The Effect of Prolonged Drug Usage on Fetal Development. An Epidemiological Approach
With the improvements in standards of living, nutrition, public health and ante-natal care the infant mortality rate has fallen in many countries throughout the world, with the result that maldevelopment of the fetus has come to occupy an increasingly large proportion of perinatal deaths. In the light of the recent tragic experience with thalidomide, one particularly important question needs to be answered — namely, the extent to which drug usage (just before, during or after conception) may affect fetal development. Very many physical and chemical agents have been shown to be teratogenic in the animal laboratory, including some that are commonly prescribed in medical practice, e.g., insulin, cortisone, hypoglycemic agents, sulphonomides, etc. A search by epidemiological methods for environmental components in the etiology of human malformations has been less rewarding. There is good evidence that environmental influences are involved, for the incidence of various defects shows geographical, secular and seasonal fluctuations and social class, maternal age and parity differences. So far, however, very few specific agents have been firmly incriminated (syphilis, rubella, toxoplasmosis, ionizing radiations, thalidomide) and it now seems likely that, although environmental influences are undoubtedly important, they will prove to be much more subtle to distinguish and much less accessible to control than was at one time hoped.
KeywordsSpina Bifida Fetal Development Cleft Palate Perinatal Death Case Finding
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