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Prenatal Risk Factors

Prenatal Risk Factors. PSY 417. Maternal Status. Maternal Nutrition Protein Folic Acid Maternal Diseases HIV Diabetes. Prenatal Infections: STORCH. Syphilis Toxoplasmosis Rubella Cytomegalovirus Herpes. Teratogen. “toxic” agents that cause deficits/malformations in the fetus

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Prenatal Risk Factors

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  1. Prenatal Risk Factors PSY 417

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

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

  4. Teratogen • “toxic” agents that cause deficits/malformations in the fetus • Agent that can produce a permanent alteration of structure or function in an organism exposed during embyronic or fetal life.

  5. Example of a MalformationAgent 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. Factors That Influence Teratogenicity • Nature of the agent • Dose • Route • Frequency of exposure • Duration of exposure

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

  11. Timing

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

  13. Birth Defects in Childhood Teratogens

  14. Birth Defects Caused By Teratogenic Exposures Are Preventable.

  15. Alcohol • Fetal Alcohol Syndrome (FAS) • confirmed maternal drinking during pregnancy • pattern of facial features • growth retardation • evidence of CNS disturbance • Fetal Alcohol Effect (FAE)

  16. Mechanism of Transmission

  17. FAS: Brain development

  18. Facial Features: Dysmorphology

  19. Cigarettes • Low birth weight • CNS deficits - LD, Attention • SIDS • Respiratory problems • Increased risk for cancer

  20. Cigarettes

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

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

  23. Other Teratogens • Rubella • 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

  24. Rubella continued • 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.

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