nach oben

Erschienen in:

2016 | OriginalPaper | Buchkapitel

6. Embryologie und Teratologie

verfasst von : Wolfgang E. Paulus

Erschienen in: Die Geburtshilfe

Verlag: Springer Berlin Heidelberg

Einloggen, um Zugang zu erhalten

Zusammenfassung

Im Verlauf der intrauterinen Entwicklung durchläuft die Frucht Stadien unterschiedlicher Empfindlichkeit gegenüber äußeren Einflüssen. Während sich die Reaktion auf schädigende Agenzien in den ersten beiden Wochen nach Konzeption weitgehend auf die Alternativen vollständige Heilung des Defekts oder Absterben beschränkt, können Einflüsse von Woche 3–8 nach Konzeption zu Störungen der Organdifferenzierung und damit zu Fehlbildungen führen.

In der Fetalperiode stehen Wachstums- und Funktionsstörungen durch exogene Noxen im Vordergrund.

Seit nach Einnahme von Thalidomid ca. 10.000 Kinder mit schweren Gliedmaßendefekten geboren wurden, herrscht bei pharmazeutischer Industrie, Ärzten und Patientinnen berechtigte Vorsicht gegenüber dem Einsatz von Arzneimitteln in der Schwangerschaft. Ein therapeutischer Nihilismus bei chronisch kranken Schwangeren kann jedoch zu einer dramatischen Verschlechterung der Grunderkrankung und damit zu einer erheblichen Gefährdung der fetalen Entwicklung führen.

Vorheriges Kapitel Ungewollte Schwangerschaft

Nächstes Kapitel Pränatale Diagnostik: Molekularbiologische Methoden

ACOG (1994) Substance abuse in pregnancy. ACOG Tech Bull No 195. Int J Gynaecol Obstet 47:73–80CrossRef

ACOG (2003) Immunization during pregnancy. ACOG Committee Opinion No. 282. Obstet Gynecol 101:207–212CrossRef

ACOG Committee on Obstetric Practice (2004) ACOG Committee Opinion Number 299. Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 104:647–651CrossRef

ACOG Committee on Practice Bulletins (2005) Clinical management guidelines for obstetrician-gynecologists. Pregestational diabetes mellitus. Obstet Gynecol 105:675–685CrossRef

Alwan S, Friedman JM (2009) Safety of selective serotonin reuptake inhibitors in pregnancy. CNS Drugs 23:493–509CrossRefPubMed

Andrade SE et al (2009) Antidepressant medication use and risk of persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf 18:246–252CrossRefPubMed

Antiretrovir Pregnancy Registry Steering Committee (2007) Antiretrovir Pregnancy Registry interim report for 1 January 1989 through 31 Juli 2007, Wilmington

Briggs GG, Freeman RK, Yaffe S (2011) Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk, 9. Aufl. Lippincott Williams & Wilkins, Philadelphia

Burtin P, Taddio A, Ariburnu O, Einarson TR, Koren G (1995) Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol 172:525–529CrossRefPubMed

Campbell E, Kennedy F, Irwin B, Morrison P, Delanty N, Hunt S, Craig J, Morrow J (2013) Malformation risks of antiepileptic drug monotherapies in pregnancy. J Neurol Neurosurg Psychiatry 84:e2CrossRef

Costedoat-Chalumeau N, Amoura Z, Duhaut P, du Huong LT, Sebbough D, Wechsler B, Vauthier D, Denjoy I, Lupoglazoff JM, Piette JC (2003) Safety of hydroxychloroquine in pregnant patients with connective tissue diseases: a study of one hundred thirty-three cases compared with a control group. Arthritis Rheum 48:3207–3211CrossRefPubMed

De Santis M, Di Gianantonio E, Cesari E, Ambrosini G, Straface G, Clementi M (2009) First-trimester itraconazole exposure and pregnancy outcome: a prospective cohort study of women contacting teratology information services in Italy. Drug Saf 32:239–244CrossRefPubMed

Degenhardt KH (1971) Pränatale Pathologie: Definition, Häufigkeit, Ätiologie und Pathogenese von Mißbildungen. In: Opitz H (Hrsg) Handbuch der Kinderheilkunde, Bd I/1. Springer, Berlin/Heidelberg/New York, S 602–624

DFG – Deutsche Forschungsgemeinschaft (2006) Maximale Arbeitsplatzkonzentrationen und biologische Arbeitsstofftoleranzwerte. VCH, Weinheim

Diav-Citrin O, Ornoy A (2002) Teratogen update: antithyroid drugs-methimazole, carbimazole, and propylthiouracil. Teratology 65:38CrossRefPubMed

Enders G (1991) Infektionen und Impfungen in der Schwangerschaft, 2. Aufl. Urban & Schwarzenberg, München

Fried PA, Watkinson B (1990) 36- and 48-month neurobehavioral follow-up of children prenatally exposed to marijuana, cigarettes and alcohol. J Dev Behav Pediatr 11:49–58CrossRefPubMed

Fried S, Kozer E, Nulman I, Einarson TR, Koren G (2004) Malformation rates in children of women with untreated epilepsy: a meta-analysis. Drug Saf 27:197–202CrossRefPubMed

Geisler WM (2007) Management of uncomplicated Chlamydia trachomatis infections in adolescents and adults: evidence reviewed for the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis 44(Suppl 3):77–83CrossRef

Gisbert JP (2010) Safety of immunomodulators and biologics for the treatment of inflammatory bowel disease during pregnancy and breast-feeding. Inflamm Bowel Dis 16:881–895CrossRefPubMed

Gonzalez CH, Marques-Dias MJ, Kim CA (1998) Congenital abnormalities in Brazilian children associated with misoprostol misuse in first trimester of pregnancy. Lancet 351:1624–1627CrossRefPubMed

Harden CL et al (2009a) Practice parameter update: management issues for women with epilepsy – focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology 73:133–141CrossRefPubMedPubMedCentral

Harden CL et al (2009b) Practice parameter update: management issues for women with epilepsy – focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology 73:142–149CrossRefPubMedPubMedCentral

Hoeltzenbein M, Elefant E, Vial T, Finkel-Pekarsky V, Stephens S, Clementi M, Allignol A, Weber-Schoendorfer C, Schaefer C (2013) Teratogenicity of mycophenolate confirmed in a prospective study of the European Network of Teratology Information Services. Am J Med Genet A 158:588–596

Hyoun SC, Obican SG, Scialli AR (2012) Teratogen update: methotrexate. Birth Defects Res A Clin Mol Teratol 94:187–207CrossRefPubMed

Jamieson DJ, Novel Influenza A (H1N1) Pregnancy Working Group et al (2009) H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 374:451–458CrossRefPubMed

Kallen BA, Otterblad Olausson P (2007) Maternal use of selective serotonin re-uptake inhibitors in early pregnancy and infant congenital malformations. Birth Defects Res A Clin Mol Teratol 79:301–308CrossRefPubMed

Kalter H, Warkany J (1983) Congenital malformations. N Engl J Med 308:491–497CrossRefPubMed

Keller F, Griesshammer M, Haussler U, Paulus W, Schwarz A (2001) Pregnancy and renal failure: the case for application of dosage guidelines. Drugs 61:1901–1920CrossRefPubMed

Knörr K, Knörr-Gärtner H, Beller FK, Lauritzen C (1989) Geburtshilfe und Gynäkologie. Physiologie und Pathologie der Reproduktion, 3. Aufl. Springer, Berlin/Heidelberg/New YorkCrossRef

Lamotrigine Pregnancy Registry (2008) Interim report. September 1992 through 30 September 2007, Wilmington, Jan 2008

Lennestål R, Källén B (2007) Delivery outcome in relation to maternal use of some recently introduced antidepressants. J Clin Psychopharmacol 27:607–613CrossRefPubMed

Mahadevan U, Cucchiara S, Hyams JS, Steinwurz F, Nuti F, Travis SP, Sandborn WJ, Colombel JF (2011) The London position statement of the world congress of gastroenterology on biological therapy for IBD with the European Crohn’s and Colitis Organisation: pregnancy and pediatrics. Am J Gastroenterol 106:214–223CrossRefPubMed

McElhatton PR, Garbis HM, Elefant E, Vial T, Bellemin B, Serafini MA, Arnon J, Rodriguez-Pinilla E, Schaefer C, Pexieder T, Merlob P, dal Verme S (1996) The outcome of pregnancy in 689 women exposed to therapeutic doses of antidepressants. Reprod Toxicol 10:285–294CrossRefPubMed

McElhatton PR, Bateman DN, Evans C, Pughe KR, Thomas SHL (1999) Congenital anomalies after prenatal ecstasy exposure. Lancet 154:1441–1442CrossRef

Merlob P, Stahl B, Klinger G (2009) Tetrada of the possible mycophenolate mofetil embryopathy: a review. Reprod Toxicol 28:105–158CrossRefPubMed

Mølgaard-Nielsen D, Pasternak B, Hviid A (2013) Use of oral fluconazole during pregnancy and the risk of birth defects. N Engl J Med 369:830–839CrossRefPubMed

Moretti ME, Bar-Oz B, Fried S, Koren G (2005) Maternal hyperthermia and the risk for neural tube defects in offspring: systematic review and meta-analysis. Epidemiology 16:216–219CrossRefPubMed

Morrow J, Russell A, Guthrie E, Parsons L, Robertson I, Waddell R, Irwin B, McGivern RC, Morrison PJ, Craig J (2006) Malformation risks of antiepileptic drugs in pregnancy: a prospective study from the UK epilepsy and pregnancy register. J Neurol Neurosurg Psychiatry 77:193–198CrossRefPubMed

Mulligan ML, Felton SK, Riek AE, Bernal-Mizrachi C (2010) Implications of vitamin D deficiency in pregnancy and lactation. Am J Obstet Gynecol 202:429.e1–429.e9CrossRef

Nahum GG, Uhl K, Kennedy DL (2006) Antibiotic use in pregnancy and lactation: what is and is not known about teratogenic and toxic risks. Obstet Gynecol 107:1120–1138CrossRefPubMed

Nulman I, Rovet J, Stewart DE, Wolpin J, Gardner HA, Theis JGW, Kulin N, Koren G (1997) Neurodevelopment of children exposed in utero to antidepressant drugs. N Engl J Med 336:258–262CrossRefPubMed

Oren D, Nulman I, Makhija M, Ito S, Koren G (2004) Using corticosteroids during pregnancy. Are topical, inhaled, or systemic agents associated with risk? Can Fam Physician 50:1083–1085PubMedPubMedCentral

Ornoy A (2009) Valproic acid in pregnancy: how much are we endangering the embryo and fetus? Reprod Toxicol 28:1–10CrossRefPubMed

Pasternak B, Svanström H, Hviid A (2013) Ondansetron in pregnancy and risk of adverse fetal outcomes. N Engl J Med 368:814–823CrossRefPubMed

Paulus WE, Lauritzen C (2014) Medikamente und Schadstoffe in Schwangerschaft und Stillzeit. 23. Aktualisierung. Spitta, Balingen

Polifka JE, Friedman JM (2002) Teratogen update: azathiprine and 6-mercaptopurine. Teratology 65:240–261CrossRefPubMed

Rösch C, Steinbicker V (2003) Aetiology of congenital malformations – analysis of malformation registry data compared with the Kalter & Warkany study. Reprod Toxicol 17:503–504

Schaefer C, Hannemann D, Meister R, Eléfant E, Paulus W, Vial T, Reuvers M, Robert-Gnansia E, Arnon J, De Santis M, Clementi M, Rodriguez-Pinilla E, Dolivo A, Merlob P (2006) Vitamin K antagonists and pregnancy outcome. A multi-centre prospective study. Thromb Haemost 95:949–957PubMed

Scialli AR, Ang R, Breitmeyer J, Royal MA (2010) A review of the literature on the effects of acetaminophen on pregnancy outcome. Reprod Toxicol 30:495–507CrossRefPubMed

Sellinger CP, Leong RW, Lal S (2012) Pregnancy related issues in inflammatory bowel disease: evidence base and patients’ perspective. World J Gastroenterol 18:2600–2608CrossRef

Shepard TH, Brent RL, Friedman JM, Jones KL, Miller RK, Moore CA, Polifka JE (2002) Update on new developments in the study of human teratogens. Teratology 65:153–161CrossRefPubMed

Snijder CA, Kortenkamp A, Steegers EA, Jaddoe VW, Hofman A, Hass U, Burdorf A (2012) Intrauterine exposure to mild analgesics during pregnancy and the occurrence of cryptorchidism and hypospadia in the offspring: the Generation R Study. Hum Reprod 27:1191–1201CrossRefPubMed

Ständige Impfkommission am Robert Koch-Institut – STIKO (2010) Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut. Epid Bull 31/2010

Steinhausen HC, Willms J, Spohr HL (1995) Die Berliner Verlaufsstudie von Kindern mit einem Fetalen Alkoholsyndrom (FAS). 2. Psychiatrische und psychologische Befunde. Monatsschr Kinderheilkd 143:157–164

Streissguth AP, Barr HM, Sampson PD (1990) Moderate prenatal alcohol exposure: effects on child IQ and learning problems at age 7 1/2 years. Alcohol Clin Exp Res 14:662–669CrossRefPubMed

Streissguth AP, Aase JM, Clarren SK, Randels SP, La Due RA, Smith DF (1991) Fetal alcohol syndrome in adolescents and adults. JAMA 265:1961–1967CrossRefPubMed

Tunks RD, Clowse ME, Miller SG, Brancazio LR, Barker PC (2013) Maternal autoantibody levels in congenital heart block and potential prophylaxis with antiinflammatory agents. Am J Obstet Gynecol 208:64.e1–64.e7CrossRef

van Driel D, Wesseling J, Sauer PJ, Touwen BC, van der Veer E, Heymans HS (2002) Teratogen update: fetal effects after in utero exposure to coumarins overview of cases, follow-up findings, and pathogenesis. Teratology 66:127–140CrossRefPubMed

Vauzelle C, Beghin D, Cournot MP, Elefant E (2013) Birth defects after exposure to misoprostol in the first trimester of pregnancy: prospective follow-up study. Reprod Toxicol 36:98–103CrossRefPubMed

Wilson JD (1977) Embryotoxicity of drugs to man. In: Wilson JD, Frazer FC (Hrsg) Handbook of teratology. Plenum, New York, S 309–355CrossRef

Yacobi S, Ornoy A (2008) Is lithium a real teratogen? What can we conclude from the prospective versus retrospective studies? A review. Isr J Psychiatry Relat Sci 45:95–106PubMed

Titel: Embryologie und Teratologie
verfasst von: Wolfgang E. Paulus
Verlag: Springer Berlin Heidelberg
Buch: Die Geburtshilfe
Print ISBN: 978-3-662-45063-5

Electronic ISBN: 978-3-662-45064-2

Copyright-Jahr: 2016
DOI: https://doi.org/10.1007/978-3-662-45064-2_6

Springerpflege

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten