Table 601. Drugs with Significant Adverse Effects on the Fetu ( at!

ung"
Drug A#E inhibitors A(ino%terin A(%heta(ines Androgens Antide%ressants$ tric&clic +arbiturates +usulfan #arba(a!e%ine #hlor%ro%a(ide #lo(i%ra(ine #ocaine Trimester All$ es%eciall& second and third First All Second and third Third All All First All Third All Effect 'enal da(age )ulti%le gross ano(alies Sus%ected abnor(al develo%(ental %atterns$ decreased school %erfor(ance )asculini!ation of fe(ale fetus *eonatal withdrawal s&(%to(s have been re%orted in a few cases with clo(i%ra(ine$ desi%ra(ine$ and i(i%ra(ine #hronic use can lead to neonatal de%endence. #ognitive loss has been described ,arious congenital (alfor(ations- low birth weight *eural tube defects .rolonged s&(%to(atic neonatal h&%ogl&ce(ia *eonatal letharg&$ h&%otonia$ c&anosis$ h&%other(ia /ncreased ris0 of s%ontaneous abortion$ abru%tion %lacentae$ and %re(ature labor- neonatal cerebral infarction$ abnor(al develo%(ent$ and decreased school %erfor(ance ,arious congenital (alfor(ations ,arious congenital (alfor(ations #hronic use (a& lead to neonatal de%endence and increase ris0 for oral cleft ,aginal adenosis$ clear cell vaginal adenocarcino(a 'is0 of fetal alcohol s&ndro(e and alcohol1related neurodevelo%(ental defects 2igh ris0 of (ulti%le congenital (alfor(ations #hronic use leads to neonatal de%endence #ongenital goiter$ h&%oth&roidis( E3tre(el& high ris0 of #*S$ face$ ear$ and other (alfor(ations Ebstein5s ano(al& #hronic use leads to neonatal de%endence )ulti%le congenital (alfor(ations 2&%oth&roidis( )a& be (utagenic (fro( ani(al studies- there is no evidence for (utagenic or teratogenic effects in hu(ans" )ulti%le (alfor(ations and effects on brain develo%(ent )7bius se8uence

#&clo%hos%ha(ide #&tarabine Dia!e%a( Dieth&lstilbestrol Ethanol Etretinate 2eroin /odide /sotretinoin 4ithiu( )ethadone )ethotre3ate )eth&lthiouracil )etronida!ole 6rganic solvents )iso%rostol

First First$ second All All All All All All All First All First All First First First

Drug .enicilla(ine .henc&clidine .hen&toin .ro%&lthiouracil Stre%to(&cin S(o0ing (constituents of tobacco s(o0e" Ta(o3ifen Tetrac&cline Thalido(ide Tri(ethadione ,al%roic acid 9arfarin

Trimester First All All All All All All All First All All First Second Third

Effect #utis la3a$ other congenital (alfor(ations Abnor(al neurologic e3a(ination$ %oor suc0 refle3 and feeding Fetal h&dantoin s&ndro(e #ongenital goiter Eighth nerve to3icit& described in a few cases /ntrauterine growth retardation- %re(aturit&- sudden infant death s&ndro(e- %erinatal co(%lications /ncreased ris0 of s%ontaneous abortion or fetal da(age Discoloration and defects of teeth .hoco(elia (shortened or absent long bones of the li(bs" and (an& internal (alfor(ations )ulti%le congenital ano(alies *eural tube defects 2&%o%lastic nasal bridge$ chondrod&s%lasia #*S (alfor(ations 'is0 of bleeding. Discontinue use 1 (onth before deliver&