Effects of certain prenatal drugs on the fetus and newborn.

Abstract

1. Robert J. Boyle, MD* 1. *Professor of Pediatrics, University of Virginia Health System, Charlottesville, VA. After completing this article, readers should be able to: 1. Describe the short- and long-term effects of moderate-to-severe alcohol use in pregnancy. 2. List the risks and long-term effects of smoking relative to pulmonary disease, sudden infant death syndrome, and infant intelligence. 3. Characterize the range of anomalies associated with antiepileptic drug use during pregnancy. 4. Describe the risk of Ebstein anomaly following lithium exposure. 5. Describe the effect of angiotensin-converting enzyme inhibitors in the newborn period. Many pregnant women use multiple prescription, over-the-counter, and recreational drugs during their pregnancies. Questions frequently arise from the mother, the mother’s clinician, and the physician caring for the newborn about the potential risks of these agents for the fetus and newborn. Few of these agents have been evaluated prospectively in pregnant women prior to licensure and marketing. Our knowledge of potential risks to the fetus and newborn, therefore, is based on case reports, epidemiologic surveys of exposed individuals, and animal studies. Multiple factors may influence whether a specific drug may affect an individual fetus or newborn and the magnitude of that effect (Table 1). Clearly, not every infant exposed to an individual drug is affected. Likewise, it is important to note that many of these agents are critical to the mother’s health, and discontinuing the drug may place the mother and fetus at higher risk than continuing the drug. The physician also must acknowledge that patients often take medications that were not prescribed specifically for them. These may include over-the-counter medications that the patient does not recall taking, does not understand the active ingredients, or even does not consider a “medication” or “drug.” Or they may be taking medications that they are reluctant to disclose or that were prescribed to another individual. Reluctance to disclose exposures may be especially true of drugs that carry negative social stigmas in …