Neurodevelopment following exposure to antiseizure medications in utero: a review

2021 ◽  
Vol 19 ◽  
Author(s):  
Rebecca L Bromley ◽  
Matthew Bluett-Duncan
Keyword(s):  
Lower Risk ◽  
In Utero ◽  
Neurodevelopmental Outcomes ◽  
Unexposed Control ◽  
Long Period ◽  
Risks And Benefits ◽  
Limited Experience ◽  
Potential Impact ◽  
Child's Brain ◽  
In Pregnancy

: Exposure in the womb to antiseizure medications and their potential impact on the developing child's brain has long been researched. Despite this long period of interest, this review highlights above the well-known risks associated with valproate exposure; more data is required for conclusions regarding all other antiseizure medications. Limited experience with phenytoin and phenobarbital in monotherapy clearly defines the risk to later child postnatal functioning difficult. However, the evidence of an impact is stronger for phenobarbital than for phenytoin. The widely prescribed lamotrigine is limited in its investigation compared to unexposed control children. It has been demonstrated to carry a lower risk than valproate for specific outcomes; whether associated with a more moderate impact on broader aspects of neurodevelopmental functioning is still to be understood. Data for levetiracetam, topiramate, and oxcarbazepine are too limited to conclude most neurodevelopmental outcomes confidently. This slow accumulation of evidence impacts the safest use of medications in pregnancy and makes counseling women regarding the risks and benefits of specific antiseizure drugs difficult. Improved focus, funding, and research methodologies are urgently needed.

scholarly journals Neuroplacentology in congenital heart disease: placental connections to neurodevelopmental outcomes

2021 ◽  
Author(s):  
Rachel L. Leon ◽  
Imran N. Mir ◽  
Christina L. Herrera ◽  
Kavita Sharma ◽  
Catherine Y. Spong ◽  
...  
Keyword(s):  
Brain Development ◽  
Congenital Heart ◽  
Fetal Brain ◽  
In Utero ◽  
Structure And Function ◽  
Brain Growth ◽  
Neurodevelopmental Outcomes ◽  
Fetal Brain Development ◽  
And Function

Abstract Children with congenital heart disease (CHD) are living longer due to effective medical and surgical management. However, the majority have neurodevelopmental delays or disorders. The role of the placenta in fetal brain development is unclear and is the focus of an emerging field known as neuroplacentology. In this review, we summarize neurodevelopmental outcomes in CHD and their brain imaging correlates both in utero and postnatally. We review differences in the structure and function of the placenta in pregnancies complicated by fetal CHD and introduce the concept of a placental inefficiency phenotype that occurs in severe forms of fetal CHD, characterized by a myriad of pathologies. We propose that in CHD placental dysfunction contributes to decreased fetal cerebral oxygen delivery resulting in poor brain growth, brain abnormalities, and impaired neurodevelopment. We conclude the review with key areas for future research in neuroplacentology in the fetal CHD population, including (1) differences in structure and function of the CHD placenta, (2) modifiable and nonmodifiable factors that impact the hemodynamic balance between placental and cerebral circulations, (3) interventions to improve placental function and protect brain development in utero, and (4) the role of genetic and epigenetic influences on the placenta–heart–brain connection. Impact Neuroplacentology seeks to understand placental connections to fetal brain development. In fetuses with CHD, brain growth abnormalities begin in utero. Placental microstructure as well as perfusion and function are abnormal in fetal CHD.

Early Childhood Neurodevelopmental Outcomes in Infants Exposed to Infectious Syphilis In Utero

2018 ◽  
Vol 37 (6) ◽  
pp. 576-579 ◽  
Author(s):  
Valsan P. Verghese ◽  
Leonora Hendson ◽  
Ameeta Singh ◽  
Tamara Guenette ◽  
Jennifer Gratrix ◽  
...  
Keyword(s):  
Early Childhood ◽  
In Utero ◽  
Neurodevelopmental Outcomes

Vertebral malformation in the mouse foetus caused by X-radiation of the mother during pregnancy

Development ◽  
1964 ◽  
Vol 12 (4) ◽  
pp. 841-850
Author(s):  
Ujihiro Murakami ◽  
Yoshiro Kameyama
Keyword(s):  
Early Pregnancy ◽  
Vertebral Column ◽  
Strain Differences ◽  
In Utero ◽  
Oxygen Deprivation ◽  
Experimental Animals ◽  
Vertebral Malformation ◽  
Pregnant Mice ◽  
Maternal Hypoxia ◽  
In Pregnancy

Maternal hypoxia in early pregnancy can result in malformations of the vertebrae of mouse foetuses, and there is a tendency for more posterior vertebrae to be affected the later in pregnancy the oxygen deprivation occurs (Murakami & Kameyama, 1963). Ingalls et al. (1957) and Degenhardt (1954, 1959) had earlier obtained similar results. We have also exposed pregnant mice to X-radiation and studied the consequent malformations. The effects on the extremities have already been described (Murakami, Kameyama & Nogami, 1963), and in the present paper we shall describe the effects on the vertebral column. Vertebral malformations in animals irradiated in utero have been described by Job, Leibold & Fitzmaurice (1935), Warkany and Schraffenberger (1947), Russell. (1950, 1954), and Russell & Russell (1954). In order to obtain results comparable with those of our experiments with hypoxia, no less than to detect inter-strain differences, we used mice of the ddN and CF1 strains originally supplied by the Central Laboratories for Experimental Animals, Tokyo (Zikkendobutsu Chuo Kenkyujo).

Risks and Benefits of Nicotine to Aid Smoking Cessation in Pregnancy

Drug Safety ◽  
2001 ◽  
Vol 24 (4) ◽  
pp. 277-322 ◽  
Author(s):  
Delia A. Dempsey ◽  
Neal L. Benowitz
Keyword(s):  
Smoking Cessation ◽  
Risks And Benefits ◽  
In Pregnancy

Neurodevelopmental outcomes and in-utero antiretroviral exposure in HIV-exposed uninfected children

AIDS ◽  
2018 ◽  
Vol 32 (17) ◽  
pp. 2583-2592 ◽  
Author(s):  
Micah Piske ◽  
Matthew A. Budd ◽  
Annie Q. Qiu ◽  
Evelyn J. Maan ◽  
Laura J. Sauvé ◽  
...  
Keyword(s):  
In Utero ◽  
Neurodevelopmental Outcomes ◽  
Hiv Exposed ◽  
Exposed Uninfected

scholarly journals Severe Pain in a Leiomyoma with Twin Pregnancy- An Analgesic Dilemma

2021 ◽  
pp. 247-250
Keyword(s):  
Case Report ◽  
Premature Birth ◽  
Severe Pain ◽  
Twin Pregnancy ◽  
Multidisciplinary Approach ◽  
Common Complication ◽  
Risks And Benefits ◽  
Background Pain ◽  
Analgesic Agents ◽  
In Pregnancy

BACKGROUND: Pain is the most common complication of fibroids in pregnancy and can be difficult to treat. The choices of pain relief in pregnancy are limited due to myriad risks including miscarriage, teratogenicity, premature birth, and low birth weight. CASE REPORT: This paper describes the analgesic challenges faced when managing severe pain in the antepartum period for a woman pregnant with twins who also suffered from uterine leiomyomas. Multiple analgesic regimens were trialled over the course of the pregnancy with large doses of opioids required for long periods. Ultimately the patient underwent a laparotomy and myomectomy at 25 weeks gestation in an attempt to alleviate her pain. CONCLUSION: There should be early discussions and planning around the choice of analgesic agents and their planned duration, with the risks and benefits weighed in each instance. A multidisciplinary approach with obstetricians, neonatologists, anesthetists, and pain specialists is likely to result in the most benefit while limiting the risk to the fetus

THE PIERRE ROBIN SYNDROME

PEDIATRICS ◽  
1965 ◽  
Vol 36 (3) ◽  
pp. 336-341 ◽  
Author(s):  
Wallace M. Dennison
Keyword(s):  
Nursing Care ◽  
Surgical Procedures ◽  
Tube Feeding ◽  
In Utero ◽  
Skilled Nursing ◽  
Pierre Robin Syndrome ◽  
Limited Experience ◽  
Pierre Robin

The whole object of the medical and nursing care of infants with the Pierre Robin syndrome is to keep them alive and thriving in their perilous passage through the early months of life until the failure of mandibular development in utero is subsequently rectified by nature. From my limited experience of this condition I suggest that surgery has little to offer in the treatment of the Pierre Robin syndrome. Cap suspension, tube feeding, and skilled nursing are more important than any surgical procedures.

Coronal Craniostenosis: Fetal Head Constraint as One Possible Cause

PEDIATRICS ◽  
1980 ◽  
Vol 65 (5) ◽  
pp. 995-999 ◽  
Author(s):  
John M. Graham ◽  
Richard J. Badura ◽  
David W. Smith
Keyword(s):  
Retrospective Study ◽  
In Utero ◽  
Foot Deformities ◽  
Coronal Suture ◽  
Fetal Head ◽  
Normal Children ◽  
Possible Cause ◽  
In Pregnancy

A retrospective study of 11 instances of idiopathic coronal craniostenosis in otherwise normal children revealed that early lightening, prolonged moderate to severe pelvic discomfort late in pregnancy, and/or an abnormal fetal lie were unusual gestational features indicative of intrauterine constraint for eight of these patients. The impression of unusual constraint in utero was futher implied by finding associated positional foot deformities in four of these latter eight children. We hypothesize that prolonged constraint of the fetal head may limit anteroposterior growth stretch at the coronal suture and thereby predispose toward early sutural fusion.

Brain death in pregnancy: what will be left of the life of foetus?

2020 ◽  
Vol 69 (3) ◽  
pp. 281-291
Author(s):  
Matteo Gulino ◽  
Gianluca Montanari Vergallo ◽  
Rosagemma Ciliberti ◽  
Antonio G. Spagnolo
Keyword(s):  
Brain Death ◽  
Human Life ◽  
Rare Event ◽  
High Impact ◽  
Social Implications ◽  
Vital Functions ◽  
Clinical Consequences ◽  
Potential Impact ◽  
The Moment ◽  
In Pregnancy

Brain death in pregnancy (BDinP) has been described in literature as a “rare event” and “hopeless condition for patients”, who has a devastating potential to negatively affect the poetry of the moment of welcoming a new human life to the world. Clinical consequences of BDinP are extremely dangerous for the life of a foetus that, without prompt medical actions, is doomed to suffer the same fate as the mother. Modern medical techniques make it possible to maintain basic vital functions of the pregnant woman for months, in order to achieve a level of development of the foetus. Although maternal somatic support requires the consideration of specific medical parameters, from a bioethical standpoint, this option gives rise to multiple ethical and social implications. In this manuscript, we identify the main ethical and social implications about maternal somatic support, including the potential impact on the clinical practice of medical staff, and discuss some Italian high-impact media cases.* The authors contributed equally to the work.

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