Volume 8, Issue 6, June – 2023 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Teratogenic Effect of Different Drugs at Different

Stages in Pregnancy
Ambeya khatoon, Rohit Kumar Trivedi (Guide)
College of Pharmacy (Shivalik Campus), Dehradun

Abstract:- Because of the potential for teratogenic II. STAGES OF PREGNANCY

medication effects on the foetus, treating common
ailments during pregnancy is challenging. The first eight  First trimester: - 1 to 3 Months (week1 through 12)
weeks of human development are referred to as the The first trimester lasts 12 weeks and starts at
embryogenesis period, sometimes known as the fertilisation. Pregnancy usually goes like way for the first
organogenesis period. Such a deficiency is caused by a three months. During this trimester, the fertilised egg will
teratogenic agent, which are compounds that could harm grow from a small group of cells into a foetus that is
the human embryo or foetus physically or functionally. beginning to exhibit human characteristics [3]. Although the
An acknowledgment of the tragedies caused by the first trimester is delightful, the majority of people also go
thalidomide epidemic in the 1970s and the rubella through this time with painful symptoms including fatigue
epidemic in the early 1960s in the field of teratology. and morning sickness [5].
Chloramphenicol, Warfarin, Valproate, and
Thalidomide are a few of the medications that might  Second trimester: - 4 to 7 Months (weeks13 through 28)
cause abnormalities such microcephaly, hydrocephalus, The second trimester of pregnancy is usually viewed as
spina bifida, and a number of other syndromes. Many of the best part. By this time, any morning sickness should
these substances can enter human tissue and a have passed, along with any discomfort from the early
developing foetus, which can have detrimental effects on stages of pregnancy. You may also start to feel movement
the human reproductive health. Numerous biological when the foetus flips and spins inside your uterus. [1].
and physical elements, like as radiation and infection,
contribute to teratogenic effects.  Third trimester: - 8 to 10 Months (weeks29 through 40)
The last stage of your pregnancy is this. Avoid the
Keywords:- Teratogenic, Teratogenicity, Birth Defects, temptation to start counting down the days until your due
Pregnancy, Early Pregnancy, Miscarriage, Stillbirth, date in the hopes that it will arrive early by resisting the
Preterm Birth, Congenital abnormalities. urge. With each week of this final period of development,
the foetus prepares for birth. During the third trimester, the
I. INRODUCTION foetus gains weight quickly and gains body fat that will be
advantageous after birth [6].
Due to the risk of teratogenic consequences from the
drug and physiologic changes in the mother as a result of the III. RISK OF TERATOGENICITY OF DRUGS
pregnancy, drug therapy presents a specific concern during USED IN PREGNANCY
pregnancy [1,7]. When a sperm enters an egg, pregnancy
happens. This process, known as fertilisation, often takes  Antiepileptic drugs:
place in the fallopian tube of the female. The fertilised egg AEDs have been suspected as having teratogenic
starts to divide right away, creating a huge mass of cells. potential since the 1960s. Most WWE cannot afford to stop
The fertilised egg implants into the uterine wall between 5-7 using AEDs because seizures pose a risk of harm or perhaps
days after ovulation and begins to create the placenta [2]. death [10]. Anti-epileptic medications increase the
The first eight weeks of pregnancy are primarily when likelihood of conceiving a kid with congenital abnormalities
medications have an impact on how the human embryo more than the general population [3]. AED use during the
develops. The blastocyst is free to move around in the uterus first trimester of pregnancy may increase the likelihood that
for the first week and relies on uterine secretion for children delivered to WWE (Well Women Exam) women
sustenance. At this point, it is unknown if exogenous factors will require medical countermeasures [10].
like medications can result in congenital abnormalities, but
they can cause the embryo's death [3]. A, B, C, D, or X risk  Analgesics and Anti-inflammatory Drugs:
categories were created by the FDA to indicate a drug's Acetaminophen and Propoxyphene are reasonable
potential to cause birth defects if used during pregnancy in choice when symptomatic relief of pain is required.
1979 [5]. The formation of deformities in the foetus is Acetylsalicylic acid has probably more widely used in
referred to as teratogenic. A teratogenic drug causes such a pregnancy but high doses may cause intrauterine growth
defect. The term "teratogen" is typically used to describe retardation. Propoxyphene has not been associated with
chemicals that impede the normal anatomical development teratogenic effects, but codeine has been related to
of an embryo [4]. congenital abnormalities in the respiratory system [3].

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Volume 8, Issue 6, June – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
 Antidepressants and Anxiolytics Drugs:
Clinical experience has shown that pregnant women IV. HOW DO DRUGS CROSS THE PLACENTA
exposed to antidepressants experience greater spontaneous
abortions and stillbirths. Poor Neonatal Adaptation (PNA) is  Most drugs can cross the placenta by passive diffusion
more common when pregnant women receive treatment in  Placental membrane is semi-permeable
the third trimester [11]. Diazepam (Valium) use during  Movement of drugs through the placenta is limited by a
pregnancy has been linked in certain studies to birth single layer of trophoblast [31].
malformations include cleft lip, heart issues, and pyloric
stenosis [3]. Due to the possibility of congenital V. TERATOGENESIS AND FDA
malformations, lithium should be avoided during pregnancy CLASSIFICATION DRUG
[3].
 Teratogenesis
 Ciprofloxacin and Levofloxacin: Congenital abnormalities of the foetus occur. These are
Levofloxacin and Cipro are examples of other compounds that, when exposed to an embryo or foetus, can
antibiotics. These medications may impair the baby's poison them and result in lifelong birth abnormalities.
skeletal and muscular development as well as the mother's (Mistakes in functionality or structure) [31].
joints and possibly even cause nerve damage [21].

Table 1 FDA Classification Drugs

Category Characteristics Examples
The foetus in the first trimester of pregnancy is not at risk, according
A Folic acid Thyroxine
to adequate and controlled research conducted in women.
There are no controlled trials in pregnant women, despite animal
B Paracetamol Erythromycin
reproductive research failing to show a risk to the foetus
Only if the potential benefits outweigh the potential risks to the foetus
should drugs be given, regardless of whether studies in animals have
C Morphine
demonstrated a harmful effect on the foetus (teratogenic, embryocidal,
or other).
Based on data from studies on adverse reactions, there is strong
D evidence that there is a danger to the human foetus, although the Antiepileptics
benefits of using the medicine while pregnant may outweigh the risks.
Proven foetal abnormalities in animal and human studies. Drugs
X should only be administered if the possible advantages outweigh the Thalidomide Sedative
potential hazards to the foetus [2].

VI. TERATOGENESIS OF DRUGS AT STAGES

Table 2 First Trimester

FIRST TRIMESTER
 Phocomelia: - Absence of organ, one or more limbs and is denoted a terminal
Thalidomide transverse defect.
 Shortened or absent long bones of the limbs
 Foetal Hydantoin Syndrome
Phenytoin  Nail and digital hypoplasia
 Oral cleft (cleft lip and palate)
 Foetal Alcohol Syndrome
 CVS abnormalities
Alcohol
 CNS abnormalities

 Permanent teeth staining

Tetracycline  Discoloration and hypoplasia
 Caries and pigmentation of permanent teeth
Corticosteroids  Cleft lip and palate

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Volume 8, Issue 6, June – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
 Hypoplasia of nasal bridge
Warfarin  CNS malformation
 Anticoagulant

Table 3 The Second and Third Trimester

THE SECOND AND THIRD TRIMESTER
Chloramphenicol  Gray baby syndrome
 Bradycardia
Propranolol  Neonatal hypoglycaemia
 Poor uterine blood flow
 Prostaglandin synthesis inhibitors
NSAIDs
 Increase risk for postpartum haemorrhage
ACE inhibitor  Renal damage
Risk for neonatal hypothyroidism and goitres (Methimazole, Carbimazole, Iodide and
Antithyroids Propylthiouracil)
Chloramphenicol  Gray baby syndrome

VII. CONCLUSION [7]. https://my.clevelandclinic.org/health/articles/7247-

fetal-development-stages-of-growth
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worries about medication use during pregnancy are not Irvine. Prenatal medication prescribed in primary care:
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