THALIDOMIDE AND TERATOGENICITY: A SYSTEMATIC REVIEW OF MOLECULAR EVIDENCE FOR RISK ASSESSMENT IN PRENATAL CARE

Abstract

Thalidomide, despite its contemporary therapeutic applications, remains associated with severe teratogenic effects. This study conducted a systematic review of molecular evidence related to thalidomide teratogenicity, focusing on its interaction with the Cereblon (CRBN) protein and the mechanisms leading to fetal malformations. Searches were performed in the PubMed, SciELO, and Google Scholar databases, following PRISMA guidelines and using the PICo strategy. Seven studies met the eligibility criteria. The findings indicate that thalidomide teratogenicity is strongly linked to its binding to CRBN, triggering the degradation of proteins essential for embryonic development. Additional evidence suggests that the drug interferes with physiological angiogenesis and may increase oxidative stress, contributing to tissue hypoxia and cellular damage. Alterations in regulatory pathways associated with limb development and neural proliferation also reinforce the teratogenic potential described in the literature. Collectively, the studies demonstrate that elucidating these mechanisms is essential to guide medication safety practices, support preventive strategies against gestational exposure, and strengthen prenatal care. Understanding the molecular pathways involved in thalidomide action is crucial for minimizing risks and informing rational use policies for women of reproductive age.