Paeds Vivas · fetal-neonatal-and-perinatal
Maternal disease, medication and substance effects on the fetus — branching viva
Branching viva from principles of teratogenesis through valproate counselling, infant of a diabetic mother, fetal warfarin syndrome, and neonatal opioid withdrawal with mimic exclusion.
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Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the neonatal registrar. The examiner releases information in stages about a series of pregnancies complicated by maternal disease, medication and substance exposure, and asks you to reason through the fetal and neonatal consequences.
Station opening
Examiner: "A pregnant woman has been exposed to a number of agents. Before we go to specifics, give me your framework for thinking about how maternal exposures affect the fetus." [1]
Strong candidate (must-hit)
- Teratogenic harm is timing-dependent: all-or-none in the first two weeks, structural defects in organogenesis weeks 3 to 8, growth and neurodevelopmental effects from week 9. [1]
- Harm is classified as structural, growth, functional or neurodevelopmental, or neonatal adaptation and withdrawal. [1]
- Prevention is folic acid for all and high-dose for high-risk, magnesium sulfate under 30 weeks, and pre-conception switching of known teratogens. [2]
Weak candidate
- "Everything in pregnancy is dangerous." [1]
References8ShowHide
- [1]Frias JL, Thomas IT Teratogens and teratogenesis: general principles of clinical teratology. Annals of Clinical and Laboratory Science, 1988.PMID 3289471
- [2]van Gool JD, Hirche H, Lax H, et al. Folic acid and primary prevention of neural tube defects: A review. Reproductive Toxicology, 2018.PMID 29777755
- [9]Tomson T, Landmark CJ, Battino D Antiepileptic drug treatment in pregnancy: changes in drug disposition and their clinical implications. Epilepsia, 2013.PMID 23360413
- [11]Clayton-Smith J, Bromley R, Dean J, et al. Diagnosis and management of individuals with Fetal Valproate Spectrum Disorder; a consensus statement from the European Reference Network for Congenital Malformations and Intellectual Disability. Orphanet Journal of Rare Diseases, 2019.PMID 31324220
- [5]Hornberger LK Maternal diabetes and the fetal heart. Heart, 2006.PMID 16698822
- [16]Chan KY, Gilbert-Barness E, Tiller G Warfarin embryopathy. Pediatric and Developmental Pathology, 2003.PMID 14692224
- [27]Coyle MG, Brogly SB, Ahmed MS, et al. Neonatal abstinence syndrome. Nature Reviews Disease Primers, 2018.PMID 30467370
- [4]Ye W, Luo C, Zhou J, et al. Association between maternal diabetes and neurodevelopmental outcomes in children: a systematic review and meta-analysis of 202 observational studies comprising 56.1 million pregnancies. Lancet Diabetes and Endocrinology, 2025.PMID 40209722