methimazole and Esophageal-Atresia

Clinical hyperthyroidism has been associated with an increased risk of maternal, fetal, and neonatal complications. The available antithyroid drugs are methimazole/carbimazole and propylthiouracil. Several case reports and some epidemiologic studies suggest that methimazole/carbimazole exposure during the first trimester of pregnancy is associated with an increased risk of congenital malformations, including ectodermal anomalies, choanal atresia, esophageal atresia, and omphalocele. However, the absolute risk appears to be very small, and it remains unclear whether the association is driven by the maternal disease, the medication, or the combination of both factors. Propylthiouracil exposure has not been associated with an increased risk of congenital malformations and is the recommended drug during the first trimester of pregnancy. Since propylthiouracil-induced hepatotoxicity has been reported in approximately 0.1% of exposed adults and the number of case-reports of severe liver injury is increasing, treatment with low dose methimazole during the second and third trimesters should be considered. Until now, there has been no evidence that children prenatally exposed to methimazole/carbimazole or propylthiouracil have an increased risk of neurodevelopmental delay.

Topics: Antithyroid Agents; Carbimazole; Choanal Atresia; Drug Administration Schedule; Esophageal Atresia; Female; Hernia, Umbilical; Humans; Hyperthyroidism; Infant, Newborn; Maternal Exposure; Methimazole; Pregnancy; Pregnancy Trimester, First; Propylthiouracil

We report on a further case of congenital anomalies in a child exposed to methimazole during the first trimester of pregnancy (from first to seventh gestational week), and define a specific malformation pattern related to prenatal methimazole exposure and consisting of choanal and esophageal atresia, scalp defects, minor facial anomalies and psychomotor delay.

Topics: Abnormalities, Drug-Induced; Adult; Antithyroid Agents; Child, Preschool; Choanal Atresia; Esophageal Atresia; Female; Graves Disease; Humans; Male; Maternal-Fetal Exchange; Methimazole; Phenotype; Pregnancy; Pregnancy Trimester, First; Teratogens

Topics: Alcohols; Chromosome Aberrations; Diabetes Mellitus; Environmental Exposure; Esophageal Atresia; Female; Genetic Predisposition to Disease; Herbicides; Humans; Insecticides; Maternal Age; Meta-Analysis as Topic; Methimazole; Obesity; Parity; Paternal Age; Pregnancy; Prenatal Exposure Delayed Effects; Risk Factors; Smoking; Socioeconomic Factors; White People

Topics: Abnormalities, Drug-Induced; Antithyroid Agents; Choanal Atresia; Drug Monitoring; Esophageal Atresia; Female; Fetal Diseases; Health Knowledge, Attitudes, Practice; Humans; Infant, Newborn; Methimazole; Pregnancy; Propylthiouracil

We report two infants with gastrointestinal anomalies: one with esophageal atresia and tracheo-esophageal fistula and the other with biliary tree atresia, born to hyperthyroid women diagnosed and treated with methimazole after 14 weeks' gestation. Euthyroidism was documented in both infants. These cases raise the issue of whether untreated hyperthyroidism and not methimazole intake is the teratogen.

Topics: Abnormalities, Multiple; Adolescent; Adult; Antithyroid Agents; Biliary Atresia; Digestive System; Digestive System Abnormalities; Esophageal Atresia; Female; Humans; Hyperthyroidism; Infant, Newborn; Methimazole; Pregnancy; Pregnancy Complications; Time Factors; Tracheoesophageal Fistula; Treatment Outcome

A specific phenotype of methimazole (MMI) induced malformations has recently been postulated. MMI embryopathy is characterized by minor dysmorphic features, choanal atresia and/or esophageal atresia, growth retardation, and developmental delay.. We prospectively studied the outcome of pregnancy in 241 women counseled by 10 Teratology Information Services (TIS) of the European Network of Teratology Information Services (ENTIS) because of MMI exposure, and compared them with those of 1,089 pregnant women referred to TIS because of exposure to nonteratogenic drugs (control group). Information was obtained by mail or telephone interview.. There was no increase in the general rate of major anomalies or of spontaneous or induced abortions in the MMI-exposed group in comparison with the control group. Two newborns were affected with one of the major malformations that are part of the postulated embryopathy.. The results of this study indicate that choanal as well as esophageal atresia may have a higher incidence than expected in fetuses exposed to MMI between 3 and 7 gestational weeks. Until further data are available, thyrotoxicosis should be treated with propylthiouracil, as it is apparently safer for use during the fertile period.

Topics: Abnormalities, Drug-Induced; Abortion, Spontaneous; Adult; Age Factors; Body Weight; Cohort Studies; Developmental Disabilities; Esophageal Atresia; Europe; Female; Humans; Infant, Newborn; Information Services; Male; Methimazole; Phenotype; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Teratogens; Time Factors

Topics: Abnormalities, Drug-Induced; Adult; Antithyroid Agents; Esophageal Atresia; Female; Humans; Hyperthyroidism; Infant, Newborn; Male; Methimazole; Pregnancy; Pregnancy Complications; Tracheoesophageal Fistula

We report on 2 newborn infants with esophageal atresia and tracheoesophageal fistula (EA + TEF) born to hyperthyroid mothers receiving methimazole (Tapazol) before and during their entire pregnancies. Both mothers were euthyroid during gestation and developed hydramnios diagnosed during weeks 34 and 33 of gestation. Premature delivery (36.2 weeks of gestation) occurred in one case, and both newborn infants were small for date with palpable goiter; one of them had other associated malformations. Hypothyroidism was diagnosed by laboratory tests in both cases. Corrective surgery was undertaken, but both newborn infants developed septicemia and renal insufficiency and died in the first week of life. The EA + TEF and a normally placed enlarged thyroid gland were confirmed at necropsy. These cases represent a previously unreported example of the association of maternal ingestion of methimazole during pregnancy and EA + TEF.

Topics: Abnormalities, Drug-Induced; Adult; Esophageal Atresia; Female; Humans; Hyperthyroidism; Infant, Newborn; Male; Maternal-Fetal Exchange; Methimazole; Pregnancy; Pregnancy Complications; Tracheoesophageal Fistula