An Ongoing Epidemic of Birth Defects


In the 1990s, misoprostol (synthetic prostaglandin E1 analogue) was found to be an effective abortive agent when taken orally and became widely used in Latin America as a means to terminate unwanted pregnancies. A variety of congenital anomalies have been observed among the children of women who ingested misoprostol, but failed to terminate their pregnancy. We report here eight years of experience in Panama with the detection and follow-up of the malformations seen in infants associated with the use of misoprostol prostaglandin during the first trimester of pregnancy. During the period between April 1995 and March 2003, we identified 63 infants at the Panama’s Children’s Hospital who were exposed to misoprostol while in the womb and who were born with malformations. These infants were evaluated by a team of neonatologists, geneticists, cardiologists, ophthalmologists, and radiologists.

Share and Cite:

G. Cossio, A. Bissot, M. Rivas, L. Morales, P. Gallardo, D. Ellis and J. Hal, "An Ongoing Epidemic of Birth Defects," Pharmacology & Pharmacy, Vol. 4 No. 3, 2013, pp. 312-317. doi: 10.4236/pp.2013.43045.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] C. H. Gonzalez, F. Vargas, A. B. Perez, C. A. Kim, D. Brunoni, M. J. Marques-Dias, C. R. Leone, J. Correa Neto, J. C. Llerena Junior and J. C. de Almeida, “Limb Deficiency with or without Moebius Sequence in Seven Brazilian Children Associated with Misoprostol Use in the First Trimester of Pregnancy,” American Journal of Medical Genetics, Vol. 47, No. 1, 1993, pp. 59-64. doi:10.1002/ajmg.1320470113
[2] K. Blanchard, B. Winikoff and C. Ellertson, “Use of Misoprostol during Pregnancy and Mobius’ Syndrome in Infants,” The New England Journal of Medicine, Vol. 339, No. 21, 1998, pp. 1553-1554. doi:10.1056/NEJM199811193392114
[3] L. Schüller, A. Pastuszak, M. T. Sanseverino, I. M. Orioli, D. Brunoni and G. Koren, “Pregnancy Outcome after Abortion Attempt with Misoprostol,” Teratology, Vol. 55, No. 36, 1997, pp. 1-28.
[4] F. R. Vargas, L. Schuler-Faccini, D. Brunoni, C. Kim, V. F. Meloni, S. M. Sugayama, L. Albano, J. C. Llerena, J. C. Almeida, A. Duarte, D. P. Cavalcanti Jr., E. Goloni-Bertollo, A. Conte, G. Koren and A. Addis, “Prenatal Exposure to Misoprostol and Vascular Disruption Defects: A Case-Control Study,” American Journal of Medical Genetics, Vol. 95, No. 4, 2000, pp. 302-306. doi:10.1002/1096-8628(20001211)95:4<302::AID-AJMG2>3.0.CO;2-B
[5] F. S. Collins and M. Mahoney, “Hydrocephalus and Abnormal Digits after First-Trimester Prostaglandin Abortion Attempt,” Journal of Pediatrics, Vol. 102, No. 4, 1983, pp. 620-621. doi:10.1016/S0022-3476(83)80204-2
[6] M. Wheeler, P. O’Meara and M. Stanford, “Fetal Methotrexate and Misoprostol Exposure: The Past Revisited,” Teratology, Vol. 66, No. 2, 2002, pp. 73-76. doi:10.1002/tera.10052
[7] A. L. Pastuszak, L. Schüler, C. E. Speck-Martins, K. E. Coelho, S. M. Cordello, F. Vargas, D. Brunoni, I. V. Schwarz, M. Larrandaburu, H. Safattle, V. F. Meloni and G. Koren, “Use of Misoprostol during Pregnancy and Mobius’ Syndrome in Infants,” The New England Journal of Medicine, Vol. 338, No. 26, 1998, pp. 1881-1885. doi:10.1056/NEJM199806253382604
[8] T. H. Shepard, “Mobius Syndrome after Misoprostol a Possible Teratogenic Mechanism,” Lancet, Vol. 346, No. 8977, 1995, p. 780. doi:10.1016/S0140-6736(95)91540-0
[9] K. E. Coelho, M. F. Sarmento, C. M. Veiga, C. E. SpeckMartins, H. P. Safatle, C. V. Castro and N. Niikawa, “Misoprostol Embryotoxicity: Clinical Evaluation of Fifteen Patients with Arthrogryposis,” American Journal of Medical Genetics, Vol. 95, No. 4, 2000, pp. 297-301. doi:10.1002/1096-8628(20001211)95:4<297::AID-AJMG1>3.0.CO;2-K
[10] C. H. Gonzalez, M. J. Marques-Dias, C. A. Kim, S. M. Sugayama, J. A. Da Paz, S. M. Huson and L. B. Holmes, “Congenital Abnormalities in Brazilian Children Associated with Misoprostol Misuse in First Trimester of Pregnancy,” Lancet, Vol. 351, No. 9116, 1998, pp. 16241627. doi;10.1016/S0140-6736(97)12363-7

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.