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Marleen M. Miller, Gerhard A. Zielhuis, Lolkje T. A particular birth defect may have its origins through multiple mechanisms and possible exposures, including medications. A specific pathogenic process may result in different outcomes depending upon factors such as embryonic age at which a drug is administered, duration and dose of exposure and genetic susceptibility. This review focuses on the teratogenic mechanisms associated with a number of medications. Food and Drug Administration class D or X. Mechanisms were included only if they are associated with major structural birth defects and medications that are used relatively frequently by women of reproductive age. We identified six teratogenic mechanisms associated with medication use: folate antagonism, neural crest cell disruption, endocrine disruption, oxidative stress, vascular disruption and specific receptor- or enzyme-mediated teratogenesis. Many medications classified as class X are associated with at least one of these mechanisms. Identifying teratogenic mechanisms may not only be relevant for etiologic and post-marketing research, but may also have implications for drug development and prescribing behavior for women of reproductive age, especially since combinations of seemingly unrelated prescription and over the counter medications may utilize similar teratogenic mechanisms with a resultant increased risk of birth defects. Access to content on Oxford Academic is often provided through institutional subscriptions and purchases. If you are a member of an institution with an active account, you may be able to access content in one of the following ways:. Typically, access is provided across an institutional network to a range of IP addresses. This authentication occurs automatically, and it is not possible to sign out of an IP authenticated account. Choose this option to get remote access when outside your institution. 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To purchase short-term access, please sign in to your personal account above. Don't already have a personal account? Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Advertisement intended for healthcare professionals. Sign in through your institution. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Folate Antagonism. Neural Crest Cell Disruption. Endocrine Disruption: Sex Hormones. Oxidative Stress. Vascular Disruption. Specific Receptor- or Enzyme-mediated Teratogenesis. Authors' Roles. Journal Article. Teratogenic mechanisms of medical drugs. Oxford Academic. Google Scholar. Iris A. Richard K. Gerhard A. Lolkje T. Nel Roeleveld. Revision received:. Cite Cite Marleen M. Select Format Select format. Permissions Icon Permissions. 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Prevalence of cognitive impairment in patients with substance use disorder

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Background: The USA is currently facing a serious opioid misuse epidemic that started with increased prescribing of oxycodone and the inclusion of pain as a fifth vital sign, and eventually resulted in massive overdose mortality. In Europe, including the Netherlands, the medical use of opioids mainly oxycodone has also increased since , but an increase in proxies for opioid misuse has not yet been described. Methods: For this retrospective, multi-source database study, data were requested from several national databases in the Netherlands to evaluate the following time trends: 1 number of people with opioid prescriptions, 2 number of hospital admissions related to opioid intoxication, 3 number of people treated for opioid use disorder, and 4 number of people who died from opioid poisoning. Data were presented as the number per inhabitants, using population data over the years from Statistics Netherlands Centraal Bureau voor de Statistiek. Data about opioid-related hospital admissions between and were obtained from the Dutch National Hospital Care Basic Registration Landelijke Basisregistratie Ziekenhuiszorg , a database managed by Dutch Hospital Data. Data on opioid mortality between and were obtained from the cause-of-death statistics database hosted by Statistics Netherlands. Each database covered almost the entire population of the Netherlands. Findings: Between and , the overall number of prescription opioid users nearly doubled from per inhabitants to per inhabitants, mainly because the number of oxycodone users quadrupled from to per inhabitants. Interpretation: Prescription opioid use increased substantially between and , and several proxies for misuse show a parallel increasing trend. Although the Netherlands is far from the opioid epidemic faced by the USA, safe opioid prescribing guidelines should be implemented to prevent further escalation and to keep opioid painkillers available for those in need. Published by Elsevier Ltd. Published by Elsevier Ltd.. All rights reserved. Abstract Background: The USA is currently facing a serious opioid misuse epidemic that started with increased prescribing of oxycodone and the inclusion of pain as a fifth vital sign, and eventually resulted in massive overdose mortality. Publication types Research Support, Non-U. Substances Analgesics, Opioid.

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