Before a woman realizes she is pregnant, a large amount of development has occurred in the embryo. If she consumes a drug during her pregnancy, the possibility exists that the drug could harm the fetus. The most important variable is timing, with the fetus showing the highest degree of susceptibility during the first trimester of gestation. This article presents data on the relative time a pregnancy test becomes positive as compared to fetal development; passage of drugs across the placenta; placental and fetal drug metabolism; and the availability of teratogenic information to health professionals. Teratogenic effects of specific substances or classes of substances are discussed, including alcohol, analgesics, antibiotics, anticoagulants, anticonvulsants, antithyroid/thyroid drugs, various environmental agents, and paternal drug exposure.

Phenytoin clearance by continuous ambulatory peritoneal dialysis (CAPD) was studied in a three-year, 8-month-old child. This dialysis resulted in a clearance rate less than 1 ml/min. This is different from that reported in the literature for regular peritoneal dialysis for phenytoin overdose. Unlike regular peritoneal dialysis, CAPD may not require phenytoin adjustment.

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Ratios of fetal abdominal circumference to femur length (AC/FL) and thigh circumference to femur length (TC/FL) have been suggested as indices of fetal nutrition. Birthweight, skin-fold thickness, and ponderal index are accepted neonatal indices of nutrition. The purpose of this study was to compare fetal to neonatal indices of nutrition. In 52 patients in term labor, fetal abdominal circumference, thigh circumference, and femur length were measured ultrasonographically. Neonatal skin-fold thickness was calculated as the average of tricipital, subscapular, abdominal, and anterior thigh measurements determined with Harpenden skin-fold calipers. Linear correlation analysis demonstrated a significant relationship between AC/FL and ponderal index (r = 0.340, P = 0.028) and between TC/FL and ponderal index (r = 0.368, P = 0.007). Neither AC/FL nor TC/FL were significantly related to birthweight or skin-fold thickness. These data suggest that the diagnostic reliability of antenatal studies of fetal biometric ratios may be enhanced by using the ponderal index as a neonatal endpoint rather than birthweight or skin-fold thickness.

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