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Congenital Bands with Intestinal Malrotation after Propylthiouracil Exposure in Early Pregnancy
Alexander A Leung1, Jennifer Yamamoto1, Paola Luca2
1Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, AB, Canada T2T 5C7.
Insights
Propylthiouracil exposure during early pregnancy may increase birth defect risks. This case suggests a potential link between propylthiouracil and congenital bands causing intestinal issues.
Area of Science:
- Perinatology
- Developmental Biology
- Pediatric Surgery
Background:
- Propylthiouracil (PTU) is used to treat Graves' disease during pregnancy.
- The full spectrum of PTU-associated birth defects remains unclear.
- Previous reports linked PTU to preauricular and urinary system anomalies.
Purpose of the Study:
- To investigate the potential association between first-trimester propylthiouracil exposure and congenital bands.
- To highlight congenital bands as a possible rare teratogenic effect of PTU.
Main Methods:
- Case report of a neonate with small bowel obstruction and intestinal malrotation.
- Review of maternal medical history, including first-trimester propylthiouracil use for Graves' disease.
- Analysis of the potential link between maternal PTU exposure and infant's congenital anomalies.
Main Results:
- The patient presented with acute small bowel obstruction due to intestinal malrotation caused by congenital bands.
- The mother used propylthiouracil in the first trimester for Graves' disease.
- The case suggests a possible association between maternal PTU use and congenital bands with intestinal malrotation.
Conclusions:
- Congenital bands may be a rare complication of early pregnancy propylthiouracil exposure.
- This association warrants further investigation with more reported cases.
- Early pregnancy PTU use requires careful consideration for potential teratogenic effects beyond known anomalies.
Abstract:
Exposure to propylthiouracil in early pregnancy may be associated with an increased risk of birth defects. But the spectrum of associated congenital anomalies is not yet well defined. While preliminary reports suggest that most cases of propylthiouracil-associated birth defects are restricted to the preauricular and urinary systems, careful consideration should be given to other possible manifestations of teratogenicity. We propose that congenital bands may potentially represent a rare yet serious complication of propylthiouracil exposure in early pregnancy, possibly arising from an early mesenteric developmental anomaly. We report a case of a 17-day-old girl that presented with acute small bowel obstruction associated with intestinal malrotation arising from several anomalous congenital bands. Her mother was treated for Graves' disease during pregnancy with first trimester exposure to propylthiouracil but remained clinically and biochemically euthyroid at conception and throughout the duration of pregnancy. This case suggests that the use of propylthiouracil in early pregnancy may be associated with congenital bands and intestinal malrotation. More reports are needed to further support this association.
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