Hormonal pregnancy tests and congenital malformations.

I have read with interest Dr. D.T. Janerich's article (April 23, p. 1058) confirming the teratological effect of hormonal pregnancy tests and other exogenous sex hormone preparations in relation to congenital heart diseases. The discovery of the teratological effect of hormonal pregnancy tests emerged from my studies into central nervous system malformations in 1967. In this and in further publications on this topic, the teratogenic potential of hormonal pregnancy tests has always been referred to as "congenital malformations," without specifying the type but mentioning that the observation was made on spina bifida cases as my study then included only this particular malformation. The analogous effect between hormonal pregnancy tests and the use of other exogenous sex hormone preparations in early pregnancy has been emphasized in all the above communications. I am pleased that subsequent studies have confirmed my observation in different types of birth defects. The large variety of malformations reported by the above workers seems to be a clear indication that the teratogenic effect of hormonal pregnancy tests and other exogenous sex hormones is not specific but rather depends on the stage of fetal development when the insult occurs - probably a similar mode of action to that of many other powerful teratogens. Therefore it would be more prudent to adhere to the above conventional teratological principle instead of using acronyms such as the VACTREL syndrome (after Nora and Nora) which might lead to confusion.