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Briggs Drugs

Special Pops

DrugsCritical PeriodRisk magnitudeDevelopmental 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)
Created by: richardd626