Abadie Raegan B, Keller Camryn L, Jones Nicholas T, Mayeux Erin L, Klapper Rachel J, Anderson Lillian, Kaye Adam M, Ahmadzadeh Shahab, Varrassi Giustino, Shekoohi Sahar, Kaye Alan D
School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA.
Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, USA.
Cureus. 2023 Dec 13;15(12):e50465. doi: 10.7759/cureus.50465. eCollection 2023 Dec.
Teratogenic agents have been shown to have drastic and detrimental effects on fetuses if exposed to the agent during uterine life. The most sensitive time for a developing fetus is during the first trimester, and teratogenic exposure during this time can lead to severe deformities in the fetus. The Food and Drug Administration has categorized teratogenic agents based on the severity of their effect on the fetus; these categories include A, B, C, D, and X. Category A is the safest, with the most dangerous, and highly contraindicated in pregnant patients being Category X. This review article will discuss the teratogenic agents leflunomide, isotretinoin, thalidomide, warfarin, tetracycline, and angiotensinogen-converting enzyme inhibitors. Leflunomide can cause cranioschisis, exencephaly, and vertebral, head, and limb malformations. Isotretinoin's main teratogenic effects include central nervous system malformations, hydrocephalus, eye abnormalities, cardiac septal defects, thymus abnormalities, spontaneous abortions, and external ear abnormalities. Thalidomide has been shown to cause limb deformities, bowel atresia, and heart defects when the embryo is exposed to the agent during development. Warfarin can lead to spontaneous abortion and intrauterine death, as well as nasal hypoplasia, hypoplasia of extremities, cardiac defects, scoliosis, and mental retardation when exposed in utero. Tetracycline's teratogenic effects include gastrointestinal distress, esophageal ulceration and strictures, teeth discoloration, hepatotoxicity, and calcifications. Angiotensinogen-converting enzyme inhibitors can cause skull hyperplasia, anuria, hypotension, renal failure, lung hypoplasia, skeletal deformation, oligohydramnios, and fetal death. Teratogenic effects can be avoided if the pregnant patient is educated on the teratogenic effects of these agents.
已证实，如果胎儿在子宫内发育期间接触致畸剂，这些致畸剂会对胎儿产生剧烈且有害的影响。发育中的胎儿最敏感的时期是在孕早期，在此期间接触致畸剂会导致胎儿出现严重畸形。美国食品药品监督管理局根据致畸剂对胎儿影响的严重程度对其进行了分类；这些类别包括A、B、C、D和X。A类是最安全的，而X类是最危险的，孕妇绝对禁用。这篇综述文章将讨论来氟米特、异维A酸、沙利度胺、华法林、四环素和血管紧张素转换酶抑制剂等致畸剂。来氟米特可导致颅骨裂、无脑儿以及脊柱、头部和肢体畸形。异维A酸的主要致畸作用包括中枢神经系统畸形、脑积水、眼部异常、心脏间隔缺损、胸腺异常、自然流产和外耳异常。已证实，当胚胎在发育过程中接触沙利度胺时，会导致肢体畸形、肠道闭锁和心脏缺陷。华法林可导致自然流产和宫内死亡，以及在子宫内接触时出现鼻发育不全、肢体发育不全、心脏缺陷、脊柱侧弯和智力发育迟缓。四环素的致畸作用包括胃肠道不适、食管溃疡和狭窄、牙齿变色、肝毒性和钙化。血管紧张素转换酶抑制剂可导致颅骨增生、无尿、低血压、肾衰竭、肺发育不全、骨骼变形、羊水过少和胎儿死亡。如果对孕妇进行这些药物致畸作用的教育，就可以避免致畸影响。
