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Briggs Drugs
Special Pops
Drugs | Critical Period | Risk magnitude | Developmental Toxicity |
---|---|---|---|
Anticonvulsants 1st gen: CBZ, PHB, PHT, Primidone, VPA 2nd gen: Lamotrigenes | 1st trimester 3rd trimester | Structural defects Hemorrhagic disease | |
Anti-infectives | Kanamycin, Streptomycin (throughout pregnancy), Fluconazole >400mg/d (1st trimester), Quinine @toxic doses (1st trimester), Tetracycline (>4mos) | ||
Anti-neoplastics | Busulfan (1st trimester), Cyclophosphamide (1st trimester), MTX >10mg/wk (6-8wks), Tamoxifen | ||
Corticosteroids | < 10 weeks Throughout pregnancy | Oral clefts [2-7x risk] Growth restriction [if prolonged therapy] | Cleft lip + palate Growth restriction (300-400g) |
B1-Blockers | 2nd - 3rd trimester | Dose and duration dep | ↓ placental weight, birth weight. IUGR. d/t decreased fetal perfusion |
Diethylstilbestrol | 10-18 week up to 20 weeks | Vaginal adenocarcinoma Genital defects | Female and male genital defects, infertility, preterm birth, ectopic pregnancy, ↑SABs |
Iodine | 2nd - 3rd trimester | Dose and duration dep | Hypothyroidism, goiter |
Lithium | 1st trimester 3rd trimester | cardiac defects newborn toxicity | Various heart defects Ebstein's anomaly (downward displacement of triscuspid valve to right ventricle) Toxic effects: cyanosis, hypotonia, bradycardia, atrial flutter, Twave inversion, cardiomegaly, GI bleed, sz, diabetes insipudius, shock, hepatom |
Methylene blue | 2nd - 3rd trimester | 20% jejunal-ileal astresias | Fetus: jejunal-ileal astresias --> death Newborn: hyperbilil, hemolytic anemia, methemoglobinemia |
Methimazole Carbimazole | Up to 9 weeks after LMP | Low | Pattern of rare defects --> Scalp or patchy hair defects, choanal atresia, esophageal atresia w/ fistula, minor facial anomalies, hypoplast/absent nipples, hypothyroidism, goiter |
Misoprostol | 1st trimester (esp 6-8wk) | 7x for Mobius syndrome | Abortion, Mobius syndrome, defects of cranium/scalp, oral cleft, etc Mobius: 6th and 7th nerve palsies |
Mycophenolate | 1st trimester | SAB (spont.abortion)- 45% Defects -22% | Defcts of external ear, face, oral clefts, heart, kidney, esophagus, distal limbs |
NSAID | 1st trimester > 32 weeks | SAB, ASD/VSD Patent ductus Arteriosus, renal toxicity | SAB, cardiac tox, renal tox Premature closure DA - reversible Patent DA - irreversible |
Penicillamine | Unknown | <5% | Cutis laxa |
SSRI's | 1st trimester >20 weeks | --> SAB/PPHN: 2-6% --> neonatal withdrawal: 30% | Birth defects, SAB Withdrawl, PPHN (persistent HTN of newborn) Cardiac toxicity, SAB, carniosynostosis, omphalocele, anencephaly, gastroschisis, low birth weight, PPHN, neurobehavior defcts |
Trimethoprim | 1st trimester | Unknown | Cardiovascular Can also cause oral cleft, urinary tract, and neural tube defect |
Thalidomide | 35-40 days after 1st day of LMP [50-100mg/d] | 20-30% | Defects of limbs, skeletal defects, craniofacial, CNS, major organs |
Vitamin A (Acitretin- Etretinate, Accutane) | 15 days after conception to end of 1st trimester | 30-50% | SAB, CNS, craniocial, cardiovascular, thymus gland, miscellaneous |
Warfarin | 6th - 9th week - throughout | --> fetal warfarin syndrome 5-10% --> CNS defects 4-5% | Fetal warfarin syndrome, CNS, optic, cardiac, IUGR (warfarin has very long half life) |
Alcohol | Throughout | NO SAFE DOSE!!! Can cause fetal alcohol syndrome, disruption of NTs (Glutamate, GABA) | IUGR + MR + Facial anomalies=classical triad Microcephaly, long term neurobehavioral abnormalities |
Cigarette smoking | 1st trimester 2nd - 3rd trimester | -> Malformations, SAB -> growth | Cleft lip, club foot, cardiac defects, carniosynostosis, Poland syndrome, transverse limb reduction |
Toluene | Unknown | Unknown | Similar to FAS |
Cocaine | Unknown | Unknown | Causes vascular disruption -- SAB, stillbirths, IUGR, preterm delivery, etc |
ACE-I, ARBs | 2nd - 3rd trimester | Dose / duration dependent | Renal failure, IUGR, hypocalvaria, hypotension |
Androgenic hormones | 8-13th week 2nd - 3rd trimester | Unknown | Masculinization of female fetus (labial fusion, and clitoral hypertrophy) |