teratogens + TORCH

Toxoplasmosis effects on mom

• most are asymptomatic

• similar to mononucleosis

• immune after first episode (unless immunocompromised )

Toxoplasmosis effects on fetus

• congenital infections likely to develop in 3rd trimester

• risk of fetal injury is greatest when occurs in 1st trimester

• microcephaly

• hydrocephaly

• cerebral calcification

• preterm

• cognitive impairment

• micropthalmia - small eyes

Toxoplasmosis teaching

• handwashing

• avoid raw meat

• avoid cat litter

Hepatitis A effects on mom

• liver failure (very rare)

• fever s/s, RUQ pain, jaundice, light colored stools

Hepatitis A teaching

• spread fecal-oral

• vaccination available

Hepatitis B effects on mom

• 10% of infected will be chronic carriers

• may develop severe chronic liver disease

Hepatitis B effects on baby

• infection during birth

Hepatitis B teaching

• transmitted sexually and orally

• transmitted via needled / blood

• vaccine has no risk on fetus when given while pregnant

Rubella effects on mom

• rash

• fever s/s

• myalgias and arthralgia

• swollen lymph nodes

• conjunctivitis

Rubella effects on baby

• 50-80% of exposed fetus will show s/s of congenital infection in @ 12wks

• not likely to be affected if infected after 18 wks gestation

• may cause deafness, eye defects, IUGR and cardiac defects

Rubella teaching

• NO vaccine while pregnant , only early postpartum

• pregnancy should be avoided 1 month after vaccine

• you may breastfeed with the vaccine

cytomegalovirus effects on mom

• usually asymptomatic / mild flu like symptoms

cytomegalovirus effects on baby

• hepatosplenomegaly (enlargement of liver and spleen)

• intracranial calcification

• jaundice

• IUGR

• microcephaly

• chorioretinitis

• hearing loss

• thrombocytopenia

• hyperbilluribinemia

• heptatitis

cytomegalovirus teaching

• herpes virurs

• transmitted sexually, via blood, placenta, or bodily fluids virus may be reactivated in utero or during birth

• prevention: use CMV-negative blood products in pregnant women

• careful handwashing after handing diapers and toys

HSV effects on mom

• blisters

• tender inguinal lymph nodes

• fever

• rare- viral meningitis

HSV effects on baby

• deadly systemic infection

• usually rare

• higher risk if infected in late pregnancy

HSV teaching

• 2/3 of women are asymptomatic but baby still at risk

• greater risk if lesions are present during vaginal birth

• acyclovir should be used as suppressive therapy during labor

syphillis effects on fetus

• dental anomalies

• deafness

• cognitive impairment

• skin and bone lesions

• meningitis

zika effects on fetus

• microcephaly

• intracerebral calcifications

• ventriculomegaly (fluid filled ventricles)

alcohol

• Growth restriction,

• cognitive impairment,

• microcephaly,

• various malformations of face and trunk

anticoagulant

• Skeletal abnormalities;

• broad hands with short fingers;

• nasal hypoplasia;

• anomalies of eye, neck, central nervous system

lead

Cognitive impairment, hearing deficits, growth restriction

mercury

• Cognitive impairment,

• cerebral atrophy,

• spasticity,

• blindness

isotretinoin/ Accutane

• Craniofacial defects,

• cleft palate,

• ear and eye deformities,

• nervous system defects

Valproic acid

neural tube defect

Trimethadione and paramethadione

• cleft lip and palate,

• microcephaly,

• eye defects,

• cardiac defects,

• cognitive impairment

Thalidomide

Limb defects, ear defects, cardiovascular anomalies

lead

heart defects

cocaine

• Cardiac and central nervous system anomalies,

• growth restriction