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5th year medical student
It causes mental and physical defects
represented in distinctive abnormal stigmata.
The effects are known as fetal alcohol
(1)characteristic facial anomalies .
• a. Small palpebral fissures
• b. Thin vermilion border
• c. Smooth philtrum
• Structural : microcephaly, agenesis of corpus callosum,
cerebellar hypoplasia, hipocampus…
• Neuological : epilepsy, impaired fine motor skills, hearing loss,
poor gait, clumsiness…
• Functional : communication, learing, behavior…
Newborns of smoking mothers are 200 g less than
those of nonsmokers’ baby.
Smoking also may cause
increase incidence of subfertility, spontaneous
abortion, placenta previa, placental abruption ,
Many studies found association between maternal
smoking and hydrocephaly,microcephaly,
omphalocele, gastroschisis,cleft lip and palate &
• Aspirin: not increase risk of anomalies
• Acetaminophen: not increase risk of anomalies
• Early closure of fetal ductus arteriosus and
subsequent pulmonary hypertension
• decrease fetal urine output and reduce amnionic
• reversible if discontinued before 34 weeks
(carbimazole, neomercazole, thiouracil);
thyroid hormone in the fetal thyroid gland causing
compensatory over action of the pituitary leading
to fetal goiter which may cause neonatal respiratory
• Lack of thyroid hormone will cause fetal
cretinism& mental retardation.
• If anti-thyroid drugs are used, they should
be combined with L-Thyroxin
• Radio –Active Iodine ;shouldn’t be used
in pregnancy, because the fetal thyroid
gland will be destroyed if Iodine 131 is
ingested by the mother.
• ACE inhibitors ...
C/I in pregnancy;
Oligohydraminos 2ry to renal impairment in the foetus.
Affects fetal blood pressure control.
• Angiotensin II receptor inhibitor
(Losartan, Valsartan) should be avoided(evidence of
• Methyldopa, hydralazine, calcium channel blocker:
No reports of congenital defect.[C ]
• Asthma drug : Bronchodilators
Salbutamol, Aminophylline & Theophylline safe.
If administered by inhalation (safe) no adrenal
Systemic steroids : facial clefts.
• Tetracycline; after 4th month of pregnancy it
enters the fetal circulation, chelates with Ca &
deposits in teeth, bones, nails.
• When the teeth erupt in the infant ,they are
at 1st light yellow & fluoresce in ultraviolet
light & later the color fades gradually to a non
florescent brown, in addition to hypoplasia of
teeth leading to dental carries
• Ampicillin& penicillin :safe
• Chloramphenicol : B.M. depression in
the mother & very dangerous to
premature neonate. No congenital
– Gray baby syndrome
• Aminoglycosides : Although both
nephrotoxicity and ototoxicity have
been reported in preterm newborns
and adults treated with gentamicin or
streptomycin, congenital defects
resulting from prenatal exposure
have not been confirmed.
:ANTI- CONVULSANT DRUGS
• Phenobarbitone, Phenytoin, Primidone ;
• Retrospective study suggested that cleft lip & palate
may occur in the fetus, but prospective study of 16
neonates of mother on anti-convulsant drugs showed
that 7 neonates had severe coagulation defects
similar to vitamin K deficiency.
• Prophylactic RX of the mother with vit. K may
prevent this risk.
DRUGS CAUSING KERNICTERUS&
• They cause dissociation of the bilirubin from its
protective binding to serum albumin in the fetus….. The
free bilirubin diffuse readily into the CNS producing
e.g. the following;
• Sulphonamide (sulphamethoxazole + trimethoprim)
• Salicylates, Phenylbutazone