Fetal Drug Syndromes
REBA MICHELS HILL MD1
DAVID W. SMITH MD
1 St Luke's Episcopal and Texas Children's Hospitals, Houston
1. The antiepileptic drug syndrome does occur, but 80% to 90% of the babies born to mothers on antiepileptic drugs are normal.
2. The minor malformations are not physically handicapping to the child.
3. The majority of major anomalies are medically or surgically correctable. Some, such as the VSD, correct spontaneously.
4. Exposure of the fetus to phenobarbital alone may result in a similar yndrome, so the term "hydantion syndrome" is a misnomer.
5. Infants with lQ >120 may be born to mothers on phenytoin or phenobarbital.
6. There appears to be an increased number of malformations and lowering of IQ from multiple drug exposure rather than single drug exposure.
7. The physical appearance of the child may be reasonable and not grotesque.
8. Infants exposed to alcohol, phenobarbital, or phenytoin have been reported to have malignancy, but the incidence must be compared to the general population to see whether it is significant.
9. Vitamin K3 must be given immediately after birth and a clotting profile checked to see whether additional vitamin K3 is needed, or whether frozen plasma is indicated, because hemorrhage may result in a 33% mortality.
10. Multiple deficiency states occur in patients on chronic drug therapy, and these deficiency states may contribute to the neurologic and physical disability. Vitamin supplements for pregnant epileptic patients may be indicated.
11. Seizures do not increase in the epileptic patients who are given supplementary folic acid as believed by neurologists.
12. A comparison was made between the morbidity in the infant of the epileptic and that of the infant of the diabetic. Since 1950, there have been no recommendations to abort diabetic patients. Their infants have morbidity similar to that of infants of epileptics. Physicians learned what contributed to the morbidity and treated it.
13. Physicians should not administer trimethadione or paramethadione to women of childbearing-age since by the time a pregnancy is diagnosed fetal injury may have already occurred.
