Gonzalez C H, Marques-Dias M J, Kim C A, Sugayama S M, Da Paz J A, Huson S M, Holmes L B
Instituto da Criança Faculty of Medicine, University of São Paulo, Brazil.
Lancet. 1998 May 30;351(9116):1624-7. doi: 10.1016/S0140-6736(97)12363-7.
Misoprostol is commonly used to induce abortion in Brazil, and in other countries in South and Central America where abortions are illegal. However, misoprostol is not very effective in inducing abortions, and exposure to the drug in utero can cause abnormalities in the fetus. We aimed to define the common phenotypical effects of exposure to the drug.
We studied 42 infants from São Paulo, Brazil, who were exposed to misoprostol during the first 3 months of gestation, and then born with congenital abnormalities. We interviewed each of the infants' mothers to find out about misoprostol exposure and dosage. Each infant was physically examined by a geneticist or a neuropaediatrician.
17 of the infants had equinovarus with cranial-nerve defects. Ten children had equinovarus as part of more extensive arthrogryposis. The most distinctive phenotypes were arthrogryposis confined to the legs (five cases) and terminal transverse-limb defects (nine cases) with or without Mobius sequence. The most common dose of misoprostol taken was 800 microg (range 200-16000 microg).
Deformities attributed to vascular disruption were found in these children. We suggest that the uterine contractions induced by misoprostol cause vascular disruption in the fetus, including brain-stem ischaemia. Information on the effects of taking misoprostol during pregnancy should be made more widely available, to dissuade women from misusing the drug.
米索前列醇在巴西以及南美洲和中美洲其他堕胎非法的国家被普遍用于引产。然而，米索前列醇引产效果不佳，且胎儿在子宫内接触该药物会导致胎儿出现异常。我们旨在明确接触该药物常见的表型效应。
我们研究了42名来自巴西圣保罗的婴儿，他们在妊娠前3个月接触了米索前列醇，出生时伴有先天性异常。我们采访了每个婴儿的母亲，以了解米索前列醇的接触情况和剂量。每位婴儿均由遗传学家或神经儿科医生进行体格检查。
17名婴儿患有马蹄内翻足并伴有脑神经缺陷。10名儿童的马蹄内翻足是更广泛的关节挛缩症的一部分。最具特征性的表型是局限于腿部的关节挛缩症（5例）和伴有或不伴有莫比乌斯序列的末端横向肢体缺陷（9例）。服用米索前列醇的最常见剂量为800微克（范围为200 - 16000微克）。
在这些儿童中发现了归因于血管破坏的畸形。我们认为米索前列醇引起的子宫收缩会导致胎儿血管破坏，包括脑干缺血。关于孕期服用米索前列醇影响的信息应更广泛地传播，以劝阻女性滥用该药物。
