Common Teratogens

and Their Effects

 What is a teratogen?
l Is any factor, chemical or physical, that
adversely affects the fertilized ovum,
embryo or fetus.
l Is any agent that can induce or increase the
incidence of a congenital malformation.
 What is teratology?
l is the study of abnormal development in
embryos and the causes of congenital
malformations or birth defects
 Effects of teratogens on the fetus
 Factors that influence the amount of
damage a teratogen can cause:
l Strength of teratogens (ex: radiation)
l Timing of the teratogenic insult
l Determining the effects of a teratogen
 Teratogenic Maternal Infections
TORCH:
l Toxoplasmosis
l Rubella
l Cytomegalovirus
l Herpes simplex virus
Note: some sources identify the O with “other

infections”, which include syphilis, HBV, and

HIV.
 Toxoplasmosis
lA protozoan infection, is spread most
commonly through contact with uncooked
meat, although it may also be contracted
through handling cat stool in soil or cat
litter.
l If the infection crosses the placenta, the
infant may be born with CNS damage,
hydrocephalus, microcephaly,
intracerebral calcification, & retinal
deformities.
l Pyrimethamine, an antifolic acid drug and
 Rubella
l Fetaldamage from maternal infection with
rubella (german measles) icludes
deafness, mental and motor changes,
cataracts, cardiac defects(most commonly
patent ductus arteriosus & pulmonary
stenosis), reatrded intrauterine
growth(small for gestational age),
thrombocytopenic purpura, & dental &
facila clefts, such as cleft lip & palate (Lee
& Bowden, 200)
lA women who is not immunized before
pregnancy cannot be immunized during
pregnancy.
l After a rubella immunization, a woman is
advised not to become pregnant for 3
months until the rubella virus is no longer
active.
l All women w/ low rubella titers should be
immunized to provide protection against
rubella in future pregnancies
 Cytomegalovirus (CMV)
lA member of herpes virus family
l Transmitted by droplet infection from person to
person.
l If a woman acquires primary CMV infection during
pregnancy and the virus crosses the placenta,
congenital CMV infection can occur.
l Infant may be born w/ severely neurologically
challenged, w/ eye damage, deafness, or
chronic liver disease.
l Child’s skin may be covered w/ large petechiae
(“blueberry-muffin” lesions)
 Herpes Simplex Virus (Genital
Herpes Infection)
l The virus spreads into the bloodstream (viremia)
and crosses the placenta to the fetus.
l 1st trimester – congenital anomalities or
spontaneous miscarriage may occur.
l 2nd or 3rd – high incidence of premature birth,
intrauterine growth retariodation, & continuing
infection of the newborn birth.
l Intravenous or oral acyclovir (Zorivax) can be
administered to women during preganancy
(Karch, 2001).
 Other Viral Diseases
l Syphilis – sexually transmitted infection
l Lyme Disease – a multisystem disease caused by
the spiochete Borrelia Burgdorferi, is spread by
the bite of a deer tick.
l Infection that cause illness at birth - gonorrhea,
candidiasis, chlamydia, stretococcus B, and
hepatitis B infections
 Potential Teratogenicity of
Vaccines
l Livevirus vaccines such as measles,
mumps, rubella and poliomyelitis (sabin
type), are contraindicated during
pregnancy because they may transmit the
viral infecton to the fetus.
 Teratogenicity of Drugs
2 principles related to drug intake during pregnancy:


l Any drug or herbal supplement, under certain

circumstances, may be detrimental to fetal
welfare. Therefore, during pregnancy, women
should not take any drug or supplement not
specifically prescribed by their physician or
nurse midwife.
l A woman of childbearing age and ability should
take no drugs other than those prescribed by the
physician or nurse midwife to avoid exposure to
a drug should she become pregnant.
 Teratogenicity of Alcohol
(internet)
l Alcohol is a common drug abused by women of
childbearing age. Infants born to alcoholic mothers
demonstrate prenatal and postnatal growth deficiency,
mental retardation, and other malformations.
l There are subtle but classical facial features associated
with fetal alcohol syndrome including short palpebral
fissures, maxillary hypoplasia, a smooth philtrum, and
congenital heart disease.
l Even moderate alcohol consumption consisting of 2 to 3
oz. of hard liquor per day may produce the fetal alcohol
effects.
l Binge drinking also likely has a harmful effect on embryonic
brain developments at all times of gestation.
l
 Teratogenicity of Cigarettes
l Growth retardation
l Sudden infant death syndrome (Pollack, 2001)
l Low birthweightin infants of smoking mothers
results from vasoconstriction of the uterine
vessels, an effect of nicotine that limits the blood
supply to the fetus.
l Inhaled carbon monoxide
l Reducing the number of cigarettes smoked per
day should help diminish adverse effects on the
fetus.
l
 Environmental Teratogens
l Metal and chemical hazards – ex: pesticides
& carbon monoxide
l Radiation – has been proven to be a potent
teratogen to unborn children because of
high proportion of rapidly growing cells
present.
l Hyperthermia & Hypothermia – (hyper) may
be detrimental to growth because it
interferes with cell metabolism, (hypo) the
effects is not well known.
 Teratogenicity of Maternal Stress
l Emotionally disturbed pregnancy, once filled with
anxiety and worry beyond the usual amount could
produce physiologic changes through its effect on
the sympathetic division of the autonomic nervous
system.
l Primary changes includes increase in heart rate,
constriction of the peripheral blood vessels, a
decrease in gastrointestinal motility, & dilation of
coronary blood vessels (the fight-or-flight
syndrome)
l The constriction of uterine vessels could interfere
with the blood and nutrient supply to the fetus.