Pregnancy Risk Line
Answers about Medications and other Exposures during Pregnancy and Breastfeeding 1.800.822.BABY (2229)

Teratogens

If you are taking any of the medications listed below or considering taking any of these medications, please call a counselor at the Pregnancy Risk Line to discuss the details of the current research for the medication: 801-328-2222 or 800-822-2229.

Medications not on this list may still result in harmful effects for the fetus, infant, and mother. Please call a counselor at the Pregnancy Risk Line to discuss the details of any medications or exposures: 801-328-2222 or 800-822-2229.

Drugs & Medications
Dose / Duration		 Estimated Critical Time Period Estimated Percent Affected Potential Defect(s)
Angiotensin-Converting Enzyme (ACE) Inhibitors ≥ 14 LMP Not established Renal dysgenesis, skull ossification defects, and oligohydramnios
Acitretin ≥ 4 LMP 25 to 35% Hydrocephalus; CNS defects; microtia / anotia; small or missing thymus; conotruncal defects; micrognathia
  2 to 20 LMP Not established Miscarriage
  ≥ 20 LMP Not established Stillbirth
  Not established Not established Developmental delay
Aminopterin
> 12mg/week 		≥ 14 LMP Not established Neural tube defects, craniofacial anolomies, limb defects, craniosynostosis
  2 to 20 LMP Not established Miscarriage
  ≥ 20 LMP Not established Low birth weight
Androgens / Nor-progesterones ≥ 9 LMP 0.3% Enlarged clitoris and/or fused or enlarged labia
Angiotensin II Receptor Blockers (ARBs) ≥ 14 LMP Not established Renal dysgenesis, skull ossification defects, oligohydramnios
Carbamazepine 5 to 6 LMP < 1% Spina bifida
Carbimazole / Methimazole ≥ 10 to 12 LMP Not established Hypothyroidism, goiter
  Not established Not established Scalp defects
Cigarette Smoking
≥ 20/day		 ≥ 2 to 20 LMP Not established Miscarriage
≥ 10/day ≥ 20 to term Not established Low birth weight
Cocaine Not established Not established Placental abruption, prematurity, stillbirth
  35 to term Not established Cardiovascular accidents
Diethylstilbestrol (DES) Not established Not established Genital tract anomalies
  Not established Not established Pregnancy problems and possible infertility in female offspring
  Not established 0.1% Clear cell adenocarcinoma of the vagina
  Not established Not established Squamous neoplasia of the genital tract (female offspring)
Etretinate ≥ 4 LMP 25 to 35% Hydrocephalus; CNS defects; microtia / anotia; small or missing thymus; conotruncal defects, micrognathia
  2 to 20 LMP Not established Miscarriage
  ≥ 20 LMP Not established Stillbirth
  Not established Not established Developmental delay
Isotretinoin ≥ 4 LMP 25 to 35% Hydrocephalus; CNS defects; microtia / anotia; small or missing thymus; conotruncal defects; micrognathia
  2 to 20 LMP 10 to 40% Miscarriage
  ≥ 20 LMP 10 to 40% Stillbirth
  Throughout 50 to 75% Developmental delay
Fluconazole > 400 mg/day Not established Not established Dysmorphic facies, craniosynostosis, limb defects
Lithium ≤ 8 LMP < 1% Ebstein's anomaly
Mycophenolate Mofetil 4 to 7 LMP Not established

Microtia; cleft lip +/- cleft palate and cleft palate; colobomas
Methotrexate
10mg/week

8 to 11 LMP

 Not established Craniosynostosis, underossified skull, craniofacial abnormalities, limb defects
Misoprostol

4 to 10 LMP

 Not established Moebius syndrome (paralysis of sixth and seventh cranial nerves) vascular disruption hemorrhages and cell death
  2 to 20 LMP Not established Miscarriage
Penicillamine
> 900 mg/day 		Not established Not established Cutis laxa
Phenytoin ≥ 3 to 12 LMP 10 to 30% Craniofacial anomalies, hypoplastic phalanges / nails
  ≥ 13 to 40 LMP Not established Vitamin K deficiency with resultant hemorrhage
Streptomycin ≥ 28 to 40 LMP Not established Hearing loss
Tetracyclines ≥ 20 LMP Not established Stained teeth and bone
Thalidomide ≥ 6 to 9 LMP 20 to 25% Limb reduction defects, limb hypoplasia, ear anomalies
Thiouracil / Propylthiouracil 2 to 20 LMP Not established Miscarriage
  ≥ 14 LMP Not established Goiter leading to developmental delay
  ≥ 20 LMP Not established Stillbirth
Trimethadione ≥ 3 to 12 LMP Not established V-shaped eyebrows, low set ears, irregular teeth
  ≥ 14 LMP Not established Developmental delay
Valproic acid 5 to 6 LMP 1 to 2% Spina bifida
  ≥ 3 to12 LMP Not established

Craniofacial changes, preaxial defects, hypospadias
Warfarin 8 to10 LMP 15 to 25% Nasal hypoplasia, stippled epiphyses
  Throughout 5% Developmental delay

Chemicals Estimated Critical Time Period Estimated Percent Affected Potential Defect(s)
Methylmercury (Poisoning) Not established Not established Cerebral atrophy, mental retardation
Lead > 30ug/dl 2 to 20 LMP Not established Miscarriage
  ≥ 20 LMP Not established Stillbirth
Polychlorbiphenyls (PCBs) ≥ 20 LMP Not established Low birth weight
  Not established Not established Hyperpigmentation

Maternal Infections Estimated Critical Time Period Estimated Percent Affected Potential Defect(s)
Cytomegalovirus Not established 5 to 15% Mental retardation, microcephaly
  ≥ 20 LMP Not established Hearing loss, low birth weight
Primary Genital herpes Type II Active Genital Herpes 2 to 20 LMP Not established Miscarriage
  At term with vaginal delivery Not established Vertical transmission of Herpes CNS effects
Listeriosis 2 to 20 LMP Not established Miscarriage
  ≤ 37 LMP Not established Premature delivery
  ≥ 20 LMP Not established Stillbirth
Lymphocytic Choriomeningitis Virus (LCMV) Not established Not established Hydrocephaly, microcephaly, chorioretinitis, mental retardation
  2 to 20 LMP Not established Miscarriage
  ≥ 20 LMP Not established Stillbirth
Parvovirus 3 to 12 LMP 2 to 5 % Fetal hydrops
  2 to 20 LMP 5 to 10 % Miscarriage
  ≥ 20 LMP 5 to 10 % Stillbirth
Rubella 1 to 8 LMP 85% Deafness
  9 to 12 LMP 52% Cataracts
  12 to 20 LMP 16% Heart defects
  ≤ 27 LMP 5% Mental retardation
Syphillis (untreated) ≥ 20 LMP Not established

Abnormal teeth and bones; mental retardation
Toxoplasmosis 12 to 26 LMP 5 to 6% Hydrocephaly, blindness, mental retardation
Varicella 1 to 20 LMP 1%

Limb reduction defects, skin scarring, muscle atrophy, chorioretinitis
Venezuelan equine encephalitis Not established Not established CNS abnormalities
    Not established Stillbirth

Maternal States Estimated Critical Time Period Estimated Percent Affected Potential Defect(s)
Active Alcoholism** 2 to 20 LMP 15 to 50% Miscarriage
  3 to 12 LMP

10 to 15%
 
 8 to 10%

 FAS: Minor facial changes, heart defects (VSD)
  ≥ 20 LMP 10 to 15% IUGR
  ≥ 20 LMP 15 to 20% Developmental Delay
Diabetes Mellitus
a) HbA1c < 7.9
b) HbA1c 8.0-9.9
c) HbA1c > 10		 3 to 12 LMP a) 3.2%
b) 8.1%
c) 23.5% 		Cardiac defects, microcephaly, neural tube defects, holosprosencephaly, caudal regression sequence, sacral dysgenesis, renal agenesis, hydronephrosis, renal dysplasia
Hypertension 2 to 20 LMP Not established Miscarriage
  ≥ 20 LMP Not established IUGR, placental insufficiency, placental abruptio / previa
Hypothyroidism / Hyperthyroidism ≥ 10 LMP Not established Goiter
  Throughout Not established Mental retardation
  Throughout Not established Growth retardation
Phenylketonuria (PKU) (untreated) Throughout Not established> Cranifacial features, heart defects, microcephaly, mental retardation
  2 to 20 LMP Not established Miscarriage
  ≥ 20 LMP Not established Stillbirth
Rheumatoid Arthritis 2 to 20 LMP Not established Miscarriage
  ≥ 20 LMP Not established Stillbirth
Seizure Disorder (treated) 3 to 12 LMP 6 to 8% Cleft lip +/- cleft palate, heart defects
Systemic Lupus Erythematosus (SLE) (uncontrolled) 2 to 20 LMP Not established Miscarriage
  ≥ 20 LMP Not established Stillbirth, congenital heart block, IUGR
  ≤ 37 LMP Not established Prematurity

LMP: Last Menstrual Period, gestational weeks
Adapted from Rudolph's Pediatrics by Colin David Rudolph
**Medical or social problems related to drinking

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