prenatal risk factors psy 417. maternal status maternal nutrition maternal nutrition –protein...
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Maternal StatusMaternal Status
Maternal NutritionMaternal Nutrition– ProteinProtein– Folic AcidFolic Acid
Maternal DiseasesMaternal Diseases– HIVHIV– DiabetesDiabetes
Prenatal Infections: STORCHPrenatal Infections: STORCH
SyphilisSyphilis ToxoplasmosisToxoplasmosis RubellaRubella CytomegalovirusCytomegalovirus HerpesHerpes
TeratogenTeratogen
““toxic” agents that cause toxic” agents that cause deficits/malformations in the fetusdeficits/malformations in the fetus
AAgent that can produce a permanent alteration of structure or function in an organism exposed during embyronic or fetal life.
Nature of the agentNature of the agent
Factors That Influence Factors That Influence TeratogenicityTeratogenicity
Dose Route Frequency of exposure Duration of exposure
Gestational timingGestational timing
Factors That Influence Factors That Influence TeratogenicityTeratogenicity
Concurrent exposures Concurrent illness Genetic susceptibility
– Mother– Fetus
Multifactorial42%
Unknown37% Chromosomal
3%
Monogenic8%
Teratogens10%
Baird et al. AJHG 42:677, 1988
Birth Defects in Childhood
AlcoholAlcohol
Fetal Alcohol Syndrome (FAS)Fetal Alcohol Syndrome (FAS)– confirmed maternal drinking during confirmed maternal drinking during
pregnancypregnancy– pattern of facial featurespattern of facial features– growth retardationgrowth retardation– evidence of CNS disturbanceevidence of CNS disturbance
Fetal Alcohol Effect (FAE)Fetal Alcohol Effect (FAE)
CigarettesCigarettes
Low birth weightLow birth weight CNS deficits - LD, AttentionCNS deficits - LD, Attention SIDSSIDS Respiratory problemsRespiratory problems Increased risk for cancerIncreased risk for cancer
CocaineCocaine
No addictionNo addiction Crack baby mythCrack baby myth PrematurityPrematurity Growth retardation - SGAGrowth retardation - SGA Poorer reflexesPoorer reflexes
Other TeratogensOther Teratogens
Radiation - genetic mutations, Radiation - genetic mutations, malformed organsmalformed organs
Aspirin - enamel defectsAspirin - enamel defects
Other TeratogensOther Teratogens
RubellaRubella Norman GreggNorman Gregg
– An Australian opthamologistAn Australian opthamologist– In early 1940s, saw many blind infantsIn early 1940s, saw many blind infants– Surveyed his colleagues in SydneySurveyed his colleagues in Sydney– Found 78 blind infants visited doctors that yearFound 78 blind infants visited doctors that year– 68 had been exposed to rubella68 had been exposed to rubella– Published 1941 paper about rubella and infant Published 1941 paper about rubella and infant
blindnessblindness
Rubella continuedRubella continued
Norman GreggNorman Gregg– 1941 paper reported widely in popular press1941 paper reported widely in popular press– When it came out, Gregg got two phone callsWhen it came out, Gregg got two phone calls– Mothers who had rubella during first trimesterMothers who had rubella during first trimester– Infants were not blind but deafInfants were not blind but deaf– Sent others to check the historical recordsSent others to check the historical records– Outbreaks of rubella had regularly been followed Outbreaks of rubella had regularly been followed
by epidemics of infant blindness and hearing by epidemics of infant blindness and hearing problemsproblems
– Thus, learned that rubella is a teratogenThus, learned that rubella is a teratogen– Today – vaccine.Today – vaccine.