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Running head: Teratogenic Exposure

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Teratogenic Exposure: A Case Study

Of the Effects on a Developing Fetus

Aleksandr Babchanik, Heather Hill, and Madeleine Mathews

American River College

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Abstract

The purpose of this case study is to discuss specific agents that could potentially cause a

birth defect or negatively alter cognitive and behavioral development of an unborn child or fetus,

known as a teratogen (Santrock, 2010, p. 73). We examined the exposure of one test participant

during the first fifty-six days of her unknown pregnancy. Data was collected from the participant

through a journal kept of all foods, prescribed drugs, non-prescribed drugs, and physical activity.

We focused our attention on three specific teratogens. These agents include the prescription drug

Maxalt, caffeine, and social alcohol use. Many experts believe that the first eight weeks of fetal

development are the time of greatest risk to a developing fetus (Garvey, 2012), even though

exposure of a teratogen to a fetus at any time during pregnancy may be detrimental to its healthy

maturation.

Keywords: Teratogen, caffeine, Maxalt

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Teratogenic Exposure: A Case Study

Of the Effects on a Developing Fetus

Teratogens, as described above, are agents that can potentially cause a birth defect or

even alter cognitive and behavioral development of a fetus (Santrock, 2010). Teratogens can be

found everywhere in day-to-day life. They include stress; alcohol consumption; environmental

exposures; smoke, including second hand smoke; and prescriptions, as well as over the counter

(OTC) medications, just to name a few. The effects of teratogens can range from pre-term birth

to miscarriage. With all of these dangers lurking around every corner, it is remarkable that babies

are ever carried full term and are born healthy.

During the fifty-six day period prior her knowledge of an active pregnancy the participant

in our study had limited exposure to the prescription drug Maxalt, a drug consumed to treat

migraine headaches. Though this drug has not been formally studied for teratogenic effects in

humans, Maxalt has been designated as a class C drug for pregnancy (Pregnancy Category,

2010). Class C drugs are medications that are not prohibited during pregnancy but come with a

strict warning. When rats were experimented, the results showed the effects to include an

increased mortality rate of the rat offspring within three days of birth, decreased birth weights,

decreased pre and post-weaning weight gain, and decreased learning capacity (Maxalt Manual,

2011). It is important to note that the negative effects of Maxalt were found with 100 to 250

mg/kg/day with the usual dosing to be no more than 30 mg in a twenty-four hour period

regardless of weight (Merck circulars 2011). It is recommended that the participant of the

Maxalt study should discuss the potential extended use of this medication for the remainder of

the pregnancy with her physician.

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Caffeine was another teratogen that was consumed during the fifty-six days of our

participant’s unknown pregnancy. Caffeine is something that we innocently ingest almost every

day of our lives. In fact, on average most adults consume about 3 to 5 cups of it every day. Our

participant, like most adults, consumed the average amount that most adults do. However, as

innocent as the consumption of caffeine may seem, it is considered the most used drug

worldwide. In 1980, the Food and Drug Administration (FDA) cautioned women against the

consumption of caffeine during pregnancy. These warnings were due to previous animal testing.

Though caffeine does not have major effects on the child after birth, it can, however, cause low

birth weight and/or miscarriage. Caffeine can also cause an increase in heart rate of the child in

the uterus which can cause abnormal reflexes and other complications during birth. Lastly,

caffeine can heighten the effects of other teratogens.

It is recommended that pregnant women

limit their caffeine intake to 200 mg or less per day the equivalent of one cup of

coffee (Caffeine in Pregnancy, 2010).

Alcohol, a dangerous teratogen to the fetus, was also consumed during our participant’s

pregnancy. Although the consumption of alcohol may seem harmless, there is no amount of

alcohol that has been proven safe during pregnancy

(U.S. Department of Health and Human

Services, 2005)

. Alcohol is absorbed from a pregnant woman’s body to the placenta and then to

the unborn baby. Because the fetus, is not yet mature enough and its metabolism slow, the

alcohol is absorbed at a larger concentration and is broken down to harmless molecules at a

slower rate (Drinking Alcohol During Pregnancy, 2008). As a result, the alcohol stays in the

fetus’ system much longer than in the mother’s, causing much more damage. The developmental

stages of an unborn child are extremely essential; alcohol, however, interferes with these

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potentially even for the rest of the child's life.

Maternal exposure to alcohol is usually the most

likely factor to leave a child permanently damaged with mental retardation, as well as other

defects involving the face, heart and other organs that are vital for life. In the United States, each

year for every 1000 births, between 0.5 and 2 cases are affected with Fetal Alcohol Syndrome

(FAS), and an additional three children are born without the physical characteristics, but inhibit

the neurobehavioral deficiencies from the exposure to alcohol at a premature age known as Fetal

Alcohol Effects (FAE) (U.S. Department of Health and Human Services, 2005). Fetal Alcohol

Syndrome (FAS) is the leading known preventable and most severe effect of alcohol

consumption, which affects the mental and physical state of a child. According to the U.S.

Surgeon General, binge drinking and drinking seven or more drinks per week poses the greatest

threat to a child being born with FAS, but studies show that women who consume even less

alcohol than seven drink per week are still at risk to give birth to children with FAS, among other

complications (U.S. Department of Health and Human Services, 2005). Unfortunately, there is

no cure for Fetal Alcohol Syndrome, therefore leaving a child who was exposed to alcohol

during the developmental stage, damaged for life. Summing up all the data that have been

provided by previous studies, the wisest choice for women, who can become pregnant or are

currently pregnant, is to refrain from drinking in order to ensure a successful pregnancy and a

healthy baby.

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Method

The case study was performed via a journal (see Appendix I), when our subject kept a

record of everything she ingested during a fifty-six day period (eight weeks). The participant did

not know she was pregnant during these eight weeks, therefore we were able to get an unfiltered

idea of her exposure. We decided to focus our attention on three specific items that had regularly

showed up in the data. These items are caffeine, alcohol consumption, and prescription drug use

of Maxalt specifically.

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Conclusion

In order to gain a complete understanding of how teratogens can potentially cause

physical or mental damage to the developing fetus, we concocted this case study in order to track

the effects that teratogens have on our unknowingly pregnant participant. During this fifty-six

day period of study, we took note of all the food, prescription and non-prescription drugs, and

physical activity. During this time, we focused our attention to three teratogens: Maxalt, caffeine,

and alcohol. There were many possible effects that these teratogens could have had on the

subject. Some of these included a higher chance of miscarriage, permanent retardation, heart

disease, decreased birth weight and more. This case study proves how important it is that women

carefully control what they consume during pregnancy, especially during the embryonic stage.

By doing so, they can be better assured to have a both mentally and physically healthy baby.

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References

Alcohol policies project. (1995). Retrieved from

Drinking alcohol during pregnancy. March of Dimes. (n.d.). Pregnancy, Baby, Prematurity,

Birth Defects | March of Dimes. Retrieved from

Garvey, A. (2012). Biological Beginnings. Retrieved from

http://www.someprofs.org/moodle/file.php/37/Slides/Ch2-TextVersion.pdf

March of Dimes Foundation (2011). Caffeine in Pregnancy. Retrieved from

Maxalt Manual (2011) Retrieved from

http://www.merck.com/product/usa/pi_circulars/m/maxalt/maxalt_pi.pdf

Neighborhood link. (2012). Retrieved from

Santrock, J.W. (2010). Biological Beginnings. A Topical Approach to Life-Span Development

5th Edition. Boston: McGraw Hill.

U.S. Surgeon General Releases Advisory On Alcohol Use In Pregnancy. (2005). Retrieved from

Wikipedia (2010) Pregnancy Category Retrieved from

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Appendix A

 

Breakfast

Lunch

Dinner

Exercise

Medications

Day 1

1

cup ½ caf

½ PB&J

Sushi

-

Pre-natal vit Vit B complex Vit D3 5000iu Allegra 180 mg Fioricet 2 tabs

coffee,

sandwich

Water

light yogurt

asperagus

banana

Water

Frozen yogurt

Day 2

1

cup ½ caf

Tuna sandwich, cheez-it crackers

Chips &Salsa,

-

Pre-natal vit Vit B complex Vit D3 5000iu Allegra 180mg Aleve 220mg 2 tab Maxalt 10mg

coffee

Tri-tip

1 fried egg

Water

Salad

1 slice dry toast

Pasta

2

glasses red

wine

Day 3

1 cup ½ caf

Popcorn

Salad

30 min

Pre-natal vit Vit B complex Vit D3 5000iu Allegra 180mg Aleve 220mg 2 tab Maxalt 10mg Docycycline 100mg twice daily

coffee

Yogurt

Water

elliptical

PB&J sandwich

Caramello

1

glass white

banana

Water

wine

Day 4

cup ½ caf coffee

1

Turkey burger

Lasagna

1 hour eliptical

Pre-natal vit Vit B complex Vit D3 5000iu Allegra 180mg Ibuprofen 600mg Vicodin 5/500 1 tab Docycycline 100mg twice daily

fried zuccini

Salad

2 Pancakes

Coke Zero

Water

HSG=

1

glass white

abdominal x-

wine

ray, with

iodine contrast

Day 5

1 cup coffee

Veggie sandwich fries chai w/ espresso shot

Side salad Pasta w/ marinara sauce

-

Aspirin 1tablet

 

Day 6

Medium Vanilla

Pasta w/

Small salad Stuffed red pepper w/ rice

-

-

Latte

marinara sauce

Cereal

2

slices bread

Day 7

Medium Vanilla

Bowl of rice

Chinese food

-

-

Latte

Day 8

Large Vanilla

Bowl of rice Sweet tea

Turkey sandwich Potato salad Cookie

-

-

Latte

 

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Appendix A

 
 

Breakfast

Lunch

Dinner

Exercise

Medications

Day 9

1 cup coffee

1

In-n-Out

slices pepperoni pizza

2

-1.5 Hours

-

cheeseburger

1

Large Coke

French bread w/

5

Oreo Cookies

“I Can't believe it's Not Butter”

 

1

cup black tea

Day 10

1 cup tea

Mashed potatoes Salad White Bread

Salad

-

Aspirin 1 tablet

2

slices white

bread

 

1

cup orange

juice

Day 11

1 Bowl Honey

1 Bowl rice

1

McDonald's

-1.5 Hours

-

Nut Cheerios w/ milk

2 Pickles

double

cheeseburger

 

1

McDonald's

large fries

1

McDonald's

cherry pie

1

cup black tea

Day 12

-

1 cup Pepsi

Bologna

-

-

2 Slices

Oreo Shake

pepperoni pizza

Fritos chips

1

Orange