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:

Gali Pariente MD1, Tom Leibson MD1, Talya Shulman1, Thomasin Adams-Webber2, Eran Barzilay MD PhD3 and Irena Nulman "Pregnancy outcomes following in utero exposure to lamotrigine- A systematic review and meta- analysis."   2017 - CNS Drugs , In revision 

Diav-Citrin O, Shechtman S, Arnon J, Wajnberg R, Borisch C, Beck E, Richardson JL, Bozzo P, Nulman I, Ornoy A. Methylphenidate in pregnancy: A multicenter, prospective, comparative, observational study. J Clin Psychiatry 2016 ;77(9):1176-1181

Terrana N, Koren G, Pivovarov J, Etwel F, Nulman I. Pregnancy outcomes following in-utero exposure to second generation antipsychotics: a systematic review and meta-analysis. J Biol Psychiatry 2015 : 35 (5):559-65

Nulman I, Koren G, Rovet J, Barrera M, Streiner DL, Feldman BM. Neurodevelopment of Children Prenatally Exposed to Selective Reuptake Inhibitor Antidepressants: Toronto Sibling Study.  J Clin Psychiatry 2015;76(7):e842–e847

Kaplan YC, Ozsarfati J, Nickel C, Nulman I, Koren G. Pregnancy Outcome Following First Trimester Exposure to Topical Retinoids: A Systematic Review and Meta-Analysis. The British Journal of Dermetology 2015 Jul Jul;173 (5):1132-1141

Marchenko A, Etwel F, Olukayode O, Nickel C, Koren G, Nulman I. Pregnancy Outcome Following Prenatal Exposure to Triptan Medications: A Meta-Analysis. Headache: The Journal of Head and Face Pain. April, 2015; 55 (4): 490-501

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.  SRA , Int J Gynecol Cancer. 2014 Mar;12(3):394-403

Choi JS, Koren G, Nulman I. Pregnancy and isotretinoin therapy. CMAJ, 2013 Mar 19;185(5):411-3

Nulman I. Carbamazepine in pregnancy. Editorial. BMJ 2010 Dec; 341:c6582

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:e00306

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. CMAJ 2012 Feb


Irena Nulman MD, MSc, FRCPC Neurology, PhD
Professor of Pediatrics, Pharmacology, and Pharmacy, University of Toronto
Staff, Division of Clinical Pharmacology and Toxicology
The Hospital for Sick Children,
University of Toronto Fellowship Program Director, Clinical Pharmacology,
Senior Associate Scientist Child Health Evaluative Sciences (CHES)
Research Institute
Phone: 416-813-7887

E-Mail: irena.nulman@sickkids.ca


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