TERATOGENS

● any factor chemical or physical that adversely affects the fertilized ovum, embryo, or
fetus.
● A fetus needs sound genes and healthy intrauterine environment that protects it from the
influence of teratogens.

EFFECTS OF TERATOGENS ON THE FETUS

FACTORS
1. Strength of the teratogen
● In small amount- causes no damage
● Large doses- causes serious fetal defects or death
2. Timing of the teratogenic insult
● If teratogen is introduced during implantation, either the zygote is destroyed or
appears unaffected
● If the insult occurs when the main body systems are being formed ( in the 2nd to 8th
weeks of embryonic life) the fetus is very vulnerable to injury.
● During the last trimester = potential harm decreases because all the organs of the
fetus has been formed.
● Deformities usually occur in the early embryonic life are the effects caused by the
organisms of syphilis and toxoplasmosis.
3. Teratogen’s affinity for a specific tissue
● Lead attacks and disables nervous tissue
● Thalidomide causes limb defects
● Tetracycline causes tooth enamel deficiency and long bone deformities
● Rubella virus can affect organs like the eyes, ears, heart, and brain

TERATOGENIC MATERNAL INFECTIONS

● Involve either sexually transmitted or systemic infections.
● The group of diseases is under the umbrella TORCH
● All these infections are known to cross the placenta affects the fetus during pregnancy
● tORCH screen was developed as an immunologic survey to determine infections from
the pregnant woman and the newborn
● infections that cross the placenta can be viral, bacterial, or protozoan
● cause milk, flulike symptoms in a woman but has a serious effect to the fetus.

COMMON TERATOGENIC INFECTIONS:

1. T- TOXOPLASMOSIS
● A protozoan infection spread most commonly through contact with uncooked
meat, handling cat stool
● The woman experiences no symptoms of the disease except a few days of
malaise a and posterior cervical lymphadenopathy
 ● If the infection crosses the placenta= it causes central nervous system damage,
hydrocephalus, microcephaly, intracerebral calcification and retinal deformities’
● Pyrimethamine , an antiprotozoal agent may be used.
= an antifolic acid drug so it is not administered early in pregnancy to prevent
folic acid levels.
Management:
✔ Prepregnancy serum analysis to identify women who have never had a
disease and are susceptible ( about 50% of women)
✔ Avoid eating undercokedmeat
✔ Avoid working in a soil in which cats had made use for defecation.

2. O - OTHER VIRAL DISEASES

a. Syphillis
● A sexually transmitted infection
● Can place the fetus at risk for congenital syphilis
● Causative agent: Treponema Pallidum- can extremely damaged the fetus after
the 16th-18th week of intrauterine life, when the cytotrophoblastic layer of the
placental villi has atrophied and no longer protects it.
● If treated earlier, the fetus is rarely affected.
● If left untreated beyond the 18th week , deafness, cognitive challenge,
osteochondrosis and fetal death are possible.
● Newborn with congenital syphilis may have congenital anomalies, extreme
rhinitis and a syphilitic rash, indicating high-risk at birth.

Management”
✔ Safer sex practice
✔ Early detection
✔ Immediate treatment with antibiotic
✔ Serologic screening should be done in the 1st prenatal visit

b. Lyme disease
● A multisystem disease caused by Spirochete Borrelia Burgdorferi
● Spread by a spread of a deer tick.
● After a tick bite, typical skin rash (erythema chronicum migrans)develops,
pain in large body joints
● Infect in pregnancy can result in spontaneous miscarriage or severe
congenital anomalies.

Management:
✔ Women anticipating becoming pregnant or who are pregnant should avoid
areas such as wooded or tall greasy areas
✔ If hiking in these areas, woman should avoid the use of tick repellants
containing diethyltoluamide because the ingredient is teratogenic.
 ✔ Wear long light colored slacks tucked into her socks to prevent leg s from
being esposed.
✔ After returning from hiking, woman should inspect her body carefully and
immediately remove the ticks
✔ Treatment for nonpregnant: tetracycline and doxycycline but cannot be
used during pregnancy because they can cause tooth discoloration and
possibly long bone malformation
✔ Penicillin can be used by the pregnant woman to reduce symptoms.
c. Infections that cause illness at birth
● A number of infections are not teratogenic to the fetus during pregnancy but
are harmful if they are present at the time of birth like gonorrhea, candidiasis,
Chlamydia, streptococcus B and hepatitis B.

3. R- RUBELLA
● Fetal damage from maternal infection with rubella includes:
✔ Deafness
✔ mental and motor challenges
✔ Cataracts
✔ cardiac defects ( patent ductus arteriosus and pulmonary stenosis)
✔ retarded intrauterine growth
✔ thrombocytopenic purpura
✔ dental and facial clefts- cleft lip and palate
● a woman who is not immunized before pregnancy cannot ne immunized
during pregnancy because the vaccine uses a live virus that would have
effect s similar to those occurring with a subclinical case of rubella.
● After rubella immunization, not advised to become pregnant for 3 months until
the rubella virus is no longer active.
● Should not be in contact with children who have rubella.
4. C - CYTOMEGALOVIRUS
● A member of the herpes virus family
● Transmitted through droplets infection from person to person
● 40%-100% of women are estimated to have been infected with CMV before
pregnancy.
● Crosses the placenta causing congenital CMV infection
● Effects:
✔ Hydrocephalus
✔ Microcephaly
✔ Spasticity
✔ Eye damage
✔ Deafness
✔ Chronic liver diasease
✔ Blueberry -muffin lesions
 Management:
✔ Thorough handwashing before eating
✔ Avoid crowds of young children

5. H - HERPES SIMPLEX VIRUS (GENITAL HERPES INFECTION)

● The virus spreads into the bloodstream and crosses the placenta to the fetus.
● 1st trimester – causes severe congenital anomalies or spontaneous miscarriage
● 2nd or 3rd trimester – high incidence of premature birth, intrauterine growth
retardation and continuing infection of the newborn at birth.

Management:
✔ Acyclovir (Zovirax)
✔ Safe sex

Potential Teratogenicity of Vaccines

● Live virus vaccines such as measles, mumps, rubella and poliomyelitis are
contraindicated during pregnancy because they may transmit the viral infection to the
fetus.

TERATOGENICITY OF DRUGS
● NOT all drugs crosses the placenta like heparin since it has a large molecular size.
● Herbs, ginseng are not safe during pregnancy
● 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 approved by the physician.
● “Pregnancy applies ONLY to PRESCRIPTION DRUGS
● Thalidomide – classic teratogenic drug
Causes:
✔ Amelia or pocomelia when taken between 34th and 45th day of pregnancy.
✔ Narcotics such as meperidine (demerol) and heroin causes intrauterine growth
retardation.

TERATOGENICITY OF ALCOHOL
▪ High incidence of alcohol causes congenital deformities an cognitive impairment.

▪ Fetal alcohol syndrome - SGA

TERATOGENICITY OF CIGARETTES
▪ Causes growth retardation.

▪ Greater risk for sudden infant death syndrome

● LBW
ENVIRONMENTAL TERATOGENS
a.Metal and Chemical Hazard
● Pesticides and carbon monoxide
● Arsenic (byproduct of copper and lead smelting, used in pesticides, paints and leather
processing
● Formaldehyde – used in paper manufacturing
● Mercury – used in manufacture of electrical apparatuses
● Lead ingestion – may lead to newborn neurologically and cognitively challenge

b.Radiation
● Produces a range of malformations
● Can damage nervous system, brain and retinal innervation
● Before implantation : fetal death
● Critical period : from implantation to 6 weeks of pregnancy
● RULE : “ All women of childbearing age should be exposed to pelvic x-rays on the 1 st 10
days of menstrual cycle.”
● Pregnancy test prior the X-rays
● Sonogram and MRI may replaced x-ray examinations
● Increase the risk of cancer among children
● X-ray with lead apron to shield her pelvis during the procedure
● Fluoroscopy uses lower radiation doses
● Long term use of slight radiation sources (word processor, computer or cellular phone) are
still on investigation

c.Hyperthermia
● Detrimental to fetal growth w/c interferes with cell metabolism
● Acquired through saunas, hot tubs, welding or steel making
● Maternal fever early in pregnancy can cause abnormal fetal brain development and
possible seizure disorder, hypotonia and skeletal deformities

d.Teratogenic Maternal Stress

● Emotionally disturbed pregnancy could produced physiologic changes through its
effect on the sympathetic division of the autonomic nervous system
🢭 Can cause constriction of the peripheral blood vessels (fight-or-flight syndrome)
● If anxiety is prolonged – uterine vessels constrict – interfere with blood and nutrient
supply to a fetus
* passive immunization from measles lasts over a year