Podcast
Questions and Answers
What does the term teratogen refer to?
What does the term teratogen refer to?
- An agent that destroys normal cells
- An agent that only affects certain genetic traits
- An agent that promotes healthy fetal growth
- An agent that alters structure or function during development (correct)
Which of the following principles of clinical teratology indicates that there are instances where teratogens do not cause any malformation?
Which of the following principles of clinical teratology indicates that there are instances where teratogens do not cause any malformation?
- Teratogens act at vulnerable periods
- Teratogens can produce characteristic patterns
- There are no absolute teratogens (correct)
- Combination exposures increase risks
What is teratology primarily concerned with?
What is teratology primarily concerned with?
- The treatment of congenital anomalies
- The study of abnormalities in fetal development (correct)
- The study of genetic disorders
- The prevention of pregnancy complications
Which statement reflects the incidence of congenital anomalies globally?
Which statement reflects the incidence of congenital anomalies globally?
What describes the possible outcomes during the pre-implantation stage of development?
What describes the possible outcomes during the pre-implantation stage of development?
What is the primary mechanism by which methotrexate acts as a teratogen?
What is the primary mechanism by which methotrexate acts as a teratogen?
Which of the following is a potential consequence during the fetal to neonatal stage as a result of teratogenic exposure?
Which of the following is a potential consequence during the fetal to neonatal stage as a result of teratogenic exposure?
Which of these categories does NOT fall under teratogenic agents?
Which of these categories does NOT fall under teratogenic agents?
How does a deficiency of energy supply affect organogenesis during pregnancy?
How does a deficiency of energy supply affect organogenesis during pregnancy?
Which of the following is an example of a congenital infection associated with teratogenicity?
Which of the following is an example of a congenital infection associated with teratogenicity?
What type of abnormity is associated with chromosomal aberration during organogenesis?
What type of abnormity is associated with chromosomal aberration during organogenesis?
Which of the following teratogenic agents can be classified as an environmental factor?
Which of the following teratogenic agents can be classified as an environmental factor?
What is a common effect of hypoxia during the fetal development stage?
What is a common effect of hypoxia during the fetal development stage?
What is the main consideration for using drugs during pregnancy?
What is the main consideration for using drugs during pregnancy?
Which of the following drug categories demonstrates that controlled human studies show no risk?
Which of the following drug categories demonstrates that controlled human studies show no risk?
Which category of drugs indicates that the evidence for risk outweighs any benefits?
Which category of drugs indicates that the evidence for risk outweighs any benefits?
What can be concluded about Category B drugs?
What can be concluded about Category B drugs?
Which of the following symptoms is NOT commonly associated with congenital syphilis?
Which of the following symptoms is NOT commonly associated with congenital syphilis?
Which of the following is an example of a Category D drug?
Which of the following is an example of a Category D drug?
What is a common finding in Fetal Cytomegalovirus syndrome?
What is a common finding in Fetal Cytomegalovirus syndrome?
What is true about Category C drugs according to the classification?
What is true about Category C drugs according to the classification?
Which of the following is a symptom of Fetal Rubella syndrome?
Which of the following is a symptom of Fetal Rubella syndrome?
Which of these drugs is associated with significant teratogenic risk?
Which of these drugs is associated with significant teratogenic risk?
What syndrome is associated with congenital varicella zoster infection?
What syndrome is associated with congenital varicella zoster infection?
Which statement regarding drug categories in pregnancy is accurate?
Which statement regarding drug categories in pregnancy is accurate?
Which finding is typically NOT associated with congenital herpes simplex?
Which finding is typically NOT associated with congenital herpes simplex?
What is one of the most common outcomes of congenital infection by Toxoplasmosis gondii?
What is one of the most common outcomes of congenital infection by Toxoplasmosis gondii?
What is a likely neurological consequence of congenital HIV/AIDS?
What is a likely neurological consequence of congenital HIV/AIDS?
Which of the following is a characteristic finding of congenital cytomegalovirus?
Which of the following is a characteristic finding of congenital cytomegalovirus?
What is a notable risk associated with the use of ACE inhibitors during the second and third trimester of pregnancy?
What is a notable risk associated with the use of ACE inhibitors during the second and third trimester of pregnancy?
What is a potential effect of taking high doses of Vitamin A during pregnancy?
What is a potential effect of taking high doses of Vitamin A during pregnancy?
Which antibiotics are associated with an increased risk of sensory-neural hearing loss in the fetus?
Which antibiotics are associated with an increased risk of sensory-neural hearing loss in the fetus?
What type of birth defects can occur as a result of using Trimethoprim during pregnancy?
What type of birth defects can occur as a result of using Trimethoprim during pregnancy?
What are common congenital anomalies linked with the use of anticonvulsants during pregnancy?
What are common congenital anomalies linked with the use of anticonvulsants during pregnancy?
Which of the following outcomes is linked to Corticosteroid use in pregnant women?
Which of the following outcomes is linked to Corticosteroid use in pregnant women?
What is a notable risk of using Coumadin (Warfarin) during pregnancy?
What is a notable risk of using Coumadin (Warfarin) during pregnancy?
What is the recommended maximum daily dose of Vitamin A during pregnancy?
What is the recommended maximum daily dose of Vitamin A during pregnancy?
Which condition is associated with an increased risk of specific major malformations such as spina bifida and cleft lip?
Which condition is associated with an increased risk of specific major malformations such as spina bifida and cleft lip?
What is the recommended daily intake of folic acid to reduce the risk of neural tube defects during pregnancy?
What is the recommended daily intake of folic acid to reduce the risk of neural tube defects during pregnancy?
What effect could hyperthyroidism, particularly due to Graves' disease, have on pregnancy?
What effect could hyperthyroidism, particularly due to Graves' disease, have on pregnancy?
Which teratogenic exposure is linked to anophthalmia and neural tube defects?
Which teratogenic exposure is linked to anophthalmia and neural tube defects?
Which maternal condition is NOT associated with an increased risk of early loss of pregnancy?
Which maternal condition is NOT associated with an increased risk of early loss of pregnancy?
What is a potential consequence of paternal exposure to toxic substances?
What is a potential consequence of paternal exposure to toxic substances?
What teratogenic effect is associated with malnutrition due to a lack of minerals?
What teratogenic effect is associated with malnutrition due to a lack of minerals?
Which of the following is a result of untreated fetal hyperthyroidism due to maternal Graves' disease?
Which of the following is a result of untreated fetal hyperthyroidism due to maternal Graves' disease?
Which principle of clinical teratology suggests variability in how different embryos respond to teratogens?
Which principle of clinical teratology suggests variability in how different embryos respond to teratogens?
What is a significant outcome during the pre-implantation stage of development when exposed to teratogens?
What is a significant outcome during the pre-implantation stage of development when exposed to teratogens?
Which statement reflects a characteristic of teratogenic exposures in relation to patterns of anomalies?
Which statement reflects a characteristic of teratogenic exposures in relation to patterns of anomalies?
Which of the following best describes the concept of teratogenicity?
Which of the following best describes the concept of teratogenicity?
Which statement is true regarding the incidence of congenital anomalies globally?
Which statement is true regarding the incidence of congenital anomalies globally?
Which of the following findings is typically associated with congenital syphilis?
Which of the following findings is typically associated with congenital syphilis?
What is a noted effect of congenital rubella (German measles) on the fetus?
What is a noted effect of congenital rubella (German measles) on the fetus?
Which symptom is most directly associated with congenital varicella zoster infection?
Which symptom is most directly associated with congenital varicella zoster infection?
Which of the following is a common neurological consequence of congenital herpes simplex?
Which of the following is a common neurological consequence of congenital herpes simplex?
What is a significant complication of congenital cytomegalovirus (CMV) infection?
What is a significant complication of congenital cytomegalovirus (CMV) infection?
Which of the following congenital infections is specifically linked to fetal Toxoplasmosis syndrome?
Which of the following congenital infections is specifically linked to fetal Toxoplasmosis syndrome?
Which category of drugs indicates that controlled animal studies are not acceptable, and no human data is available?
Which category of drugs indicates that controlled animal studies are not acceptable, and no human data is available?
What characteristic defines Category D drugs in terms of teratogenicity?
What characteristic defines Category D drugs in terms of teratogenicity?
In congenital infections, which symptom is typically NOT associated with congenital herpes simplex?
In congenital infections, which symptom is typically NOT associated with congenital herpes simplex?
Which condition is characterized by both gastrointestinal and genitourinary anomalies in a congenital infection?
Which condition is characterized by both gastrointestinal and genitourinary anomalies in a congenital infection?
Which of the following is classified as a Category X drug due to its teratogenic potential?
Which of the following is classified as a Category X drug due to its teratogenic potential?
Which group of drugs is represented in the examples of potential teratogens specifically for hormonal effects?
Which group of drugs is represented in the examples of potential teratogens specifically for hormonal effects?
What is the primary implication of categorizing a drug as Category B during pregnancy?
What is the primary implication of categorizing a drug as Category B during pregnancy?
What is the main concern associated with the use of ACE inhibitors during the second and third trimesters of pregnancy?
What is the main concern associated with the use of ACE inhibitors during the second and third trimesters of pregnancy?
Which of the following drugs is commonly noted for its teratogenic risk particularly in the context of neurodevelopmental effects?
Which of the following drugs is commonly noted for its teratogenic risk particularly in the context of neurodevelopmental effects?
Which of the following could result from maternal hyperthyroidism during pregnancy?
Which of the following could result from maternal hyperthyroidism during pregnancy?
What is a potential consequence of maternal hyperthermia during pregnancy?
What is a potential consequence of maternal hyperthermia during pregnancy?
Which substance is primarily linked to Minamata Syndrome due to maternal exposure?
Which substance is primarily linked to Minamata Syndrome due to maternal exposure?
Which of the following maternal conditions can adversely affect fetal development?
Which of the following maternal conditions can adversely affect fetal development?
What effect does lead exposure during pregnancy typically have?
What effect does lead exposure during pregnancy typically have?
Which outcome is associated with exposure to carbon monoxide during pregnancy?
Which outcome is associated with exposure to carbon monoxide during pregnancy?
Which developmental issues are linked to maternal hyperthermia at an early gestational stage?
Which developmental issues are linked to maternal hyperthermia at an early gestational stage?
What is a likely consequence of maternal exposure to nicotine?
What is a likely consequence of maternal exposure to nicotine?
What is a common neurological disorder result of excessive lead exposure during pregnancy?
What is a common neurological disorder result of excessive lead exposure during pregnancy?
What major developmental malformation is associated with insulin-dependent diabetes during pregnancy?
What major developmental malformation is associated with insulin-dependent diabetes during pregnancy?
How does maternal hyperthyroidism affect pregnancy outcomes?
How does maternal hyperthyroidism affect pregnancy outcomes?
What nutritional deficiency during pregnancy is directly linked to conditions such as anophthalmia?
What nutritional deficiency during pregnancy is directly linked to conditions such as anophthalmia?
What is the recommended daily intake of folic acid to minimize risks of neural tube defects during pregnancy?
What is the recommended daily intake of folic acid to minimize risks of neural tube defects during pregnancy?
What effect does maternal malnutrition have regarding mineral deficiencies during pregnancy?
What effect does maternal malnutrition have regarding mineral deficiencies during pregnancy?
What is a significant risk associated with untreated systemic lupus erythematosus during pregnancy?
What is a significant risk associated with untreated systemic lupus erythematosus during pregnancy?
What consequence is likely if fathers are exposed to toxic substances affecting sperm cells?
What consequence is likely if fathers are exposed to toxic substances affecting sperm cells?
How does maternal hyperthyroidism, particularly in the case of Grave's disease, impact fetal development?
How does maternal hyperthyroidism, particularly in the case of Grave's disease, impact fetal development?
Which of the following antisensory effects is linked to the use of aminoglycoside antibiotics during pregnancy?
Which of the following antisensory effects is linked to the use of aminoglycoside antibiotics during pregnancy?
What specific congenital defect may result from the use of Warfarin during pregnancy?
What specific congenital defect may result from the use of Warfarin during pregnancy?
What is the teratogenic effect associated with high doses of vitamin A during pregnancy?
What is the teratogenic effect associated with high doses of vitamin A during pregnancy?
Which of these drugs is likely to suppress fetal development when used during pregnancy?
Which of these drugs is likely to suppress fetal development when used during pregnancy?
What is a potential outcome of taking Trimethoprim in pregnancy?
What is a potential outcome of taking Trimethoprim in pregnancy?
Which of the following effects is most likely associated with the use of anticonvulsants during pregnancy?
Which of the following effects is most likely associated with the use of anticonvulsants during pregnancy?
What is one of the major risks when using ACE inhibitors such as enalapril during the second and third trimester?
What is one of the major risks when using ACE inhibitors such as enalapril during the second and third trimester?
Which defect is NOT commonly associated with the use of Tetracycline during pregnancy?
Which defect is NOT commonly associated with the use of Tetracycline during pregnancy?
Flashcards
Teratogen
Teratogen
An agent causing permanent structural or functional changes during embryonic/fetal development by disrupting normal development.
Teratogenicity
Teratogenicity
The study of the production of birth defects, including their causes, mechanisms, and patterns.
Critical Periods (Embryogenesis)
Critical Periods (Embryogenesis)
Specific stages of development during which exposure to a teratogen has the greatest impact.
Birth Defects (Incidence)
Birth Defects (Incidence)
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Teratology
Teratology
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Mechanism of teratogens
Mechanism of teratogens
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Congenital infections
Congenital infections
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Congenital Toxoplasmosis gondii
Congenital Toxoplasmosis gondii
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Congenital Syphilis
Congenital Syphilis
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Maternal disorders
Maternal disorders
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Teratogenic Agents
Teratogenic Agents
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Fetal/Neonatal Stage
Fetal/Neonatal Stage
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Fetal Toxoplasmosis Syndrome
Fetal Toxoplasmosis Syndrome
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Fetal Syphilis Syndrome
Fetal Syphilis Syndrome
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Fetal Cytomegalovirus Syndrome
Fetal Cytomegalovirus Syndrome
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Fetal Rubella Syndrome
Fetal Rubella Syndrome
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Fetal Varicella Zoster Syndrome
Fetal Varicella Zoster Syndrome
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Congenital Herpes Simplex
Congenital Herpes Simplex
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Congenital HIV/AIDS
Congenital HIV/AIDS
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Congenital Tuberculosis
Congenital Tuberculosis
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FDA Drug Risk Classification
FDA Drug Risk Classification
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Category A Drugs
Category A Drugs
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Category B Drugs
Category B Drugs
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Category C Drugs
Category C Drugs
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Category D Drugs
Category D Drugs
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Category X Drugs
Category X Drugs
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ACE Inhibitors (Teratogenic)
ACE Inhibitors (Teratogenic)
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Examples of Potential Teratogens
Examples of Potential Teratogens
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ACE Inhibitors & Pregnancy
ACE Inhibitors & Pregnancy
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Streptomycin & Hearing Loss
Streptomycin & Hearing Loss
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Tetracycline & Tooth Discoloration
Tetracycline & Tooth Discoloration
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Trimethoprim & Birth Defects
Trimethoprim & Birth Defects
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Coumadin & Birth Defects
Coumadin & Birth Defects
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Anticonvulsants & Birth Defects
Anticonvulsants & Birth Defects
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Vitamin A & Birth Defects
Vitamin A & Birth Defects
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Corticosteroids & Birth Defects
Corticosteroids & Birth Defects
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Insulin-dependent diabetes during pregnancy
Insulin-dependent diabetes during pregnancy
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Hypothyroidism during pregnancy
Hypothyroidism during pregnancy
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Systemic lupus erythematosus (SLE) during pregnancy
Systemic lupus erythematosus (SLE) during pregnancy
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Hyperthyroidism during pregnancy
Hyperthyroidism during pregnancy
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Vitamin A deficiency during pregnancy
Vitamin A deficiency during pregnancy
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Folic acid deficiency during pregnancy
Folic acid deficiency during pregnancy
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Vitamin D deficiency during pregnancy
Vitamin D deficiency during pregnancy
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Importance of paternal health in pregnancy
Importance of paternal health in pregnancy
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What is a teratogen?
What is a teratogen?
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Why are there no absolute teratogens?
Why are there no absolute teratogens?
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What's a critical period in embryogenesis?
What's a critical period in embryogenesis?
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Why are multiple birth defects common?
Why are multiple birth defects common?
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What happens during pre-implantation exposure?
What happens during pre-implantation exposure?
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Congenital CMV
Congenital CMV
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Fetal CMV Syndrome
Fetal CMV Syndrome
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Congenital Rubella
Congenital Rubella
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Congenital Varicella Zoster
Congenital Varicella Zoster
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Fetal Varicella Syndrome
Fetal Varicella Syndrome
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Congenital Toxoplasmosis
Congenital Toxoplasmosis
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Importance of Paternal Health
Importance of Paternal Health
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Coumadin (Warfarin) & Birth Defects
Coumadin (Warfarin) & Birth Defects
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Insulin-dependent diabetes risk
Insulin-dependent diabetes risk
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Hypothyroidism effect on fetus
Hypothyroidism effect on fetus
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Systemic lupus erythematosus risk
Systemic lupus erythematosus risk
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Vitamin A deficiency risk
Vitamin A deficiency risk
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Folic acid deficiency risk
Folic acid deficiency risk
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Vitamin D deficiency risk
Vitamin D deficiency risk
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Paternal health role
Paternal health role
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Radiation during pregnancy
Radiation during pregnancy
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Tobacco's impact on the fetus
Tobacco's impact on the fetus
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Maternal hyperthermia
Maternal hyperthermia
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Lead exposure during pregnancy
Lead exposure during pregnancy
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Mercury and Minamata Syndrome
Mercury and Minamata Syndrome
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Carbon monoxide's impact on the fetus
Carbon monoxide's impact on the fetus
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Pesticides and fetal death
Pesticides and fetal death
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Maternal diabetes and pregnancy outcome
Maternal diabetes and pregnancy outcome
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Study Notes
Teratogenicity
- Teratogen: An agent that causes permanent structural or functional alterations by interfering with normal embryonic/fetal development
- Teratogenicity: The capability of producing fetal malformations
- Teratology: The science studying causes, mechanisms, and patterns of abnormal development. Exposure to a teratogen leads to teratogenicity.
Incidence of Birth Defects
- Approximately 303,000 newborns die within 28 days of birth globally due to congenital anomalies (WHO, World Birth Defects Day: March 3, 2021)
- Teratogens account for about 10% of birth defects.
- Unknown causes or factors account for about 37% of birth defects.
- Multifactorial factors contribute to about 42% of birth defects.
- Chromosomal abnormalities account for approximately 3% of birth defects.
- Monogenic disorders account for about 8% of birth defects.
Principles of Clinical Teratology
- No absolute teratogens exist
- Susceptibility to teratogens differs between individuals
- Embryogenesis and fetal development are vulnerable periods for teratogen exposure
- Multiple teratogens can interact and have more significant effects than a single teratogen
Critical Periods
- Pre-implantation (fertilization to implantation)
- Implantation to organogenesis (first two months)
- Fetal/neonatal stage (second and third trimesters)
Mechanisms of Action of Teratogens
- Interference with nucleic acids (e.g., methotrexate)
- Inhibition of enzymes
- Deficiency in energy supply needed for organ building
- Lack of necessary substrates
- Replication, transcription, or RNA translation
- Preventing folic acid formation
- Glucose deficiency
- Internal respiration interference
- Hypoxia
- Vitamin or mineral absorption issues
- Genetic mutations
- Chromosomal aberrations
Teratogenic Agents
- Infectious agents (e.g., toxoplasmosis, syphilis, CMV, rubella, varicella zoster, herpes simplex, HIV/AIDS, tuberculosis)
- Environmental chemicals and physical agents (e.g., alcohol, ionizing radiation, toluene, tobacco, maternal hyperthermia, cocaine, lead, mercury, carbon monoxide, pesticides)
- Drugs and pharmaceuticals
- Maternal disorders (e.g., diabetes, hypothyroidism, hyperthyroidism, systemic lupus erythematosus, malnutrition)
Congenital Infections (STORCH)
- Toxoplasmosis gondii
- Syphilis (Treponema pallidum)
- Cytomegalovirus (CMV)
- Rubella (German Measles)
- Varicella-zoster (Chickenpox)
- Herpes simplex
- HIV/AIDS
- Tuberculosis
Congenital Infections (examples with syndromes)
- Fetal toxoplasmosis syndrome
- Fetal syphilis syndrome
- Fetal CMV syndrome
- Fetal rubella syndrome
- Features of varicella zoster syndrome: hypoplasia, paresis, skin lesions, eye findings, CNS anomalies
Drugs and Pharmaceuticals
- All drugs have theoretical teratogenic potential.
- Medications should be carefully considered during pregnancy.
- FDA classification system for drug risk during pregnancy:
- Category A: no risk in human studies
- Category B: no risk in animal studies, limited human data
- Category C: animal studies show risk; limited human data
- Category D: Evidence of risk; potential benefits outweigh risk
- Category X: risk outweighs any potential benefits
Examples of Specific Medications and Exposures
- Angiotensin-converting enzyme (ACE) inhibitors
- Antibiotics (streptomycin, tetracycline, trimethoprim)
- Anticoagulants (coumadin/warfarin)
- Anticonvulsants
- Vitamins (vitamin A, folic acid, vitamin D, minerals)
- Corticosteroids
- Oral contraceptives
- Androgenic agents
- Acetyl salicylic acid (aspirin)
- Chemotherapy agents
- Antiparasitic agent (metronidazole)
- Lithium
Maternal Disorders
- Diabetes mellitus: increased risk of early pregnancy loss and major birth defects
- Hypothyroidism: increased risk of pregnancy loss, but not affecting fetal thyroid development
- Hyperthyroidism: increased risk of pregnancy loss
Environmental and Chemical/Physical Agents
- Alcohol (fetal alcohol syndrome)
- Ionizing radiation
- Toluene (glue sniffing)
- Tobacco (nicotine)
- Maternal hyperthermia
- Cocaine
- Lead
- Mercury
- Carbon monoxide
- Pesticides
Maternal Hyperthermia
- Temperatures above 38.9°C (102°F) over a 24-hour period or more with an intercurrent illness
- Minimal exposure (30-45 mins) in hot environments can be harmful during weeks 4-14 of pregnancy.
- Can lead to IUGR, microcephaly, central nervous system damage, among others
Tobacco (Nicotine)
- Associated with reduced fetal growth, increased prematurity risk, and death
Lead
- Found in old paint and water pipes
- Causes abortions, anemia, neurological problems, brain & MR abnormal development
Mercury
- Exposure through fish consumption or contaminated seed corn
- Associated with Minamata Syndrome.
Carbon Monoxide
- Results from incomplete combustion, inhalation leads to oxygen starvation (hypoxia) in the fetus.
- Associated with spontaneous abortion, stillbirth, and growth/development retardation.
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