Preconception Teratogen and Medication Exposure Review
Key Points
- Teratogens can cause structural or functional fetal abnormalities.
- Preconception exposure review should include medications, substances, infections, and environmental hazards.
- Medication reconciliation before conception is a core nursing safety action.
- Early folate planning and risk counseling reduce preventable congenital risk.
Pathophysiology
Embryonic development is highly sensitive to toxic exposures, especially during early organogenesis. Exposure timing, dose, and duration influence severity and pattern of harm.
Unrecognized teratogenic medications or infections before conception can increase risk of congenital anomalies, growth restriction, or pregnancy loss.
Classification
- Medication-related teratogens: Prescription and nonprescription drugs with fetal-risk potential.
- Substance-related teratogens: Alcohol, nicotine/tobacco, and recreational-drug exposures.
- Infectious teratogen risk: Preconception vulnerability to infections that harm fetal development.
- Environmental teratogen risk: Occupational or household chemical/radiation exposures.
Nursing Assessment
NCLEX Focus
Prioritize complete exposure history before conception rather than waiting until first prenatal visit.
- Assess all medications, supplements, and OTC products currently used.
- Assess alcohol, tobacco, and other substance exposures with nonjudgmental screening.
- Assess immunization status and infection-risk history relevant to pregnancy.
- Assess workplace and home toxin/radiation exposure patterns.
Nursing Interventions
- Perform structured preconception medication reconciliation and risk review.
- Coordinate provider-led medication substitutions for safer conception planning.
- Provide counseling on substance cessation and available support pathways.
- Reinforce infection prevention and indicated preconception immunization updates.
- Educate on folic-acid timing and dose according to risk status.
Late-Review Hazard
Deferring exposure review until pregnancy confirmation may miss the highest-risk developmental window.
Pharmacology
Folic acid is typically advised before conception (commonly 400-800 mcg daily, with higher dosing in selected high-risk histories) while teratogenic medication alternatives are coordinated.
Clinical Judgment Application
Clinical Scenario
A patient planning pregnancy uses multiple chronic medications and occasionally consumes alcohol on weekends.
Recognize Cues: Potential teratogenic exposure profile exists before conception. Analyze Cues: Current regimen may not be pregnancy-compatible. Prioritize Hypotheses: Immediate exposure-risk review and transition plan are needed. Generate Solutions: Reconcile medications, initiate cessation supports, and update prevention plan. Take Action: Coordinate safer regimen and confirm understanding of exposure precautions. Evaluate Outcomes: Preconception risk profile improves prior to conception attempt.
Related Concepts
- preconceptual-care - Exposure review is a central preconception counseling task.
- preconception-conditions-affecting-pregnancy - Chronic-condition management requires medication safety alignment.
- interpregnancy-interval-and-birth-spacing-planning - Adequate spacing may allow safer medication transitions.
- sdoh-screening-and-resource-linkage-in-reproductive-care - Resource barriers can prevent safer treatment access.
- reproductive-care-access-policy-and-autonomy - Coverage limits may affect medication-switch feasibility.
Self-Check
- Why is preconception exposure review more effective than first-trimester-only review?
- Which exposure domains should always be included in teratogen screening?
- How does nursing coordination reduce medication-related fetal risk before conception?