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Prenatal Risk Factors

This article explores critical prenatal risk factors influencing fetal development, focusing on maternal status, nutrition, and the impact of diseases such as HIV and diabetes. It examines teratogenic agents and congenital infections like STORCH, emphasizing the effects of alcohol, drugs, and certain infections on fetal health. The mechanisms of teratogenicity and the importance of timing and exposure are discussed, alongside statistical data on birth defects. Prevention of teratogenic effects is highlighted as a crucial aspect of maternal health.

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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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