1. Prenatal Risk Factors PSY 417

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

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

4. 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.

5. Example of a Malformation Agent Orange

6. Thalidomide

7. There is no such thing as a teratogenic agent.

8. Many agents can produce a teratogenic effect under some circumstances.

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

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

11. Timing

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

13. Teratogens Birth Defects in Childhood

14. Birth Defects Caused By Teratogenic Exposures Are Preventable.

15. 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)

17. Mechanism of Transmission

18. FAS: Brain development

19. Facial Features: Dysmorphology

21. 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

22. Cigarettes

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

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

25. 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

26. 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.