NCM107: MATERNAL

Care of Mother, Child, and Adolescent (LECTURE)

BS Nursing - 2BSN3 | SEM 1 2023

Lesson 6: TERATOGENIC MATERNAL

Fetal Teratogens INFECTION
● Can involve either sexually
TERATOGENS
transmitted or systemic infections
● Any factor, chemical or physical,
● These organisms that cross the
that adversely affects the fertilized
placenta can be viral, bacterial, or
ovum, embryo or fetus
protozoan
● can affect at any stage of
● TORCH SCREEN
pregnancy
Several diseases that are
commonly known to cross the
EXAMPLES OF TERATOGENS
placenta and cause fetal harm
● Maternal Infection/Diseases
● Potentially Teratogenic Vaccines
● Teratogenic Drugs
Toxoplasmosis
● Alcohol Other Infections (Hep. B & HIV)
● Cigarettes Rubella
● Environmental Teratogens Cytomegalovirus (CMV)
● Maternal Stress Herpes Simplex Virus

Factors that Influence the Amount of

Damage a Teratogen can Cause
1. Strength of the teratogen
2. Timing of teratogenic insult (When
was the mother exposed?)
3. Teratogens affinity for specific
tissues
TOXOPLASMOSIS
● Protozoan infection
● Is spread most commonly through
contact with uncooked meat
● May also be contracted through
handling cat stool or cat litter

For Example: CYTOMEGALOVIRUS (CMV)

● Lead & Mercury — attack and ● A member of the herpes virus
disable nervous tissue; the baby family
would have neurological problems ● Transmitted from person to person
● Thalidomide — a drug used to by droplet infection
relieve nausea in pregnancy; ● Can cause extensive damage to a
causes limb defects fetus while causing few symptoms
● Tetracycline — common in a woman
antibiotic; causes tooth enamel ● Diagnosis in the mother or infant
deficiencies and possible can be established by the isolation
long-bone deformities of CMV antibodies in blood
● Rubella Virus — can affect many serum
organs; most commonly attacked
organs: the eyes, ears, heart and IMPORTANT NOTE
brain
● There is no treatment or vaccine
for the disease; routine screening
for CMV during pregnancy is not
recommended
● Women can help prevent
exposure by thorough
NCM107: MATERNAL
Care of Mother, Child, and Adolescent (LECTURE)
BS Nursing - 2BSN3 | SEM 1 2023

handwashing before eating and IMPORTANT NOTE

avoiding crowds of young children ● Several infections are not
at daycare or nursery settings. teratogenic to a fetus during
pregnancy but are harmful if
present at time of birth.
HERPES SIMPLEX VIRUS
(GENITAL HERPES INFECTION)
● The virus in the mother's
INFECTIONS THAT CAUSES
bloodstream (viremia) crosses the ILLNESS AT BIRTH
placenta to the fetus ● Gonorrhea
● If genital lesions are present at the ● Candidiasis
time of birth, a fetus may contract ● Chlamydia
the virus from direct exposure ● Streptococcus B
during birth. ● Hepatitis B Infection
● In the first trimester, severe
congenital anomalies or
POSSIBLE TERATOGENIC VACCINES
spontaneous miscarriage may
● Live virus vaccines are
occur.
contraindicated during pregnancy
● During the second trimester or
because they may transmit the
third trimester, there is a high
viral infection to the fetus
incidence of premature birth,
Examples:
intrauterine growth restriction, and
○ Measles
continuing infection of the newborn
○ HPV (Human Papilloma
at birth.
Virus)
● Unless recognized and treated, the
○ Mumps
fetal mortality and morbidity rates
○ Rubella
are as high as 80%.
○ Poliomyelitis (Sabin Type)
● Intravenous or oral acyclovir
(Zorivax) can be administered to
IMPORTANT NOTE
women during pregnancy.
● Make sure that adolescents about
SYPHILIS to be vaccinated are not pregnant
○ Women who work in
● If left untreated beyond the 18th
biologic laboratories
week of gestation, hearing where vaccines are
impairment, cognitive challenge, manufactured are
osteoarthritis, and fetal death are well-advised not to work
possible. with live virus products
● First Prenatal Visit: during pregnancy
○ VDRL test (blood test done
to check for syphilis) or a
TERATOGENIC DRUGS
rapid plasma reagin
● Two principles always governing
serologic screening test
drug intake during pregnancy:
should be done
1. Any drug or herbal
○ Can be repeated during the
supplement, under
8th month
circumstances, may be
detrimental to fetus welfare.
NCM107: MATERNAL
Care of Mother, Child, and Adolescent (LECTURE)
BS Nursing - 2BSN3 | SEM 1 2023
Therefore, during TERATORGENICITY OF ALCOHOL
pregnancy, women should FETAL ALCOHOL SYNDROME (FAS)
not take any drug or ● Infants born with FAS not only are
supplement not specifically small for gestational age but can
prescribed or approved by cognitively challenged
their physician or ● Typical characteristics are
nurse-midwife. craniofacial deformity including
2. A woman of childbearing short palpebral fissures, thin upper
age and ability should not lip and upturned nose
take any drug other than
once prescribed by the
physician or nurse-midwife
to avoid exposure to a drug
should she become
pregnant.

EXAMPLE OF TERATOGENIC DRUGS

THALIDOMIDE
● Once liberally prescribed for
morning sickness
● Causes amelia or phocomelia
(total or partial absence of
extremities) in 100% of instances
when taken between the 34th and
45th day (embryonic stage) of
pregnancy.
MINOXIDIL (ROGAINE)
● A drug that is taken by both men
and women to restore hair growth
● can cause fetal deformities
IMPORTANT NOTE
● Babies show a high incidence of
congenital deformities and
cognitive impairment
● Women are best advised to
abstain from alcohol completely
● Because of individual variations
in metabolism, it is impossible to
define a safe level of alcohol
consumption

TERATORGENICITY OF CIGARETTE
NARCOTICS
● Cigarette smoking is associated
● Meperidine (Demerol) — narcotic
with infertility in women
analgesic; can lead to addiction
● Effects to the Fetus:
● Heroin — causing intrauterine
○ cause fetal growth
growth restriction (IUGR)
restriction
● Cocaine — partially its crack form;
○ fetus may be at greater risk
its use is associated with
for being still born
spontaneous miscarriage, preterm
○ after birth, they may be at
labor, meconium staining and
greater risk than others for
IUGR
sudden infant death
syndrome
○ low birth weight in infants
NCM107: MATERNAL
Care of Mother, Child, and Adolescent (LECTURE)
BS Nursing - 2BSN3 | SEM 1 2023
IMPORTANT NOTE
● Smoking mothers results from
vasoconstriction of the uterine
vessels, an effect of nicotine.
○ This limits the blood
supply to the fetus.
● Secondary smoke may also be
as harmful as actually smoking
cigarettes. All prenatal health
care settings should be
smoke-free environments for this
reason.
● Another contributory effect may
be related to inhaled carbon
monoxide.
ENVIRONMENTAL TERATOGENS
● Directly or deliberately ingested
teratogens from environmental
sources can be damaging to a
fetus
● Women can be exposed through
contact at home or work sites.
For Example:
○ Washing children's hair with
a shampoo such as
LINDANE (KWELL) to
remove lice should be
limited to two exposures
because of potential
toxicity.
METALS AND CHEMICAL HAZARDS
● Examples of chemical teratogens
that can be contacted at work site:
○ Carbon Monoxide — such
as from automobile exhaust
should be avoided
○ Pesticides — Arsenic, a
by-product of copper and
lead smelting, used in
pesticides, paints, and
leather processing
○ Formaldehyde — used in
paper manufacturing
○ Mercury — used in the
manufacture of electrical
apparatuses and found in
swordfish and tuna fish
○ Lead — ingestion during
pregnancy may lead to a
newborn who is cognitively
or neurologically
challenged
■ Women may ingest
lead by drinking
water that travels
through old pipes
that are leeching
lead by “sniffing”
lead-based gasoline
(Pavone &
Heuppchen, 2007)
RADIATION
● Produces a range of malformations
● The effect depends on:
1. the stage of development of
the embryo or fetus
2. strength and length of
exposure
● Before implantation, the growing
zygote apparently is killed.
○ If the zygote is not killed, it
survives apparently
unharmed.
● From implantation to 6 weeks after
conception (when many women
are not yet aware that they are
pregnant)
○ the most damaging time for
exposure
○ the nervous system, brain,
and retinal innervation are
most affected
● If in doubt, a serum pregnancy test
can be done to suspecting
pregnant women before the x-rays.
● AS A RULE, all women of
childbearing age for pelvic x-ray
examinations can be scheduled:
NCM107: MATERNAL
Care of Mother, Child, and Adolescent (LECTURE)
BS Nursing - 2BSN3 | SEM 1 2023
○ Only in the first 10 days of
menstrual cycle (when
pregnancy is unlikely
because ovulation has not
yet occurred), except in
emergency situations
○ If a woman needs
non-pelvic radiation during
pregnancy (e.g. dental
x-ray examinations, an arm
or leg x-ray examination
after fall), be certain that
she is supplied with a
lead apron to shield her
pelvis during the
procedure.
■ Rapidly growing
cells are extremely
vulnerable to
destruction by
radiation. That
makes radiation a
potent teratogen to
unborn children
because of rapidly
growing cells.

HYPERTHERMIA & HYPOTHERMIA

● Hyperthermia — can be
detrimental to growth because it
interferes with cell metabolism
● Avoid using the following:
○ Saunas
○ Hot Tubs
○ Tanning Beds