Fetal hydrocephalus and ear anomalies associated with maternal use of isotretinoin

Abstract

Collins syndrome and may have resulted f rom defective migra t ion of neural crest cells f rom the first and second branchia l arches?. 2 Including this case, there are now 16 women retrospectively identified as having taken isotretinoin dur ing pregnancy. 3,4 Outcomes from these pregnancies include six spontaneous abortions, one normal infant , and nine infants with malformat ions . Of 18 women identified dur ing pregnancy who did not in ter rupt the pregnancy, the outcomes have included 13 spontaneous abort ions, four normal children, and one abnormal child. Therefore, in 15 pregnancies t ha t have come to term, five chi ldren were normal at b i r th and 10 were abnormal . O f the 10 abno rma l children, seven had microt ia with or wi thout agenesis of the external ear canal, nine had cent ra l nervous system abnormal i t ies , and four had congeni tal hear t defects. A l though the guidelines for using isotret inoin are established, each physician must decide whether the benefit of prescribing any retinoid outweighs the chance tha t the pa t ient will conceive while taking the d rug? Despite cur ren t warnings, with increased use of isotret inoin in women of chi ldbear ing age more f requent inadver ten t exposures have occurred. Unt i l the relat ionship between the dose and dura t ion of exposure with the likelihood and severity of a mal format ion is be t ter understood, the desirabil i ty of cont inuing the pregnancy af ter an exposure should be discussed. Physicians should document tha t sexually active female pat ients are not p regnant when the drug is begun, are using effective b i r th control methods, and are provided with wr i t ten informat ion about the teratogenic effects of this drug.