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- W2276147764 abstract "Dr. Nora and Dr. Nora (April 28 p. 241) reported 1) that patients with congenital heart-disease were more likely to have been exposed to a progestagen-estrogen compound or progestagen alone during the vulnerable period of cardiogenesis than a group of controls and 2) that a high proportion of persons with the group of congenital anomalies which might be recalled by the acronym VACTERL (vertebral anal cardiac tracheal esophageal renal limb) were exposed to these same agents at the vulnerable period of embryogenesis. Especially disturbing in their cases was that this exposure had been the result of a pregnancy test or the inadvertent use of a contraceptive by a person not known to be pregnant. We reported a patient with vertebral anomalies imperforate anus absence of the left kidney hypoplastic left thumb and preaxial polydactyly of the right foot. The pregnancy was reported as uncomplicated. The letter by Dr. Nora and Dr. Nora prompted me to inquire further about drug exposure during pregnancy. It transpired that because of first-trimester bleeding oral stilbestrol and intramuscular progesterone followed by intramuscular hydroxyprogesterone were given for 2 months beginning 47 days after the last menstrual period. This finding supports an association between VACTERL and exposure to progestagen-estrogen drugs during the vulnerable period of embryogenesis. Even before the data of Nora and Nora the possible side effects of progestagens regarding masculinization of female and undervirilization of male fetuses and the possible relation of intrauterine stilbestrol exposure to subsequent development of vaginal cancer were known. These potential hazards require that indications for use of progestagens and estrogens in pregnancy be carefully considered. The availablilty of noninvasive accurate pregnancy tests should preclude the use of hormones for this purpose and may also decrease the inadvertent use of birth control pills during pregnancy. (FULL TEXT)" @default.
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- W2276147764 date "1973-06-16" @default.
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- W2276147764 title "Birth defects and oral contraceptives. (Letter to the editor)" @default.
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