TERATOGEN DESCRIPTION SOURCE OF THE EFFECTS ON MOTHER EFFECTS ON FETUS PREVENTION

TERATOGEN

Ionizing The risk of exposure to - Ionizing radiation is - Pregnancy loss -Malformation

radiation ionizing radiation radiation composed (miscarriage, stillbirth) (microcephaly - small - Spend as little time as

varies, depending on of particles, x rays, or head possible in locations with

the dose of exposure gamma rays that circumference,microphth high radiation levels.

and pregnancy carry an adequate almia - small eyes) - Keeping exposure duration

stage. The highest risk energy to free an Disturbances of growth or to a minimum decreases a

is associated with electron from an development worker's dose from the

higher doses and atom or molecule radiation source.

exposure in the first resulting in - Mutagenic and

- Increase your distance
trimester. electrically charged carcinogenic effects
from the radiation source(s).
ions in matter
The radiation dose of a
- Mental Retardation
worker reduces as the
worker's distance from the
source rises. The intensity of
gamma and X-ray radiation
is inversely proportional to
the square of the distance
from the source.

- Increasing the distance by

a factor of two reduces the
dosage rate by four.
 - Use shielding for radiation
sources (putting a suitable
shield between the
radiation source(s) and
employees). Inserting
appropriate shielding (e.g.,
lead, concrete, or specific
plastic guards, depending
on the kind of radiation)
between a worker and a
radiation source would
considerably reduce or
eliminate the worker's
exposure.

Hyperthermia Hyperthermia is a - Long exposure to -Hirschsprung - Hyperthermia causes - Hot tubs or sauna use
proven teratogen hot temperatures on disease—aganglionosi central nervous system during pregnancy shall be
causing severe hot days (often s of the narrowed part malformations limited.
malformations, described at 86oF of the distal colon,
embryonic death (30oC) or higher) can which could be - Microcephaly - Staying in cool areas to
and growth cause hyperthermia caused by the prevent overheating during
retardation in . defective migration of - Abdominal wall defects pregnancy.
humans. - Extremely heavy ganglion cells along
exercise or the intestine—has - Eye defects - Try limiting activities that
prolonged exposure shown a significant would raise core
(longer than 10 relationship to a - Palate defects temperature above 39C
minutes) to heat history of degrees.
 sources such as hot hyperthermia in the - Limb reduction defects - Take steps on trying not to
tubs, very hot baths, mother during the first get sick or have an
or saunas can also trimester - Embryonic death infection for this can
raise body possibly raise core
temperature to 102 -Maternal - Growth retardation temperature.
degrees fahrenheit or hyperthermia
higher interferes with neural - Neural tube defects
crest migration, and skeletal defects
leading to embryonic
death due to heart
failure

Teratogen - It is any substance that can harm the fetus. Or any agent that causes an abnormality following fetal exposure
during pregnancy.
A teratogenic agent is defined by its potentiality and capability to increase the frequency of one or several malformations, such as
cardiomyopathy with lithium, a drug for bipolar disorder (Fornaro et al., 2020) and skeletal and face damage with vitamin K
antagonists, common anticoagulant drugs (Dhillon et al., 2018).
Teratogens can be found at home and even in one's workplace, the effect is related to type of agent, dose, duration and time of
exposure.

During this early time of organogenesis (organ formation), the growing structure is most vulnerable to invasion by
teratogens (i.e., any factor that affects the fertilized ovum, embryo, or fetus adversely, such as a teratogenic medicine;
an infection such as toxoplasmosis; cigarette smoking; or alcohol ingestion)
A teratogen is a substance that may lead to birth defects in an embryo or fetus. During pregnancy, exposure to certain
chemicals, infections, and drugs may increase the risk that a person will miscarry or that the embryo or fetus could have a
developmental abnormality.

Physical agents - this includes Radiation and Heat that can lead to Hyperthermia.

List of teratogens for the type assigned:

Teratogens Physical Agents

a. ionizing radiation
b. hyperthermia

Description for each:

A. Ionizing Radiation
- The risk of exposure to ionizing radiation varies, depending on the dose of exposure and pregnancy stage. The highest risk is
associated with higher doses and exposure in the first trimester.
- Women exposed to radiation in sufficient doses will have an increased risk of abnormal pregnancy and infertility (Lione, 2019)
- Ionizing radiation represents a possible teratogen for the fetus, but this risk has been found to be dependent on the dosage
and the effects correlatable to the gestational age at exposure. Recently, of particular note is the fact that maternal thyroid
exposure to diagnostic radiation has been associated with a slight reduction in the birth weight. Inadvertent exposure from
diagnostic procedures in pregnancy doesn’t usually increase the natural risk of congenital anomalies but creates a
considerable state of maternal anxiety. Diagnostic radiological procedures should be avoided in pregnant women unless the
information cannot be obtained by other techniques (De Santis et al., 2005).
- By producing free radicals, ionizing radiation causes cellular damage by interfering with chemical bonds between molecules
regulating critical cellular processes and events. This process generally leads to DNA mutation or cell death and sometimes
causes damage to essential cellular enzymes. Susceptibility to radiation injury depends on the rate of cellular proliferation and
 differentiation of exposed tissues. Hence lymphoproliferative tissues with rapid cell turnover are the most susceptible, while
nervous tissue with little or no cell turnover is the least affected.

Sources:
- ionizing radiation is radiation composed of particles, x rays, or gamma rays that carry an adequate energy to free an electron
from an atom or molecule resulting in electrically charged ions in matter

Effects on mother:
Significant potential harmful effects of ionizing radiation can be summarized into four main categories (De Jesus & Kumar, 2023):
- Pregnancy loss (miscarriage, stillbirth)
Effects on fetus:
- Malformation (microcephaly - small head circumference, microphthalmia - small eyes)
- Disturbances of growth or development
- Mutagenic and carcinogenic effects
- Mental Retardation

Prevention:

1. Spend as little time as possible in locations with high radiation levels. Keeping exposure duration to a minimum decreases a
worker's dose from the radiation source.
2. Increase your distance from the radiation source(s). The radiation dose of a worker reduces as the worker's distance from the
source rises. The intensity of gamma and X-ray radiation is inversely proportional to the square of the distance from the
source. Increasing the distance by a factor of two reduces the dosage rate by four.
3. Use shielding for radiation sources (putting a suitable shield between the radiation source(s) and employees). Inserting
appropriate shielding (e.g., lead, concrete, or specific plastic guards, depending on the kind of radiation) between a worker
and a radiation source would considerably reduce or eliminate the worker's exposure.

B. Hyperthermia
- Hyperthermia is a proven teratogen causing severe malformations, embryonic death and growth retardation in humans.
- Hyperthermia interferes with protein synthesis via heat-shock proteins, which can entail membrane disruption, cell death,
vascular disruption, and placental infarction. All these mechanisms can induce severe fetal malformations or death. The
mechanism by which heat shock causes cell damage is not precisely known; however, the effects of heat shock on embryo
 development are probably closely associated with the generation of reactive oxygen species (ROS) and subsequent oxidative
stress
- Furthermore, direct heat shock can increase reactive oxygen species production in bovine embryos, especially in the earlier
stages, and that the generation of reactive oxygen species affects embryonic development. The response of a cell to
oxidative stress can be very different, ranging from the stimulation of cell proliferation to growth arrest or to cell death by
apoptosis or necrosis.The particular outcome observed can vary significantly, depending on cell type, the agent examined, its
dosage and/or the duration of treatment.

Sources:
- Long exposure to hot temperatures on hot days (often described at 86oF (30oC) or higher) can cause hyperthermia.
- Extremely heavy exercise or prolonged exposure (longer than 10 minutes) to heat sources such as hot tubs, very hot baths,
or saunas can also raise body temperature to 102 degrees fahrenheit or higher

Effects on mother:
- Hirschsprung disease—aganglionosis of the narrowed part of the distal colon, which could be caused by the defective
migration of ganglion cells along the intestine—has shown a significant relationship to a history of hyperthermia in the mother
during the first trimester
- maternal hyperthermia interferes with neural crest migration, leading to embryonic death due to heart failure

Effects on fetus:
- hyperthermia causes central nervous system malformations
- microcephaly
- abdominal wall defects
- eye defects
- palate defects
- limb reduction defects
- embryonic death
- growth retardation
- neural tube defects and skeletal defects
Prevention:
1. Hot tubs or sauna use during pregnancy shall be limited.
2. Staying in cool areas to prevent overheating during pregnancy.
3. Try limiting activities that would raise core temperature above 39C degrees.
4. Take steps on trying not to get sick or have an infection for this can possibly raise core temperature.

References:

De Santis, M., Di Gianantonio, E., Straface, G., Cavaliere, A. F., Caruso, A., Schiavon, F., Berletti, R., & Clementi, M. (2005). Ionizing

radiations in pregnancy and teratogenesis. Reproductive Toxicology, 20(3), 323–329.

https://doi.org/10.1016/j.reprotox.2005.04.004

Genetic Alliance. (2010, February 17). Teratogens/Prenatal substance abuse. Understanding Genetics - NCBI Bookshelf.

https://www.ncbi.nlm.nih.gov/books/NBK132140/

Karch, A. M. (2017). Focus on nursing pharmacology. Seventh edition. Philadelphia, Wolters Kluwer.

Krausova, T., & Peterka, M. (2007). Teratogenic and lethal effects of 2–24h hyperthermia episodes on chick embryos. Journal of

Thermal Biology. https://doi.org/10.1016/j.jtherbio.2006.12.003

Kumar, R., & De Jesus, O. (2023, February 12). Radiation Effects On The Fetus. StatPearls - NCBI Bookshelf.

https://www.ncbi.nlm.nih.gov/books/NBK564358/
Sass, L., Urhoj, S. K., Kjærgaard, J., Dreier, J. W., Strandberg-Larsen, K., & Andersen, A. N. (2017). Fever in pregnancy and the risk

of congenital malformations: a cohort study. BMC Pregnancy and Childbirth, 17(1). https://doi.org/10.1186/s12884-017-1585-0

Tantibanchachai, C. (2014). Teratogens | The Embryo Project Encyclopedia. https://embryo.asu.edu/pages/teratogens

Valeii, K. (2021). A substance that leads to Birth Defects. Verywell health.

https://www.verywellhealth.com/teratogens-5118058#:~:text=Physical%20Agents&text=Radiation%20exposure%20and%20h

eat%20are%20both%20considered%20physical%20teratogens.&text=Hyperthermia%20(abnormally%20high%20body%20te

mperature,%2C%20hot%20tubs%2C%20and%20saunas.

U.S. Environmental Protection Agency (EPA). (2014). Publication No. EPA-402-R-10003, Federal Guidance Report #14, Radiation

Protection Guidance for Diagnostic and Interventional X-Ray Procedures. Washington, DC: EPA; National Council on

Radiation Protection and Measurements (NCRP). (2004). Report No. 147: Structural shielding design for medical x-ray

imaging facilities. Bethesda, MD: NCRP