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Calado AM, Seixas F, Pires MDA. Updating an Overview of Teratology. Methods Mol Biol 2024; 2753:1-38. [PMID: 38285332 DOI: 10.1007/978-1-0716-3625-1_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
In this chapter, the authors aim to update an overview of the principles of teratology, beginning with the definition of teratology, the critical point at which this process occurs, and some of the most common etiological agents that improve our understanding of teratology.Modern teratology has greatly improved in recent years with advances in new methods in molecular biology, toxicology, animal laboratory science, and genetics, increasing our knowledge of ambient influences. Nevertheless, there is a lot to do to reduce the influence of hazardous intervening agents, whether they target our genetics or not, that can negatively affect pregnancy and induce congenital development disorders, including morphological, biochemical, or behavioral defects.Certain agents might indeed be related to certain defects, but we have not been able to identify the cause of most congenital defects, which highlights the importance of finding and testing out new genetics techniques and conducting laboratory animal science to unravel the etiology and pathogenicity of each congenital defect.
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Affiliation(s)
- Ana Margarida Calado
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Fernanda Seixas
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Maria Dos Anjos Pires
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.
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Zhou Y, Tao J, Wang K, Deng K, Wang Y, Zhao J, Chen C, Wu T, Zhou J, Zhu J, Li X. Protocol of a prospective and multicentre China Teratology Birth Cohort (CTBC): association of maternal drug exposure during pregnancy with adverse pregnancy outcomes. BMC Pregnancy Childbirth 2021; 21:593. [PMID: 34470618 PMCID: PMC8411516 DOI: 10.1186/s12884-021-04073-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As reported, 27-93 % of pregnant women take at least one drug during pregnancy. However, drug exposure during pregnancy still lacks sufficient foetal safety evidence of human origin. It is urgent to fill the knowledge gap about medication safety during pregnancy for optimization of maternal disease treatment and pregnancy drug consultation. METHODS AND ANALYSIS The China Teratology Birth Cohort (CTBC) was established in 2019 and is a hospital-based open-ended prospective cohort study with the aim of assessing drug safety during pregnancy. Pregnant women who set up the pregnancy health records in the first trimester or who seek drug consultation regardless of gestational age in the member hospitals are recruited. Enrolled pregnant women need to be investigated four times, namely, 6-14 and 24-28 weeks of gestational age, before discharge after hospital delivery, and 28-42 days after birth. Maternal medication exposure during pregnancy is the focus of the CTBC. For drugs, information on the type, name, and route of medication; start and end time of medication; single dose; frequency of medication; dosage form; manufacturer; and reason for medication is collected. The adverse pregnancy outcomes collected in the study include birth defects, stillbirth, spontaneous abortion, preterm birth, post-term birth, low birth weight, macrosomia, small for gestational age, large for gestational age and low Apgar score. CTBC uses an electronic questionnaire for data collection and a cloud system for data management. Biological samples are collected if informed consents are obtained. Multi-level logistic regression, mixed-effect negative binomial distribution regression and spline function regression are used to explore the effect of drugs on the occurrence of birth defects. DISCUSSION The findings of the study will assist in further understanding the risk of birth defects and other adverse pregnancy outcomes associated with maternal drug exposure and developing the optimal treatment plans and drug counselling for pregnant women. TRIAL REGISTRATION This study was approved by the Research Ethics Committee of the West China Second Hospital of Sichuan University and registered at the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/index.aspx , registration number ChiCTR1900022569 ).
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Affiliation(s)
- Yangwen Zhou
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Sichuan Province, 610041, Chengdu City, People's Republic of China
| | - Jing Tao
- Key Laboratory of Birth Defects And Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ke Wang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Sichuan Province, 610041, Chengdu City, People's Republic of China
| | - Kui Deng
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Sichuan Province, 610041, Chengdu City, People's Republic of China
| | - Yanping Wang
- Key Laboratory of Birth Defects And Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jianxin Zhao
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Sichuan Province, 610041, Chengdu City, People's Republic of China
| | - Chunyi Chen
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Sichuan Province, 610041, Chengdu City, People's Republic of China
| | - Tingxuan Wu
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Sichuan Province, 610041, Chengdu City, People's Republic of China
| | - Jiayuan Zhou
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Sichuan Province, 610041, Chengdu City, People's Republic of China
| | - Jun Zhu
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Sichuan Province, 610041, Chengdu City, People's Republic of China. .,Key Laboratory of Birth Defects And Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China. .,National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Sichuan Province, 610041, Chengdu City, People's Republic of China.
| | - Xiaohong Li
- Key Laboratory of Birth Defects And Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China. .,National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Sichuan Province, 610041, Chengdu City, People's Republic of China.
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Abstract
In this chapter, we provide an overview of the basic principles of teratology, beginning with its definition, the critical point for teratogenesis to occur and the most evident etiological agents to improve the understanding of this science.Teratology is a recent science that began in the early twentieth century, and has greatly improved over the recent years with the advancements in molecular biology, toxicology, animal laboratory science, and genetics, as well as the improvement on the knowledge of the environmental influences.Nevertheless, more work is required to reduce the influence of hazardous products that could be deleterious during pregnancy, thus reducing teratogenic defects in the newborn. While some teratogenic defects are attributed to their agents with certainty, the same for a lot of other such defects is lacking, necessitating consistent studies to decipher the influence of various teratogenic agents on their corresponding teratogenic defects. It is here that the laboratory animal science is of great importance both in the present and in the future.
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Affiliation(s)
- Ana M Calado
- Departamento de Ciências Veterinárias, Universidade de Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.,Centro de Ciência Animal e Veterinária (CECAV), Universidade de Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Maria Dos Anjos Pires
- Departamento de Ciências Veterinárias, Universidade de Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal. .,Centro de Ciência Animal e Veterinária (CECAV), Universidade de Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.
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Kihal-Talantikite W, Zmirou-Navier D, Padilla C, Deguen S. Systematic literature review of reproductive outcome associated with residential proximity to polluted sites. Int J Health Geogr 2017; 16:20. [PMID: 28558782 PMCID: PMC5450119 DOI: 10.1186/s12942-017-0091-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/25/2017] [Indexed: 11/15/2022] Open
Abstract
This study aims to assess the evidence on adverse pregnancy outcome associated with living close to polluted industrial sites, and identify the strengths and weaknesses of published epidemiological studies. A systematic literature search has been performed on all epidemiological studies published in developed countries since 1990, on the association between residential proximity to industrial sites (hazardous waste sites, industrial facilities and landfill sites) and adverse pregnancy outcome (low birth weight, preterm birth, small for gestational age, intrauterine growth retardation, infant mortality, congenital malformation). Based on 41 papers, our review reveals an excess risk of reproductive morbidity. However, no studies show significant excess risk of mortality including fetal death, neonatal or infant mortality and stillbirth. All published studies tend to show an increased risk of congenital abnormalities, yet not all are statistically significant. All but two of these studies revealed an excess risk of low birth weight. Results for preterm birth, small for gestational age and intrauterine growth retardation show the same pattern. There is suggestive evidence from the post-1990 literature that residential proximity to polluted sites (including landfills, hazardous waste sites and industrial facilities) might contribute to adverse reproductive outcomes, especially congenital malformations and low birth weight-though not mortality. This body of evidence has limitations that impede the formulation of firm conclusions, and new, well-focused studies are called for. The review findings suggest that continued strengthening of rules governing industrial emissions as well as industrial waste management and improved land use planning are needed.
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Affiliation(s)
- Wahida Kihal-Talantikite
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 3 Rue de l’argonne, 6700 Strasbourg, France
| | - Denis Zmirou-Navier
- Department of Environmental and Occupational Health, School of Public Health (EHESP), Rennes and Sorbonne Paris Cité, Paris, France
- INSERM U1085-IRSET – Research Institute of Environmental and Occupational Health, Rennes, France
- Lorraine University, Vandoeuvre-les-Nancy, France
| | - Cindy Padilla
- Department of Quantitative Methods in Public Health, School of Public Health (EHESP), Rennes and Sorbonne Paris Cité, Paris, France
| | - Séverine Deguen
- Department of Environmental and Occupational Health, School of Public Health (EHESP), Rennes and Sorbonne Paris Cité, Paris, France
- Department of Social Epidemiology, Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (UMRS 1136), Paris, France
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Lubala TK, Mbuyi-Musanzayi S, Lubala N, Luboya ON, Kalenga PM, Devriendt K, Lukusa-Tshilobo P. Mirror-image gastroschisis in monochorionic female twins. Eur J Med Genet 2015; 58:266-9. [DOI: 10.1016/j.ejmg.2015.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 03/08/2015] [Indexed: 11/29/2022]
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Wiebrecht A, Gaus W, Becker S, Hummelsberger J, Kuhlmann K. Safety aspects of Chinese herbal medicine in pregnancy—Re-evaluation of experimental data of two animal studies and the clinical experience. Complement Ther Med 2014; 22:954-64. [DOI: 10.1016/j.ctim.2014.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 07/31/2014] [Accepted: 08/10/2014] [Indexed: 10/24/2022] Open
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Safety of pediatric HIV elimination: the growing population of HIV- and antiretroviral-exposed but uninfected infants. PLoS Med 2014; 11:e1001636. [PMID: 24781352 PMCID: PMC4004531 DOI: 10.1371/journal.pmed.1001636] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Lynne Mofenson and Heather Watts discuss the context and implications of the study by J. Sibuide and colleagues, which provides a detailed analysis of birth defects in infants with in utero antiretroviral drug exposure in the French Perinatal Cohort. Please see later in the article for the Editors' Summary.
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Dorlo TPC, Balasegaram M, Lima MA, de Vries PJ, Beijnen JH, Huitema ADR. Translational pharmacokinetic modelling and simulation for the assessment of duration of contraceptive use after treatment with miltefosine. J Antimicrob Chemother 2012; 67:1996-2004. [DOI: 10.1093/jac/dks164] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pratten M, Ahir BK, Smith-Hurst H, Memon S, Mutch P, Cumberland P. Primary cell and micromass culture in assessing developmental toxicity. Methods Mol Biol 2012; 889:115-146. [PMID: 22669663 DOI: 10.1007/978-1-61779-867-2_9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Under the European Commission's New Chemical Policy both currently used and new chemicals should be tested for their toxicities in several areas, one of which was reproductive/developmental toxicity. Thousands of chemicals will need testing which will require a large number of laboratory animals. In vitro systems (as pre-screens or as validated alternatives) appear to be useful tools to reduce the number of whole animals used or refine procedures and hence decrease the cost for the chemical industry. Validated in vitro systems exist for developmental toxicity/embryotoxicity testing. Indeed, three assays have recently been validated: the whole embryo culture (WEC), the rat limb bud micromass (MM), and the embryonic stem cell test (EST). In this article, the use of primary embryonic cell culture, and in particular micromass culture, including a relatively novel chick heart micromass (MM) culture system has been described and compared to the validated D3 mouse embryonic stem cell (ESC) test.
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Affiliation(s)
- M Pratten
- School of Biomedical Science, University of Nottingham, Nottingham, UK.
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Eltonsy S, Forget A, Blais L. Beta2-agonists use during pregnancy and the risk of congenital malformations. ACTA ACUST UNITED AC 2011; 91:937-47. [PMID: 21948561 DOI: 10.1002/bdra.22850] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 06/28/2011] [Accepted: 07/04/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND Treatment of asthma symptoms during pregnancy is crucial for maternal and fetal health. Short-acting beta2-agonists (SABA) are frequently used as rescue medications and long-acting beta2-agonists (LABA) are used as add-on controller therapy for asthma during pregnancy. OBJECTIVE The objective of this study was to investigate the association between exposure to SABA and LABA in the first trimester of pregnancy and the risk of congenital malformations among women with asthma. METHODS A cohort of pregnancies from women with asthma was formed through linkage of three administrative databases from Québec, Canada. The primary outcomes were major and any congenital malformations. The primary exposures were exposure to SABA and LABA during the first trimester, while secondary exposure was weekly SABA doses. The associations between congenital malformations (any, major, and specific) and SABA and LABA exposure were assessed with generalized estimating equations models. RESULTS From a group of 13,117 pregnancies, we identified 1242 and 762 infants with any (9.5%) and major (5.8%) congenital malformations, respectively. The adjusted odds ratios (95% confidence interval [CI]) for any malformations associated with the use of SABA and LABA were 1.04 (95% CI, 0.92-1.17) and 1.37 (95% CI, 0.92-2.17), respectively. The corresponding figures were 0.93 (95% CI, 0.80-1.08) and 1.31 (95% CI, 0.74-2.31) for major malformations. Significant increased risks of major "cardiac" and major "other and unspecified" congenital malformations were observed with LABA use. CONCLUSION Our study supports the evidence of SABA safety during pregnancy, but more research is required to assess whether the increased risk of malformations among LABA users is due to the medication, bias by asthma severity, or chance alone.
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Affiliation(s)
- Sherif Eltonsy
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
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Selderslaghs IWT, Blust R, Witters HE. Feasibility study of the zebrafish assay as an alternative method to screen for developmental toxicity and embryotoxicity using a training set of 27 compounds. Reprod Toxicol 2011; 33:142-54. [PMID: 21871558 DOI: 10.1016/j.reprotox.2011.08.003] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 07/06/2011] [Accepted: 08/09/2011] [Indexed: 01/20/2023]
Abstract
To anticipate to increased testing needs for reproductive toxicity and 3R approaches, we studied zebrafish embryo/larva as an alternative for animal testing for developmental toxicity and embryotoxicity and evaluated a training set of 27 compounds with a standardized protocol. The classification of compounds in the zebrafish embryo/larva assay, based on a prediction model using a TI (teratogenic index) cut-off value of 2, was compared to available animal and human data. When comparing the classification of compounds in the zebrafish embryo/larva assay to available animal classification, a sensitivity of 72% and specificity of 100% were obtained. The predictive values obtained in comparison to a limited set of human data were 50, 60% respectively for teratogens, non-teratogens. Overall, we demonstrated that the zebrafish embryo/larva assay, may be used as screening tool for prioritization of compounds and could contribute to reduction of animal experiments in the field of developmental toxicology.
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Affiliation(s)
- Ingrid W T Selderslaghs
- VITO NV, Flemish Institute for Technological Research, CARDAM, Centre for Advanced R&D on Alternative Methods, Boeretang 200, 2400 Mol, Belgium.
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Adam MP, Polifka JE, Friedman J. Evolving knowledge of the teratogenicity of medications in human pregnancy. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2011; 157C:175-82. [DOI: 10.1002/ajmg.c.30313] [Citation(s) in RCA: 216] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
A recent editorial is discussed, which implied that animal-based developmental and reproductive toxicology tests will continue to be crucial, that the thalidomide disaster could have been prevented by more animal testing, and that tests on juvenile animals would help to protect children (as developing adults) from the adverse effects of pharmaceuticals. It is argued that animal tests in these scientific areas do not provide reliable data that are predictive for human responses and, even if they did, the tests are too expensive and time-consuming for application to the very large number of substances that need to be tested. It is estimated there are already more than 100,000 man-made chemicals to which humans may be exposed on a regular basis, and it is therefore widely accepted that in vivo developmental toxicology could not possibly be used to assess all new and existing chemical substances, due to the scale of its demand upon time and resources. It is therefore imperative that alternatives such as those outlined above are embraced, further developed, accepted and used - as a matter of urgency.
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Affiliation(s)
- Jarrod Bailey
- Physicians Committee for Responsible Medicine, Washington, DC 20016, USA.
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Nokhbatolfoghahai M, Parivar K. Teratogenic Effect of Lithium Carbonate in Early Development of Balb/C Mouse. Anat Rec (Hoboken) 2008; 291:1088-96. [DOI: 10.1002/ar.20730] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Buyukkayhan D, Koklu E, Akcakus M, Kurtoglu S. Femoral hypoplasia in two newborns associated with maternal diabetes mellitus. J Pediatr Endocrinol Metab 2007; 20:1151-4. [PMID: 18051935 DOI: 10.1515/jpem.2007.20.10.1151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Femoral hypoplasia is a rare disorder, with an estimated incidence of 0.11-0.2/10,000 live births. Although the majority of cases are sporadic, a few familial cases have been described. Poor diabetic control, exposure to drugs, viral infections, radiation, focal ischemia and trauma between the 4th and 8th week of gestation have been implicated as possible etiological factors. Femoral hypoplasia with other congenital anomalies was described in children of diabetic mothers. The isolated form is uncommon. We present here two newborns with femoral hypoplasia due to maternal diabetes mellitus. One of them has isolated and unilateral left femoral hypoplasia diagnosed after birth; the other has bilateral femoral hypoplasia and bowing diagnosed by ultrasound at 24 weeks' gestation.
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Affiliation(s)
- Derya Buyukkayhan
- Department of Pediatrics, Division of Neonatology, Erciyes University, Kayseri, Turkey
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Affiliation(s)
- Dorothy K Y Sit
- Psychiatry, Women's Behavioral HealthCARE, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Katherine L Wisner
- Psychiatry, obstetrics and gynecology, and reproductive sciences, epidemiology, and women's studies, Women's Behavioral HealthCARE, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center
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Palmieri C, Canger R. Teratogenic potential of the newer antiepileptic drugs: what is known and how should this influence prescribing? CNS Drugs 2003; 16:755-64. [PMID: 12383031 DOI: 10.2165/00023210-200216110-00004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The treatment of women of childbearing age who have epilepsy raises many questions because of the interactions between epilepsy, antiepileptic therapy and different aspects of reproductive life. Menstrual cycle disorders and reduced fertility have been partially ascribed to antiepileptic drugs (AEDs). Furthermore, most AEDs induce the cytochrome P450 (CYP) enzymatic system, altering the metabolism of sex hormones and contributing to the failure of oral contraceptives. Pregnancy represents, in this context, the most critical period because of the well known teratogenic potential of all established AEDs. For most of these drugs no specific patterns of malformations have been identified, although during the past few decades basic knowledge has been acquired, particularly concerning the mechanisms of AED-induced teratogenesis and related risk factors. These issues form the basis of the current guidelines for the management of epilepsy in pregnant women. In the past decade, several new AEDs have been introduced into clinical practice. For a number of reasons, these drugs appear to be more favourable than the older ones as treatments for epilepsy in women of childbearing age. They possess a good pharmacokinetic profile that makes them more stable during pregnancy, and they have a low potential for interaction with other drugs. They are also less likely than the older AEDs to be metabolised to compounds that are teratogenic. Furthermore, most of them do not possess antifolate properties. With the exception of topiramate and vigabatrin, the newer AEDs do not appear to be teratogenic in animals when administered in subtoxic doses. However, animal teratology may not be a reliable predictor of human teratogenicity, and there is a significant lack of information regarding the teratogenic profile of these newer agents in humans. Because clinical experience with these agents is limited, it is advisable to avoid exposure of the embryo to these drugs when pregnancy is planned. The establishment of pregnancy registries could allow for the rapid collection of data related to the administration of new AEDs in pregnancy and the outcomes of such exposure.
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Affiliation(s)
- Carmela Palmieri
- Regional Epilepsy Center, University of Milan Medical School, San Paolo Hospital, Milan, Italy
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Williams LJ, Honein MA, Rasmussen SA. Methods for a public health response to birth defects clusters. TERATOLOGY 2003; 66 Suppl 1:S50-8. [PMID: 12239745 DOI: 10.1002/tera.90011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Few resources are available to guide public health officials in investigations of reported birth defects clusters. The majority of published resources focus on the investigation of cancer and infectious disease clusters and do not address clinical and epidemiologic concerns specific to birth defects research. This document aims to address these concerns, discuss the needs of the affected community, and provide suggestions for the development of a standardized protocol to be used as a guide in the investigation of birth defects clusters. We suggest that health departments and birth defects registries that may receive reports of birth defects clusters establish a protocol for responding that includes the following steps: develop a proactive plan for future birth defects cluster reports (step I), receive report of a birth defects cluster (step II), verify diagnoses and complete case ascertainment (step III), compare the observed rate to a reference rate (step IV), ascertain exposures among cases from available records (step V), interview case mothers (step VI), initiate further epidemiologic study-selection of controls (step VII), and communicate results to the community (step VIII). Specific criteria for continuing or terminating an investigation should be established before receiving cluster reports. The recommendations in this report should be carefully considered to ensure that the specific needs of the region, agency and affected community are met.
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Affiliation(s)
- Laura J Williams
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, MS F-45, Atlanta, GA 30345, USA
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Orr M, Bove F, Kaye W, Stone M. Elevated birth defects in racial or ethnic minority children of women living near hazardous waste sites. Int J Hyg Environ Health 2002; 205:19-27. [PMID: 12018013 DOI: 10.1078/1438-4639-00126] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This case-control study evaluated the relationship between birth defects in racial or ethnic minority children born during 1983-1988 and the potential exposure of their mothers to contaminants at hazardous waste sites in California. Four categories of race or ethnicity were used: black/African American, Hispanic/Latino, American Indian/Alaska Native, and Asian/Pacific Islander. Case subjects were 13,938 minority infants with major structural birth defects (identified by the California Birth Defects Monitoring Program) whose mothers resided in selected counties at the time of delivery. The control group was composed of 14,463 minority infants without birth defects who were randomly selected from the same birth cohort as the case subjects. The potential for exposure was determined by whether the mother resided at the time of delivery in the same census tract as a hazardous waste site that was on the U.S. Environmental Protection Agency's National Priorities List (NPL). Racial/ethnic minority infants whose mothers had been potentially exposed to hazardous waste were at slightly increased risk for birth defects (odds ratio [OR] = 1.12, 95% confidence interval [CI] = 0.98-1.27) than were racial/ethnic minority infants whose mothers had not been potentially exposed. The greatest association was between potential exposure and neural tube defects (OR = 1.54, 95% CI = 0.93-2.55), particularly anencephaly (OR = 1.85, 95% CI = 0.91-3.75). The strongest association between birth defects and potential exposure was among American Indians/Alaska Natives (OR = 1.19, 95% CI = 0.62-2.27). Despite the limitations of this study, the consistency of these findings with previous studies suggests an association between environmental risk factors and birth defects. This is particularly relevant to minority populations. We recommend further investigation of birth defects among minority communities, particularly among American Indians/Alaska Natives. Special attention should also be paid to those defects and contaminants that consistently are associated with exposure to hazardous waste.
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Affiliation(s)
- Maureen Orr
- Agency for Toxic Substances and Disease Registry (ATSDR), Division of Health Studies.
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