DRUG AND CHEMICAL EFFECTS ON MOTHER AND CHILD

Fetal effects of maternal bacterial and viral infections (measles, cytomegalic, herpes, etc.) are well documented. However, drug and chemical effects are less recognized and understood, and actually there was very little in the literature about these effects until recently. Evidence is overwhelming that the nonbarbiturate, sleep-inducing drug thalidomide produced severe malformations of the extremities (phocomelia - 'seal extremities') in numerous newborns in Germany and other parts of Western Europe in the early 1960s. The only medications known definitely and absolutely to be teratogenic in the human are folic-acid antagonists (primarily aminopterin), thalidomide, and masculinizing steroids. Cortisone and its analogues, suspect in cleft palate, should be avoided if possible, particularly in the first trimester of pregnancy. Oral anticoagulants pass readily through the placental barrier and can have teratogenic effects. Heparin should be used instead, since it cannot cross the placental barrier. Drugs suspected or associated with increased risk to the fetus and neonate are listed. Chronic alcoholism in the mother can produce fetal abnormalities (the'fetal alcohol syndrome'). Alcohol readily crosses the placenta and goes directly into the fetus. Assorted heavy metals are probably the leading and most serious environmental pollutants affecting the fetus.