Prenatal Risk Factors PSY 417

Maternal Status Maternal Nutrition Maternal Nutrition –Protein –Folic Acid Maternal Diseases Maternal Diseases –HIV –Diabetes

Prenatal Infections: STORCH Syphilis Syphilis Toxoplasmosis Toxoplasmosis Rubella Rubella Cytomegalovirus Cytomegalovirus Herpes Herpes

Teratogen “toxic” agents that cause deficits/malformations in the fetus “toxic” agents that cause deficits/malformations in the fetus A A gent that can produce a permanent alteration of structure or function in an organism exposed during embyronic or fetal life.

Example of a Malformation Agent Orange

Thalidomide

There is no such thing as a teratogenic agent.

Many agents can produce a teratogenic effect under some circumstances.

Nature of the agent Nature of the agent Factors That Influence Teratogenicity u Dose u Route u Frequency of exposure u Duration of exposure

Gestational timing Gestational timing Factors That Influence Teratogenicity u Concurrent exposures u Concurrent illness u Genetic susceptibility –Mother –Fetus

Timing

Multifactorial 42% Unknown 37% Chromosomal 3% Monogenic 8% Teratogens 10% Baird et al. AJHG 42:677, 1988 Birth Defects in Childhood

Teratogens Birth Defects in Childhood

Birth Defects Caused By Teratogenic Exposures Are Preventable.

Alcohol Fetal Alcohol Syndrome (FAS) Fetal Alcohol Syndrome (FAS) –confirmed maternal drinking during pregnancy –pattern of facial features –growth retardation –evidence of CNS disturbance Fetal Alcohol Effect (FAE) Fetal Alcohol Effect (FAE)

Mechanism of Transmission

FAS: Brain development

Facial Features: Dysmorphology

Cigarettes Low birth weight Low birth weight CNS deficits - LD, Attention CNS deficits - LD, Attention SIDS SIDS Respiratory problems Respiratory problems Increased risk for cancer Increased risk for cancer

Cigarettes

Cocaine No addiction No addiction Crack baby myth Crack baby myth Prematurity Prematurity Growth retardation - SGA Growth retardation - SGA Poorer reflexes Poorer reflexes

Other Teratogens Radiation - genetic mutations, malformed organs Radiation - genetic mutations, malformed organs Aspirin - enamel defects Aspirin - enamel defects

Other Teratogens Rubella Rubella Norman Gregg Norman Gregg –An Australian opthamologist –In early 1940s, saw many blind infants –Surveyed his colleagues in Sydney –Found 78 blind infants visited doctors that year –68 had been exposed to rubella –Published 1941 paper about rubella and infant blindness

Rubella continued Norman Gregg Norman Gregg –1941 paper reported widely in popular press –When it came out, Gregg got two phone calls –Mothers who had rubella during first trimester –Infants were not blind but deaf –Sent others to check the historical records –Outbreaks of rubella had regularly been followed by epidemics of infant blindness and hearing problems –Thus, learned that rubella is a teratogen –Today – vaccine.