Faculty: Irena Nulman, MD, PhD, FRCP(C)

Irena Nulman, MD, PhD, FRCP(C)Irena Nulman, MD, PhD, FRCP(C)
Professor of Pediatrics, University of Toronto
Associate Director Motherisk Program
Senior Associate Scientist, Research Institute, Hospital for Sick Children

General Research Areas:  Clinical Pharmacology, Neuropharmacology/Psychopharmacology, and Reproductive Toxicology, Behavioral Teratology (Child Neurodevelopment)

My research program has clinical/translational foci in the area of Behavioural Teratology, a novel field that is an inseparable part of reproductive toxicology. This research examines the effects of genetic (parental disorders) and environmental factors such as maternal psychotropic medications (anticonvulsants, antidepressants, antipsychotics and drugs of abuse), on fetal/child central nervous system development. In collaboration with the Motherisk and Psychology Division colleagues, I established the first National Behavioral Teratology Research Program. The ultimate goal is to determine the potential behavioral teratogenicity of medications widely used in pregnancy through in-depth neurobehavioral studies, with future objectives to investigate the individual responses (pharmacogenetics) of reproductive outcomes.

The second focus of this research is the long-term effects of maternal perinatal cancer and its treatment on developing fetuses and their future pediatric health. The incidence of cancer during pregnancy is likely to increase due to delayed childbearing and increasing exposure to environmental carcinogens. Lack of information on malignancies during gestation poses a formidable challenge to both patients and physicians. Evidence-based information regarding outcomes will help to appropriately manage cancers in pregnancy and decrease maternal and perinatal mortality. I am leading the first National Survey of Cancer in Pregnancy at SickKids in order to ensure safe pregnancies in this vulnerable population. This area is severely understudied. Evidence–based information on cancer in pregnancy results in many saved lives.

A final main interest of mine is in the effects of prenatal alcohol exposure on the child's postnatal achievements, and development of diagnostic psychological markers for children with fetal alcohol spectrum disorder. I was actively involved in the developing Canadian National Guidelines with the objective of establishing national standards of care, screening, recording, counseling, and research on alcohol-use in women of child-bearing age. Practice Guidelines have been reviewed and approved by the Executive and Council of the Society of Obstetrics and Gynecology of Canada. The Fetal Alcohol Syndrome clinic serves as an excellent base to perform evidence-based research, which greatly helps women make informed treatment decisions during pregnancy and prevent unwanted and unnecessary terminations.

Selected Publications:

Marchenko A, Etwel F, Olukayode O, Nickel C, Koren G, Nulman I. Pregnancy Outcome Following Prenatal Exposure to Triptan Medications: A Meta-Analysis, Headache Journal (in press).

Nulman I, Koren G, Rovet J, Barrera M, Streiner D, Feldman B. Neurodevelopment of Children Following Prenatal Exposure to Selective Reuptake Inhibitors: Toronto Sibling Study, Journal of Clinical Psychiatry (in press).

Amant F, Halaska M, Fumagalli M, Dahl Steffensen K, Lok C, Van Calsteren K, Han S, Mir O, Fruscio R, Uzan C, Maxwell C, Dekrem J, Strauven G, Mhallem Gziri M, Kesic V, Berveiller P, Van den Heuvel F, Ottevanger N, Vergote I, Lishner M, Morice P, Nulman I. Gynecologic Cancers in Pregnancy: guidelines of a second international consensus meeting. Int J Gynecol Cancer. 2014 Mar;12(3):394-403.

Carson G, Cox LV, Crane J, Croteau P, Graves L, Kluka S, Koren G, Martel MJ, Midmer D, Nulman I, Poole N, Senikas V, Wood R. Alcohol Use and Pregnancy Consensus Clinical Guidelines. J Obstet Gynaecol Can. 2010;245:32 (8, Suppl 3) (NOTE: All authors are primary Authors).

Sadowski A, Todorow M, Yazdani Brojeni P, Koren G, Nulman I. Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study. BMJ Open. 2013 Jul 13;3:e003062.

Nulman I, Koren G, Rovet J, Barrera M, Pulver A, Streiner D, Feldman B. Neurodevelopment of Children Following Prenatal Exposure to Venlafaxine, Selective Serotonin Reuptake Inhibitors, or Untreated Maternal Depression. Am J Psychiatry. 2012 Nov 1;169(11):1165-74.

Koren G, Nulman I, Aleksa K, Gareri J, Einarson A, Ito S. Essay for the 2011 CIHR/CMAJ award: Motherisk – caring for mothers, protecting the unborn. Can Med Assoc J. 2012 Feb 7;184(2):E155-7.

Nulman I, Sgro M, Barrera M, Chitayat D, Cairney D, Koren G. Long-term neurodevelopment of children exposed in utero to ciclosporin after maternal renal transplant. Paediatr Drugs 2010: 12(2):113-22.

Nulman I, Rovet J, Barrera M, Knittel-Keren D, Feldman BM, Koren G. Long-term neurodevelopment of children exposed to maternal nausea and vomiting during pregnancy. J Pediatr 2009 Jul;155(1):45-50.

Nulman I, Rovet J, Kennedy D, Wasson C, Gladson J, Fried S, Koren G. Binge alcohol consumption by non-alcohol – dependent women during pregnancy affects child behavior, but not general intellectual functioning: a prospective controlled study. Arch Women Ment Health 2004: 7:173–181.

Nulman I, Rovet J, Stewart DE, Wolpin J, Pace-Asciak P, Shuhaiber S, Koren G: Child development following exposure to tricyclic antidepressants of fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiat 2002: 159:1189-1195.

Nulman I, Rovet J, Greenbaum R, Loebstein M, Wolpin J, Pace-Asciak P and Koren G. Neurodevelopment of adopted children exposed in utero to cocaine: the Toronto Adoption Study. Clinical Investigations in Medicine 2001: 24(3):129-37.

Nulman I, Rovet J, Stewart D, Wolpin J, Gardner HA, Theis J, Kulin N, Koren G. Neurodevelopment of children exposed in utero to antidepressant drugs. New Engl J Med 1997: 336:258-262.


Division of Clinical Pharmacology & Toxicology
Hospital for Sick Children
555 University Avenue
Toronto, Ontario
M5G 1X8 
Telephone: 416-813-7887
Email: irena.nulman@sickkids.ca

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