SRM COLLEGE OF PHYSIOTHERAPY

Ponmathi.P
TERATOGENESIS Assitant Professor,

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TERATOGENS
• Teratogenic agent
any chemical,drug,infection,physical or
deficiency state that can alter fetal morphology or
subsequent function if the fetus is exposed during
development
Teratogenecity depends on
1. genes of their parents
2.period of exposure
3.route of administration
4.length of administration
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TERATOGENS
• Genetic susceptibility
exposure to tranquilizer thalidomide –malformation of
arms,but exposure to rat does not produce this
• Time of exposure
1.resistant period
0-7 days postovulation-survive unaffected or die
2. embryonic period
7-57 days, maximum susceptible
in some period,acc to organogenesis, organ
malformation occurs

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TERATOGENS
3. fetal period
1. after 57 weeks
2. lower susceptibility
3.cause reduction of cell size and number so cause
1.growth reatrdation
2.reduction in organ size
3.functional derangement of
organ systems
4. route and length of administration
abnormal developments increases when dosage increases

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TERATOGENS
• Teratogenic agents
1. ionizing agents
acute high dose
a. time of exposure
1. 2-4 wks-abortion
2.4-12 wks-MR,cataract, GR,microcephaly,
microopthalmia
3.12-16 wks-MR,GR
4.>20 wks-skin lesions,hair loss, bone marrow
supression

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TERATOGENS
b. dose effect
1.<10 rads-no effect
2.10-25 rads- mild effects
3.>25 rads-classic fetal effect
2.chronic low dose
a.dose have to be added up(table)

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IONIZING AGENTS
examination No of films Average to uterus

chest 2 1-8mr
Hip and pelvis 1.5 220mr
Upper gastrointestinal 4.2 558mr
Barium enema 11.6 1080mr
Kidney,ureter,bladder 1.9 140mr
Intravenous pyelogram 5. 308mr

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CHEMICALS
drugs and medications
1. congenital malformation
risk factors
1. category A-no risk-antenatal vitamins
2. category B-no risky animal studies, but no human
studies-(penicillin,digoxin,epinephrine,terbutaline)
3. category C-risky animal studies,no human studies,
given if its optionless-(furosemide,quinidine,β blockers)
4.categoryD-evidence of human risk(phenytoin)
5.category X-clear fetal risk,
contraindicated(isotretinoin)
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CHEMICALS
• Congenital defects
1. isotretinoin-CNS defects, CHD,facial palsy,deafness
2.streptomycin-ototoxicity
3.tetracycline-given after 4 month-yellow teeth, decay enamel
hypoplasia, permanent teeth is unaffected
4.thalidomide-limb reduction,ear and nasal anomalies,cardiac
and lung defects,GI atresia,pyloric or duodenal stenosis
5.warfarin-1st trimester-conradi’s syndrome-stippling of
uncalcified epiphyseal region
mid-last trimester-MR,seizures, microcephaly, optic
atrophy
6. valporic acid- cleft lip palate, NTD, renal defects

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CHEMICALS
7.diethylstilbestrol-functional defect in female child, T
shaped uterus,infertility, premature labour,cervical incompetence
8.phenytoin-craniofacial abnormalities,digital anomalies
9. lead-GR,developmental delay,abortion
10.lithium-cardiac defects,malformation of great vessels
11.mercury-seizuers,C.P,blindness,deafness

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FETAL ALCOHOLSYNDROME
• Fetal alcohol syndrome or full blown syndrome
this happens due to consumption of alcohol in pregnancy
early exposure-at conception-facial dysmorphology
late exposure-learning or behavioural disorders
syndrome consists of
>3 oz or six drinks
1. prenatal or postnatal growth retardation
2. CNS involvement-MR, delayed motor development, hyperactivity, poor
attention
3. facial dysmorphology
palpable fissures,upturned nose, thin upper lip
4. multiple joint anomalies, cardiac defect

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SMOKING
• Smoking
1.increased perinatal mortality
2.preterm delivery
3. Premature rupture of membrane(PROM)
4.Bleeding during pregnancy
heroin-no birth defects
Cocaine-congenital malformations,stillbirth,low birth
weight
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HYPERTHERMIA
• Body temperature above 38.9 degrees between 4-14
weeks
1.growth retardation
2.CNS defects
MR,microcephaly, hypotonia
3.facial anomalies
midfacial hypoplasia,cleft lip
palate,microopthalmia,external ear anomalies
4.minor limb anomalies-syndactyly
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MEDICAL DISORDERS
Diabetic mellitus
insulin dependent diabetic mother-6-22% of
cardiac ,renal,skeletal, GI,CNS malformations
3rd to 6th postconception malformations occurs
Phenyl ketonuria
genetic disorder –deficiency of phenylalnine
hydroxylase, it catalyse conversion of phenylalanine to
tryosine
MR in fetus, so diet low in phenylalanine prevent
adverse effect
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MEDICAL DISORDERS
• Virilizing tumors
masculanizing effects on motherand
child,if female child, fusion of labia, clitromegaly
Epilepsy
who take anticonvulsants-malformed infents

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MEDICAL DISORDERS
2.cardiovascular
persistent PDA
pulmonary artery stenosis
AV septal defects
3. ocular defects
catarcts
microopthalmia
retinal changes
blindness
inner ear problems
IUD

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INFECTIONS
• TORCH
rubella
first month-50% chance of anomaly
second month-22%
third-fourth month-6-10%
infected at delivery-new born-pneumonitis
congenital rubella syndrome
1. neuropathologic changes
microcephaly
mental and motor retardation
meningoencephalitis

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INFECTIONS
Cytomegalovirus
severe complication in fetus if mother is
primarily infected, than recurrent infections
1. microcephaly, hydrocephalus
2.chorioretinitis
3.hepatosplenomegaly
4.cerebral calcification
5,MR
6.heart block

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INFECTIONS
Herpes virus(HSV2)
fetal transmission-haematogenous spread,direct contact through
infected canal during birth
1 in 75000, has antenatal transmission
fetal anomalies
growth retardation
microcephaly
chorioretinitis
cerebral calcification
microopthalmia encephalitis

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INFECTIONS
Toxoplasmosis
about 30% of infected women pass this to fetus
fetal infection increases with severity of infection
1. abortion
2, chroiretinitis
3.microcephaly, hydrocephalus
4.cerebral calcification
5.severe congenital anomalies
6.transmission is more likely in last trimester

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INFECTIONS
• Syphilis
treponema pallidum causes syphilis, can cross placenta at any time
during pregnancy
fetus is rarely affected before 16-18 wks of pregnancy
preterm labour
still birth-50% of infected
hepatosplenomegaly
joint swelling, skin rash
anemia,jaundice,
CSF changes
antibiotic therapy <16 wks sucessful, high failure in secondary syphilis,
infected in last trimester of pregnancy
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INFECTIONS
• Varicella zoster
transmission is not well documented
transimission in first half of pregnancy is the most
1.leukemia
2.limbhypoplasia
3,rudimentary digits,club foot
4.microcephaly
5.seizures
6.autonomic dysfunction like loss of bowel and bladder, horners syndrome
7. microopthamia,optic atrophy,chorioretinitis
8. MR, focal brain calification
9. vesicular rashes if infection in last 3 weeks of pregnancy

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INFECTIONS
• Mumps
not strictly teratogenic
may cause
1, endocardial fibroelastosis
2. ear, eye malformations
3.urogenital abnormalities
entero viruses
coxsackieB ,
severe fetal illness, abort,if survives
cardiac malformation
hepatitis,pneumonitis,pancreatitis
adrenal necrosis

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