Important Timeline:

• 12 dy: “all or nothing”
• 5 wk: placenta starts to prevent some drugs from crossing
• Warfarin only have effect GA 6-9 wk

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Stages of Fetal Development

Causes

Types of Malformations and Syndromes

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Retinoid - (CI: G) → 2 forms of contraception preventing pregnancy

Retinoid Embryopathy

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Thalidomide

Phocomelia, Neural tube defect

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Warfarin (Coumadin ®) in 6-9 weeks → Replace with Herparin/LMWH

Fetal Warfarin Syndrome

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Lithium (0.8-1.2 mmol/L) → Ebstein’s anomaly

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Anti-Convulsant → Replace with Lamotrigine, 5 mg dailu Folic Acid Supplement 3 mon. prior to conception

• Valproate, CI: G → possible cardiac anomaly, Neural tube defect

• Carbamazepine → Neural tube defect

• Phenytoin → Fetal Hydantoin Syndrome

  

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Also, see Medication Use in Pregnancy

Management

Pregnancy Drug Safety