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Teratogenesis
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sms1371
December 19, 2012
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Teratogenesis
teratology-Teratogenesis-Birth defect-Congenital malformation- anomaly(Hereditary) abnormality
sms1371
December 19, 2012
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Transcript
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Birth defect Congenital malformation Congenital anomaly (Hereditary) abnormality
• Malformation • Disruptions • Deformations • Syndromes • Minor
anomalies • Major anomalies
1 - خساپ ( یزیذپ بیسآ ) نژًتازت لماع هب
ردام ي هیىج 2 - هیىج یلماکت هلحزم (Developmental stage at the time of exposure) 3 - نژًتازت لماع اب سامت نامس تدم ي سيد (Dose and duration of exposure to a teratogen) 4 - نژًتازت لمع هقیزط : یلًکلًم ي یلًلس حطس رد تازییغت 5 - نژًتازت هجیتو : یدزکلمع یاه یرامیب ،دشر یگدوام بقع ،یراجىهاو ،گزم
Hereditary (Genetic) causes 15-18% Environmental factors 7-10%
Multifactorial 25% Unknown 50%
First week (Resistant period) Embryonic period Maximum
susceptibility (organ morphogenesis) Fetal Period Lowered Susceptibility (functional derangement)
• 1 - تالالتخا موزومورك يدادعت ( Numerical Chromosomal Anomalies
) • فلا ) يلپ یديئولپ ( Polyploidy ) Triploidy 69 کي اب ديئولپيد کمخت اي مرپسا ود اب ديئولپاه كمخت كي مرپسا Tetraploidy 92 ژاويلك نيلوا • ب ) یديئولپونآ ( Aneuploidy ) یموزيرت يموزيرت 13 (Patau syndrome) یموزيرت 18 ( Edwards syndrome ) یموزیرت 21 مردنس نواد ( Down syndrome ) رتلف نیالك مردنس ( Klinfelter syndrome-XXY ) Triple X (Superfemale) یمزونوم رنرت مردنس ( Turner syndrome- XO )
Patau Syndrome 1/20000 cleft-lip-baby
Edwards Syndrome 1/5000
Maternal nondisjunction (95%) Mosaism Translocation
•Monosomy •Nondisjunction in sperm 80% •Struc X •Nondisjunction in mitosis
(Mosaism)
• 2 - موزومورك ينامتخاس ياه يراجنهان • ( Structural
Chromosomal Anomalies ) • Isochromosome • Crossing over : • Translocation 21,13,14, 15 in Down syndrome • Partial Deletion Cri du chat 5(microcephal, mental, cardiovas) • Microdeletion Angelman 15 (speech, mental, movement) Prader- willi 15 (fatty, mental, hypogonad) • Inversion
• 3 - ياه يراجنهان ينژ شهج زا لصاح (
Gene Mutation Anomalies ) • Marphan syndrome • Crigler-Najjar syndrome • Roberts syndrome • Alport syndrome • Aarskog-Scott syndrome • Savant syndrome • treacher-collins syndrome • Niemann–Pick disease • Cystic Fibrosis • DMD
• Infectious Agents (& other disease) • Drugs Agents (&
Hormonic Agents) • Chemical Agents • Physical Agents
• A) Viral infections • Rubella virus (German Measles) هجخرس
سوریو 1month-From placenta- atrioventricular septsl defect, cataract. Weight • Cytomegalovirus(CMV) From Placenta,Cervix,Vagina (& Lactation) - microephaly, deafness, mental retardation, hepatospleenomegally ,cardiac defect,cerebral calcification, blue spot on skin • Herpes simplex virus(HSV) From Placenta,Vagina(85%)- Defect in CNS,liver, pancreas,ren,suprarenal glands, infection on skin, Eyes or mouth – no treatment=40-50% death • Varicella-zoster virus(VZV) ناغرم هلبآ First 3 month-From Placenta- limb hypoplasia & parasis., hydrocephaly. Mental retardation, cataract • HIV After 35th week- Systematic Chronic infection(fangus,bacterial,viral,protozoan)
• B) Nonviral infections •Toxoplasma in each three munth -
death,microcephaly,hydroceohaly,cerebral calcification •Treponema pallidum Syphilis, rhinitis,eye defect(cataract),icterus,abnormal teeth, splenohepatomegaly
• Desease •Diabetes Coudal disgenesis, death •PKU mental retardation, microcephaly,
cardiac defect • Nutrient deficiency Iodine deficiency coused cretinism • Obesity ONTD, cardiac defect, … • Hypoxy
Drugs Agents Category X drugs Category D drugs
Category X drugs Thalidomide Aminopterin methotrexate
Busulfan Phenytoin Triazolam Warfarin Isotretinoin Clomiphen Diethylstilbestrol Ethisterone Norethindrone Nicotine Alcohol
Category X drugs Thalidomide
Category X drugs Thalidomide
Category X drugs Aminopterin Methotrexate Busulfan Used in chemotererapy
Dawerfism Myelomeningocele palate clef Growth retardation ophtalmic defect
Category X drugs Aminopterin Methotrexate Busulfan Used in chemotererapy
Dawerfism Myelomeningocele palate clef Growth retardation ophtalmic defect
Category X drugs Phenytoin Antileptic drug microcephaly Growth & mental
retardation palate clef Finger & nail Hypoplesia Skull defect
Category X drugs Warfarin Anti couagulant drug Mental retardation
microcephaly optic n. atrophy Fetal bleeding
Category X drugs Clomiphen Non-steroidal drug Used for stimulus ovulation
Maybe Malformatin
Category X drugs Retinoids (vitamin A) Used for Cystic akne
severe craniofacial defects cardiac defects neural tube defects (NTD) Palate cleft tretinoin (Retin-A) isotretinoin, 13-cis-retinoic acid
Category X drugs Nicotine Mental retardation Wheight loss
Fetal Hypoxy Premature Parturition
Category X drugs Alcohol Fetal Alcholic Syndrome (FAS)
Mental retardation microcephaly Cardivascular defect Limb & Face malformation Hairsutism
Category D drugs Tetracycline doxycycline Streptomycin
Phenobarbital Pentobarbital Valsuroic acid Diazepam lorazepam Lithium Hydrochlorothiazide
Category D drugs Phenobarbital & Pentobarbital paliative drug
Fetal malformation
Category D drugs Diazepam, Lorazepam , Chlorodiazepoxide antianxiety drug
palate & lip clef specially in first 3 munth
Category D drugs Lithium ,Phenothiazine Antiedepressive CardioVascular defect
None
Physical Agents
Male-mediated Teratogenesis Chromosomal defects & Mutation in germ cells
Environmental agent : transmission of paternal mediated toxicity through seminal fluid
Ultrasonography Maternal Serum Screening (AFP,hCG) AFP : Trisomy
NTD,GIT atresia,amniotic band Amniocentesis Chorionic Villus Sampling (CVS)
Fetal Transfusion Fetal Medical Treatment Fetal Surgery
Stem Cell Transplantation and Gene Therapy Befor 18th week (activation of immune system)
None
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