Drug-induced birth defects

Schardein JL (2000) Chemically Induced Birth Defects, Drug and Chemical Toxicology Series, 3rd edn., revised and expanded. New York Dekker (ISBN 0-824702654) (ISBN 0-585383693 electronic book). 

A book of interest is "Chemically Induced Birth Defects," by Schardein (ref. 6). This reference book contains data on human and animal studies on birth defects and teratogens. Drugs are covered extensively. Chemicals discussed are pesticides, metals, industrial solvents, diagnostic agents, dyes, radioactive chemicals, plastics, toxins, food additives, air-water-soil pollutants, personal chemicals, etc. 

Chemically-Induced Birth Defects (Schardein 2000) describes mammalian teratology studies on more than 3300 chemicals, including those found in occupational exposures and in drugs. Each chapter deals with a group of related agents, such as industrial solvents. Literature citations are extensive. 

Benzodiazepines readily pass from the mother to fetus through the placenta (117). There may be a risk of congenital malformations, particularly oral cleft, if a pregnant woman takes a benzodiazepine during the first trimester, but the data are inconsistent across drugs (alprazolam having the most clearly defined risk), and any overall effect is probably small (27,28). The risk of benzodiazepine-induced birth defects thus remains uncertain (118), despite two cases of fetal-alcohol syndrome reported after benzodiazepine exposure alone (119). 

Population statistics, e.g. birth defect registers and cancer registers. These are insensitive unless a drug-induced event is highly remarkable or very frequent. 

Drug-related epidemics have occurred, mercifully relatively infrequently. However, with each unfortunate episode, there is inevitably a variety of regulatory and clinical fallout. Indeed, the illnesses associated with ingestion of glycol-tainted linctus led to the Food, Drugs and Cosmetics ( ) Act in the USA, and the disastrous association of phocomelia with thalidomide propelled reforms of drug regulations worldwide. Other famous examples include, of course, practolol-induced ocu-lomucocutaneous syndrome, and, more recently, fenfluramine-induced myocardial fibrosis, and isotretinoin-associated birth defects. 

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