the most commonly implicated antiepilepsy drug in both of these studies. This situation creates an extraordinarily high degree of risk for women of childbearing age who use phenytoin. Therapy recommendations suggest that women begin taking folic acid supplements before becoming pregnant and continue taking the supplements throughout the first trimester to reduce the risk of neural tube defects.
Hemorrhagic Disease of the Newborn Phenytoin interferes with vitamin K in the formation of precursor protein for coagulation factors II, VII, IX, and X, resulting in prolongation of either the prothrombin time, the partial thromboplastin time, or both.
Additionally, the newborn should receive an injection of phytonadione immediately after birth. Without this additional phytonadione, the newborn is at risk for vitamin K deficiency and hemorrhage, usually within the first 24 hours after birth.
Sites of hemorrhage are the skin, liver, gastrointestinal tract, intracranial sites, and thorax. Cephalohematomas generally are due to birth trauma, and if a large cephalohematoma occurs, computed tomography of the head should be ordered to rule out an underlying skull fracture.
Neonatal Hypocalcemia As discussed previously, phenytoin alters metabolism of vitamin D and inhibits the intestinal absorption of calcium in pregnant women, resulting in osteomalacia with hypocalcemia.
Decreased levels of vitamin D in the maternal system can lead to low levels of vitamin D and calcium in the fetus, thus increasing the risk for neonatal hypocalcemia. Most infants with hypocalcemia are asymptomatic, and early, mild hypocalcemia often resolves without treatment.
Because neonatal jitteriness can also occur with hypoglycemia, a blood glucose level should also be determined at the same time to help differentiate possible causes. Cognitive Function The effect of maternal epilepsy on IQ in the offspring has been studied.
Small head size can occur in neonates prenatally exposed to antiepilepsy drugs. Most infants exposed to only a single drug have normal intellectual capacity, and the smaller head size does not seem to be related to cognitive functioning in adulthood.
On the basis of these results, pregnant women with epilepsy should not be concerned that taking phenytoin will result in lower IQ for the baby, but they must be aware that learning problems may occur. It is important to manage the seizure activity of pregnant women while minimizing effects on the fetus and neonate.
The major emphasis is prevention and counseling young women with epilepsy about the disease and use of antiepilepsy drugs during pregnancy. Women with epilepsy should be taught that even without medication for their epilepsy, they have a higher risk of delivering an infant with congenital malformation and cognitive impairment.
Although the exact mechanism is unknown, it is theorized that genetic factors contribute to the increased prevalence of malformations in infants born to mothers with epilepsy independent of maternal medications. It is readily accepted that the risk to the fetus from uncontrolled seizure activity is greater than the risk from antiepileptic medications, because status epilepticus during pregnancy is a critical care emergency for both the mother and the fetus.One teratogen that affects the central nervous system is alcohol.
Alcohol, at any time during the pregnancy, has the potential to cause birth defects and health problems in the baby, since the central nervous system is sensitive to teratogens the entire nine months of gestation.
Oct 28, · One teratogen that affects the central nervous system is alcohol. Alcohol, at any time during the pregnancy, has the potential to cause birth defects and health problems in the baby, since the central nervous system is sensitive to teratogens the entire nine months of gestation.
Smoking during pregnancy can cause tissue damage in the unborn baby, particularly in the lung and brain, and some studies suggests a link between maternal smoking and cleft lip. 1,2 Studies also suggest a relationship between tobacco and miscarriage.
during pregnancy, it is more likely that fetal exposure will be identiﬁed if a biological specimen is collected along with a structured interview.8 Self-reported history is an inexpensive Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed Fetus.
One teratogen that affects the central nervous system is alcohol. Alcohol, at any time during the pregnancy, has the potential to cause birth defects and health problems in the baby, since the central nervous system is sensitive to teratogens the entire nine months of gestation.
Fetal retinoid syndrome is a characteristic pattern of mental and physical birth defects that results from maternal use of retinoids, the synthetic derivatives of vitamin A, during pregnancy.
The most well known retinoid is isotretinoin (Accutane), a drug used to treat severe cystic acne.