Fluoxetine Possible transient neonatal withdrawal, hypertonicity, minor anomalies
Ibuprofen Oligohydramnios, PPHN
Indomethacin Oliguria, oligohydramnios, intestinal perforation, PPHN
Intravenous fluids during labor (e.g., salt-free solutions) Electrolyte disturbances, hyponatremia, hypoglycemia
Magnesium sulfate Respiratory depression, meconium plug, hypotonia
Methimazole Goiter, hypothyroidism
Morphine and its derivatives (addiction) Withdrawal symptoms (poor feeding, vomiting, diarrhea, restlessness, yawning and stretching, dyspnea and cyanosis, fever and sweating, pallor, tremors, convulsions)
Oxytocin Hyperbilirubinemia, hyponatremia
Phenobarbital Bleeding diathesis (vitamin K deficiency), possible long-term reduction in IQ, sedation
Propranolol Hypoglycemia, bradycardia, apnea
Propylthiouracil Goiter, hypothyroidism
Reserpine Drowsiness, nasal congestion, poor temperature stability
Sulfonamides Interfere with protein binding of bilirubin; kernicterus at low levels of serum bilirubin, hemolysis with G6PD deficiency
Stoll BJ, Kliegman RM: The fetus and neonatal infant. In Behrman RE, Kliegman RM, Jenson HB, editors: Nelson textbook of pediatrics, ed 16, Philadelphia, WB Saunders, 2000.
CNS, Central nervous system; G6PD, glucose-6-phosphate dehydrogenase; IUGR, intrauterine growth restriction; PPHN, persistent pulmonary hypertension of the newborn.
The principal determinants of fetal disease include the fetal genotype and the in utero environment. Variation in environmental factors rather than the fetal genetics plays a more significant role in determining overall fetal well-being, although a genetically abnormal fetus may not thrive as well or survive. The ability to assess a fetus genetically, biochemically, and physically is greatly enhanced through the development of amniocentesis, fetoscopy, chorionic villus sampling, fetal blood sampling, genetic testing of circulating fetal DNA in the mother’s blood, and real-time ultrasonography.
Fetuses subjected to abnormal maternal, placental, or fetal conditions that restrain growth are a high-risk group and traditionally classified as having intrauterine growth restriction (IUGR).The terms IUGR and SGA (small for gestational age) are notsynonymous. IUGR represents a deviation from expectedgrowth patterns. The decreased fetal growth associated with IUGR is an adaptation to unfavorable intrauterine conditions that result in permanent alterations in metabolism, growth, anddevelopment. IUGR most frequently occurs with a variety ofmaternal conditions that are associated with preterm delivery.SGA describes an infant whose birth weight is statistically lessthan the 10th percentile or two standard deviations below themean birth weight for gestational age. The cause of SGA may bepathologic, as in an infant with IUGR, or nonpathologic, as in an infant who is small but otherwise healthy (Table 60-1).
Only about 50% of IUGR infants are identified before delivery.Measurement and recording of maternal fundal height in conjunction with serial ultrasound assessment of the fetus (growthrate, amniotic fluid volume, malformations, anomalies, and Doppler velocimetry of uterine, placental, and fetal blood flow) can aid detection. When suspected and identified, IUGR and SGA fetuses must be monitored for fetal well-being, and appropriate maternal care needs to be instituted (see Chapter 58).