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10th edition. Thomas H Shepard. Baltimore: The Johns Hopkins University Press. 2001. ISBN 0-8018-6722-3.
This book is a cornucopia of information about potential or proven teratogenic effects of drugs and other agents. It is not only a delight for aficionados of catalogues, but also an essential addition to the library of all clinicians who deal with would be or pregnant mothers, management of illness in pregnancy, and the management of children with congenital disorders. Although the major emphasis is on pharmaceutical agents, some herbal remedies are also included, as are recreational drugs, viral infections, maternal illnesses, environmental chemicals, radiation and radioactive chemicals, and some genes. The book sets out to answer the question, “Does this agent produce congenital defects in the human or animal”, and goes a long way towards fulfilling its goal within the limitations of present knowledge. Of course, there are gaps in the catalogue; for example, some of the newer antiepileptic drugs do not appear (topiramate, tiagabin), but then there is little or no published information about their use in pregnancy. In some cases, perhaps even an entry stating that there is no information might be useful. As the mission statement suggests, the book concentrates on malformations, so there is less than one might hope on neurodevelopmental disorders following exposure to some drugs. UK readers should also be aware that drug names are taken from the Merck Index, and these do not always correspond with the names in common usage through the British National Formulary. However, for those which I checked, the British name was cross referenced through the index. The catalogue comprises some 3073 entries, including useful sections reviewing evidence for the teratogenic effects of vitamin deficiencies. The folic acid section is quite extensive, and makes reference to recent data concerning congenital heart disease, urinary tract abnormality, and orofacial clefting as well as the better known association with neural tube defects. Some gene disorders are also included, such as Hox genes and FGFR3, but curiously there is no specific section dealing with genes encoding drug metabolism enzymes, such as the cytochrome P450 enzymes. The methylene tetrahydrofolate reductase gene (mutation in which has been associated with risk of neural tube defect) appears in the folic acid section, but has no separate section of its own and is not referenced in the index. Despite these idiosyncrasies in the catalogue, the author is to be congratulated on producing such a near comprehensive work, and the book also includes some useful short introductory chapters on definitions in teratology and a comparative table of timing of embryological events in humans and experimental animals. It is very much an evidence based work, with an extensive bibliography of original publications. All in all, this is an essential reference book for clinical genetics, as well as for other specialties. With the rapid changes in drug therapies and the information explosion affecting teratology as well as other branches of genetic medicine, an electronic version with improved indexing, or an online version would be welcome. Although this is apparently available as part of a larger software package, technophiles may be disappointed that this catalogue is only available by itself on paper.
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