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Cobalt Chromium Toxicity

Zofran Birth Defects

Recent studies indicate a strong link between Zofran use in the first trimester of pregnancy and an increasing risk of birth defects. These defects include:

  • Orofacial Clefts: Birth defects happen during early pregnancy in which a baby’s lip or mouth do not form properly.
  • Laryngeal Cleft: Congenital abnormality resulting in a gap between the esophagus and trachea.


  • Congenital Heart Defects: Heart problems that develop before birth. A baby may be born with a single or several heart defects.
    • Ventricular Septal Defects (VSD): Also known as a “hole in the heart”. This happens when the septum (muscular wall) separating the right and left ventricles (bottom chambers of the heart) doesn’t fully form. According to the Mayo Clinic, VSD may lead to heart failure, pulmonary hypertension (high blood pressure in the lungs), endocarditis (infection of the heart), arrhythmias (irregular heartbeats), and delayed growth. The holes may heal on their own but large holes can require surgery or several surgeries. For more information on VSD, please visit the American Heart Association.
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    • Atrial Septal Defects (ASD): Hole occuring in the septum separating the right and left atria (top chambers of the heart) when it doesn’t close properly before birth. Minor cases may not necessitate treatment if there are no symptoms. However, larger defects would require surgeries to repair the hole. For more information on ASD, please visit the American Heart Association.
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    • Causes: In most children, the cause isn’t known. However, there are several medications taken during pregnancy linked to an increased risk of a baby being born with a congenital heart defect. According to the article, Use of ondansetron during pregnancy and congenital malformations in the infant, “…a risk increase of cardiovascular malformations and notably septum defects may exist and we suggest that the drug should not be used off label for nausea and vomiting in early pregnancy…”. Additionally, the article states, “Irrespective of the mode of action, if an association between use of ondansetron and an increased risk for cardiovascular defects is true, the strongly increasing off label use of the drug at nausea and vomiting in early pregnancy must be regarded as unsuitable and should be avoided.”
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  • Fetal Growth Restriction


  • Also known as small-for gestational age (SGA) or intrauterine growth restriction (IUGR). Fetal growth restriction is poor growth of the fetus while in the womb during pregnancy. The fetal weight is less than 90% of other fetuses in the same gestational age, or the fetal weight is below the 10th percentile for gestational age. This is considered small-for gestational age (fetus is smaller than expected at time of pregnancy). The outlook of the baby’s health, growth and development depend on the cause and severity of fetal growth restriction. Unfortunately, these babies usually suffer a myriad of health problems before and after birth.  There are two types of IUGR:
    • Symmetrical IUGR: Baby’s entire body is proportionally small
    • Asymmetrical IUGR: Baby’s body is small except for normal-size head and brain
  • Causes: Certain medications increase the risk and may contribute to fetal growth restriction. According to the Toronto star, “Four of the Canadian babies featured in the FDA side-effect reports reviewed by the Star were born weighing as little as four-and-a-half pounds. In six cases, a suspected side-effect of ondansetron was listed as “fetal growth restriction.”
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