Brenda Debus and Lori Wolfe are teratogen counselors at the Texas Teratogen Information Service/Pregnancy Riskline in Denton, Texas. Brenda Debus has a master’s degree in Counseling Psychology, and Lori Wolfe has a master’s degree in Genetic Counseling and has been the Director of the teratogen service for 17 years. They conduct free phone counseling for women and their health-care providers with questions about exposures related to their pregnancies and breastfeeding. They have prepared this basic guide on Teratogens for readers of MetroplexBaby.com.

What is a “teratogen”?

A “teratogen” is any exposure that can cause harm to an unborn or breastfeeding baby. Teratogens can be alcohol, prescription/non-prescription medications, illegal drugs, vaccines, illnesses, environmental exposures, occupational exposures, or maternal autoimmune disorders.

What is my risk of having a baby born with a birth defect?

Every woman has a 3-5% risk of having a baby born with a birth defect. Some teratogens will increase that risk, depending upon when in the pregnancy a woman has the exposure, the dose of the exposure, and the route of exposure.

What are the chances that I will miscarry during my pregnancy?

We know that 25% of all recognized pregnancies end in miscarriage. The risk of a miscarriage drops to 10% in your eighth week. Some teratogens will increase this risk, but it is dependent upon the type and amount of the exposure as well as the timing in the pregnancy.

Following is a list of some common exposures for which we are called:

Alcohol

Depending upon the amount of alcohol you consume, the risk of miscarriage and birth defects vary. A small to moderate amount (2-4 drinks frequently) can lead to “Fetal Alcohol Effect,” which increases the risk of miscarriage, developmental delay, and hyperactivity in the child. Heavy use of alcohol (5-6 drinks frequently) can lead to “Fetal Alcohol Syndrome,” where the risk of miscarriage is increased even more, and the baby has a small head size, facial abnormalities such as small eyes and nose, small nails, ear abnormalities, heart defects, learning difficulties, behavioral problems, and mental retardation.

Cigarette Smoking

The more a woman smokes, the higher the risk of miscarriage, stillbirth, low birth weight, premature birth, Sudden Infant Death Syndrome (SIDS), possible increase in developmental delays, a 1% risk for cleft palate (a hole in the roof of the mouth), and failure to thrive. Smoking over ˝ pack of cigarettes per day or more appears to put your pregnancy in the increased risk group. It is also important to not allow anyone to smoke around newborn or young infants.

Accutane

Accutane is retinoic acid that is given in pill form by prescription only for severe acne. This medication is extremely dangerous, as 25-38% of infants exposed in the first trimester will exhibit abnormalities: hydrocephalus (excess fluid in the brain), brain defects, mental retardation, ear/face abnormalities, heart and limb defects, and chronic skin lesions. There is also an increased risk of miscarriage.

Antibiotics

Most antibiotics are safe to take during your pregnancy, but there are exceptions. Aminoglycosides are used for severe infections and they have a 2% increased risk for hearing impairment. Tetracycline and Doxycycline can cause yellow-brown staining of the teeth when used during the 4th to 9th month of pregnancy. If this medication is used in the 3rd trimester, there can be decreased fetal bone growth. This type of antibiotic also should not be used while breastfeeding.

Antidepressants

With antidepressants, there can be a less than 1% increased risk for learning difficulties, and possibly mild to moderate but temporary withdrawal symptoms at birth (the baby may tend to be more irritable, have problems feeding, and difficulty in being soothed). There can also be premature delivery. However, we feel that usually the benefits to the mother outweigh the risks to the baby. Studies show that stress can cause a host of other problems to the baby, and post-partum depression can be worse in women who suffer from depression.

Cocaine

Using cocaine during pregnancy can increase the risk not only of miscarriage, but can also lead to premature detachment of the placenta, a low-birth-weight baby, brain damage, small head, limb abnormalities, gastro-urinary abnormalities, heart defects, and infant withdrawal.

If you have any further questions, please contact 1-800-733-4727, or visit www.ttis.unt.edu.