Influences on Prenatal

Development: General Risk

Factors and Teratogens
General Risk Factors Overview
Three general risk factors affect prenatal development:
nutrition, stress, and mother's age
Called "general" because they have widespread effects on
development, not limited to one organ or system

Nutrition
Importance of Maternal Nutrition
Mother is the sole source of nutrition for the developing child
Pregnant women need about 10-20% more calories than usual
Balanced diet including all five major food groups is essential
Health care providers often recommend vitamin/mineral
supplements

Key Nutrients and Their Roles

Folic Acid

Found in: green leafy vegetables

Essential for: proper neural tube and spinal cord development
Deficiency leads to: spina bifida
Iron

Found in: beef, chicken, beans, spinach, tofu

Essential for: making additional hemoglobin to carry oxygen to
body cells
Calcium

Found in: milk, yogurt, cheese

Essential for: strong teeth and bones, healthy heart, muscles,
and nerves

Spina Bifida
Disorder where embryo's neural tube does not close properly
during first month of pregnancy
Results in permanent damage to spinal cord and nervous system
Many affected children require crutches, braces, or wheelchairs

Stress
Definition
Chronic stress = ongoing physical and psychological responses
to threatening or challenging situations

Effects of Maternal Stress

Pregnancy Outcomes

Higher anxiety during pregnancy linked to:

More preterm births
Lower birth weight babies
Child Development Outcomes

Children of anxious mothers show:

Poorer attention abilities
More behavioral problems in preschool years
Disaster Studies

Pregnant women exposed to disasters (e.g., September 11, 2001

attacks) had children with affected:
Physical development
Cognitive development
Language development
Specificity of Stress Effects
Harmful effects are specific to pregnancy-related worries
Most critical during first few months of pregnancy
Not related to general anxiety

Mechanisms of Harm
Four pathways by which stress damages prenatal development:

1. Hormonal pathway: Stress hormones reduce oxygen flow to

fetus and increase fetal heart rate and activity level
2. Immune system: Stress weakens maternal immune system,
making mother more susceptible to illnesses that can harm fetal
development
3. Behavioral pathway: Stressed pregnant women more likely to:
Smoke
Drink alcohol
Neglect rest and exercise
Eat poorly
4. Epigenetic changes: Stress may alter genes that help children
regulate their behavior

Important Qualification
Effects described apply to prolonged, extreme stress
Occasional, mild anxiety is not considered harmful to prenatal
development

Mother's Age
Teenage Mothers (Under 20)
Physical Risks

Greater risk of preterm birth

Greater risk of low birth weight babies
Main Contributing Factors

More likely to live in poverty

 Often lack good prenatal care
Child Outcomes

Children generally do less well in school

More behavioral problems
As adolescents, more likely to be convicted of crimes
Protective Factor

Better outcomes when teenage mother lives with a relative

(typically grandmother)
Reality

"Happy endings" are exceptions

Most teenage mothers and children face ongoing struggles
Challenges increasing with reduced social safety nets and
greater stigma

Older Mothers (30+)

Modern Trends

American women waiting longer to have first child

Birth rate among 40-44 year-olds at highest since 1960s
Fertility Issues

Women in their 20s are twice as fertile as women in their 30s

After 35, risks of miscarriage and stillbirth increase rapidly
Pregnancy Risks (40-45 Age Group)

Much more likely to result in miscarriage

Higher risk of low birth weight babies
Higher risk of babies with Down syndrome
Positive Aspects

As caregivers, older mothers are just as sensitive and

responsive as younger mothers
Optimal Age Range
Prenatal development most likely to proceed normally when
mothers are 20-35 years old
Combined with: good health, proper nutrition, good health care,
and freedom from chronic stress

Teratogens: Definition and Categories

Definition
Teratogen: any agent that causes abnormal prenatal
development or birth defects

Historical Context
Thalidomide disaster (late 1950s Germany):
Drug given to pregnant women to help them sleep
Over 7,000 babies worldwide born with deformed arms,
legs, hands, or fingers
Led to extensive scientific study of teratogens

Three Major Categories

1. Drugs
2. Diseases
3. Environmental hazards

Teratogenic Drugs
Common Teratogenic Drugs and Their Effects
Alcohol

Fetal alcohol syndrome (FAS)

Cognitive deficits
Heart damage
Retarded growth
Aspirin
 Deficits in intelligence
Attention problems
Motor skill deficits
Caffeine

Lower birth weight

Decreased muscle tone
Cocaine and Heroin

Retarded growth
Irritability in newborns
Marijuana

Lower birth weight

Less motor control
Nicotine (Cigarette Smoking)

Retarded growth
Possible cognitive impairments

Cigarette Smoking in Detail

Mechanism of Harm

Nicotine constricts blood vessels

Reduces oxygen and nutrients reaching fetus through placenta
Outcomes

Increased risk of miscarriage (spontaneous abortion)

Babies smaller than average at birth
Dose-Response

Effects depend on degree of exposure

Heavy smoking more harmful than moderate smoking
Genetic Factors
 Some children inherit genes more effective at defending against
tobacco toxins in utero
Secondhand Smoke

Harmful even when pregnant woman doesn't smoke

Effects: smaller babies, premature birth, risk of birth defects
(cleft palate, spina bifida)
Risks reduced when smoking banned in public places and
workplaces

Alcohol and Fetal Alcohol Spectrum Disorder (FASD)

Fetal Alcohol Syndrome (FAS)

Most extreme form of FASD

Most likely in heavy drinkers (e.g., 15+ cans of beer over a
weekend)
Physical Characteristics

Slower than normal growth

Heart problems
Misshapen faces:
Small head
Thin upper lip
Short nose
Widely spaced eyes
Developmental Impact

Leading cause of developmental disabilities in United States

Serious attentional problems
Cognitive problems
Behavioral problems
Safe Drinking Levels

No proven "safe" amount of drinking during pregnancy

Safe level likely varies by individual (health and heredity)
Best policy: avoid all alcohol during pregnancy
General Drug Safety Principle
Impossible to guarantee safe levels for all women
Individual variation in susceptibility
Recommendation: avoid all drugs during pregnancy

Teratogenic Diseases
Transmission Routes
Diseases that Cross Placenta

Attack embryo or fetus directly

Examples: cytomegalovirus, rubella, syphilis
Diseases that Attack During Birth

Virus present in birth canal lining

Baby infected passing through canal
Examples: AIDS, genital herpes

Specific Diseases and Their Effects

AIDS

Frequent infections
Neurological disorders
Death
Chlamydia

Premature birth
Low birth weight
Eye inflammation
Chicken Pox (Varicella)

Spontaneous abortion
Developmental delays
Intellectual disability
Cytomegalovirus (CMV)
 Deafness
Blindness
Abnormally small head
Intellectual disability
Genital Herpes

Encephalitis
Enlarged spleen
Improper blood clotting
Rubella (German Measles)

Intellectual disability
Damage to eyes
Damage to ears
Damage to heart
Syphilis

Damage to central nervous system

Damage to teeth
Damage to bones
Toxoplasmosis

Damage to eyes and brain

Learning disabilities

Prevention
Only way to guarantee no harm: not contract disease before
or during pregnancy
Medicines that treat mother after illness do not prevent fetal
damage

Environmental Hazards
Common Environmental Teratogens
Air Pollution

Low birth weight

Premature birth
Lower test scores later in life
Lead

Intellectual disability
Mercury

Retarded growth
Intellectual disability
Cerebral palsy
Polychlorinated Biphenyls (PCBs)

Impaired memory skills

Impaired verbal skills
X-rays

Retarded growth
Leukemia
Intellectual disability

PCBs in Detail
Background

Used in electrical transformers and paints until banned in 1970s

Seeped into waterways, contaminating fish and wildlife
Mechanism of Harm

Amount in contaminated fish doesn't affect adults

When pregnant women ate large numbers of PCB-contaminated
fish:
Children's cognitive skills impaired
Reading achievement impaired
Air Pollution Research
Natural Experiment (Electronic Toll Collection)

When electronic toll collection installed at highway plazas:

Air pollution dropped substantially (no idling/acceleration)
10% drop in prematurity among nearby pregnant women
10% drop in low birth weight among nearby pregnant
women

Cell Phones
Current Evidence

Inconsistent findings
Some studies: greater risk for behavioral problems in children of
frequent users
Other studies: no harm associated with cell phone use during
pregnancy
Recommendations

Keep cell phone at distance when not in use

Never use while driving (increases accident risk by >50%)

Danger of Environmental Teratogens

Why They're "Treacherous"

People unaware of their presence in environment

Invisibility makes protection difficult
Safety Recommendations for Pregnant Women

1. Food safety:
Clean all foods thoroughly to remove insecticides
Avoid convenience foods (often contain chemical additives)
2. Air quality:
Avoid air contaminated by household products (cleansers,
paint strippers, fertilizers)
3. Occupational exposure:
 Women in jobs with potential teratogen contact
(housecleaners, hairdressers) should:
Switch to less potent chemicals (e.g., baking soda
instead of chemical cleansers)
Wear protective gloves, aprons, and masks
4. Stay informed:
Check with health care provider about other materials to
avoid
Environmental teratogens continue to increase

Five General Principles of Teratogenic

Effects
Principle 1: Genotype Dependence
The impact of a teratogen depends on the genotype of the
organism

Same substance may be harmful to one species but not another

Example: Thalidomide
Tested on pregnant rats and rabbits: offspring had normal
limbs
Given to pregnant women at comparable doses: many
babies had deformed limbs
Individual variation within species:
Some women taking thalidomide: babies with normal limbs
Other women taking same dose at same time: babies with
deformed limbs
Heredity makes some individuals more susceptible to teratogens
than others

Principle 2: Timing of Exposure

The impact of teratogens changes over the course of prenatal
development

Period of the Zygote

Exposure usually results in: spontaneous abortion of fertilized

egg
Period of the Embryo

Exposure produces: major defects in bodily structure

Examples:
Thalidomide: ill-formed or missing limbs
Rubella: heart defects
Period of the Fetus

Exposure produces:
Minor defects in bodily structure, OR
Body systems functioning improperly
Example: alcohol consumption leads to fewer brain cells
Critical/Sensitive Periods Within Each Period

Each body part/system has time of maximum vulnerability

Example: Heart
Most sensitive during first half of embryonic period
Exposure before this time: rarely produces heart damage
Exposure after this time: relatively mild damage

Principle 3: Specificity of Effect

Each teratogen affects specific aspect(s) of prenatal development

Teratogens do not harm all body systems

Damage is selective
Examples

Rubella: problems with eyes, ears, and heart; normal limbs

PCB-contaminated fish: normal body parts and motor skills;
below-average verbal and memory skills

Principle 4: Dose-Response Relationship

The impact of teratogens depends on the dose

Small doses may not harm fetus

Greater exposure = greater risk for damage

Example: PCBs
 Cognitive skills affected only in children with greatest prenatal
exposure
Implications

In theory: researchers should be able to determine "safe levels"

In practice: extremely difficult because:
Sensitivity to teratogens varies between individuals
Not practical to establish safe amounts for each person
Safest Rule: Zero exposure to teratogens

Principle 5: Delayed Effects

Damage from teratogens not always evident at birth but may
appear later in life

Immediate Effects

Malformed limbs: obvious at birth

Delayed Effects

Damage becomes evident as child develops

Example 1: PCBs

Babies normal at birth

Below-average cognitive skills not evident until several months
later
Example 2: Diethylstilbestrol (DES)

Used 1947-1971 to prevent miscarriages

Babies appeared normal at birth
Effects in daughters (as adults):
Higher risk of breast cancer
Rare cancer of vagina
Reproductive tract abnormalities making pregnancy
difficult
Effects in sons:
Risk for testicular abnormalities
Risk for testicular cancer
 Impact not evident until decades after birth

The Real World of Prenatal Risk

Multiple Risk Factors Co-occur
Infants sometimes exposed to multiple general risks AND
multiple teratogens simultaneously
Risk factors rarely occur in isolation

Common Clustering Patterns

Substance Use Clustering

Pregnant women who drink alcohol often:

Also smoke
Also drink coffee
Stress and Self-Medication

Pregnant women under stress often:

Drink alcohol
Self-medicate with aspirin or other over-the-counter drugs
Poverty Connection

Many women with substance use issues also:

Live in poverty
Have inadequate nutrition
Receive minimal medical care during pregnancy

Combined Impact
When all risks are combined: prenatal development rarely
optimal
Multiple interacting risks create compounded harm
This pattern explains challenges in studying human
developmental outcomes
Summary
Optimal Conditions for Prenatal Development
Mother's Characteristics

Age: 20-35 years

Good health
Proper nutrition
Good health care access
Life free from chronic stress

Key Prevention Strategies

1. Nutrition: Adequate intake of folic acid, iron, and calcium
2. Stress management: Avoid prolonged, extreme stress
3. Age considerations: Recognize risks at both ends of spectrum
4. Avoid teratogens: Zero exposure policy for drugs, diseases,
environmental hazards
5. Prenatal care: Regular medical checkups and monitoring
6. Environmental awareness: Vigilance about hidden
environmental hazards

Understanding Risk
Teratogenic effects depend on: genotype, timing, specificity, dose,
and may be delayed
Real-world risks are typically multiple and interacting
Prevention requires comprehensive approach addressing all risk
factors