Developmental toxicity

DART is the specific research of looking for malformations from the toxicity of chemicals, medications, pesticides, dietary supplements, etc. The National Toxicology Program (NTP) has been conducting DART research for chemicals that have not been FDA approved or undergone the appropriate research for human offspring.[3]

The research is conducted by using pregnant animals and exposing them to a certain chemical, medication, drug, pesticide, etc. throughout their pregnancy and then complete teratology on the fetuses to look for malformations. These malformations can be anything from a tissue malformation to a skeletal malformation. They can also allow the animal to deliver the offspring to look for malformations in growing animals. These malformations can be anything from behaviors, intellect, sexual maturity such as testicular development, vaginal opening, and the ability to reproduce.

Because of the complexity of the embryo-fetal development, including the maternal-fetal interactions during gestation, it is important to understand the mechanism of toxicity and test the toxic effect in more than two species before confirming the substance to be a developmental toxicant. Embryo have different critical periods for the organ formation from day 15 to day 60 and hence the susceptibility to toxicant injury is directly related to the period of development.

One of the first environmentally induced congenital malformations in humans were recognized as a result of maternal irradiation. Hiroshima (1953) and Nagasaki (1955) had ascertained this fact for the first time based on the records of births occurring before May 31, 1946, but after the atomic bombing (August 6, 1945, in Hiroshima; August 9, 1945, in Nagasaki). A 20% increase in microcephaly frequency was seen in children with in-utero radiation exposure during the first trimester of the pregnancy (Miller 1956, 1968). Sensitivity to these radiations was seen to be predominantly high during the 7–15th week of gestation.

Two pertinent points were observed during this study:

1. The severity and frequency of the congenital abnormalities seen increased with dose of radiation which depended on the closeness to the source or explosion.
2. It was determined that there were critical periods of pregnancy when these exposures had the maximum effect on the fetal development.

Cataracts in a child's eyes due to congenital rubella syndrome (CRS)

Rubella was the first recognized human epidemic of malformations. Following a widespread epidemic of rubella infection in 1940, Norman Gregg, an Australian ophthalmologist, reported in 1941 the occurrence of congenital cataracts among 78 infants born following maternal rubella infection in early pregnancy. This indicated that the virus had to cross the placental barrier to reach the fetus and cause malformations. The time of exposure to the virus also had a direct impact on the incidence of congenital malformations with exposure during week 4, 5–8 and 9–12 weeks of pregnancy caused 61%, 26% and 8% of congenital malformations. This was the first published recognition of congenital rubella syndrome (CRS). The progeny had congenital eye, heart and ear defects as well as intellectual disability.[4]

Prescription Thalidomide

Thalidomide was used as treatment for cancers, leprosy and HIV, however, the drug was extensively used for the treatment of nausea in pregnant women in the late 1950s and early 1960s until it became apparent in the 1960s that it resulted in severe birth defects. Fetus that were exposed to thalidomide while in the womb experienced limb malformation by which the limb was not developed or appeared as stumps. Other effects also seen with thalidomide exposure included deformed eyes and hearts, deformed alimentary and urinary tracts, blindness and deafness.[5] The thalidomide tragedy marked a turning point in toxicity testing, as it prompted United States and international regulatory agencies to develop systematic toxicity testing protocol. The effects of thalidomide led to important discoveries in the biochemical pathways of limb development.[6] Many thalidomide victims and their families are still seeking justice for the struggles that they had to endure. The most notable way that survivors are fighting for justice is by forming Thalidomide survivor societies. These societies provide a safe space for Thalidomide survivors to freely share their stories and rally together to fight for social change as well as enforce strict laws on drug testing and control. The most notable society in the United States is the US Thalidomide Survivors Society. This society focuses on the survivors within the United States, while also promoting other international societies.[7]

Neurulation is one of the most important stages in the development of vertebrates. It is the process of formation of a flat neural plate which then convolutes to form the hollow neural tube.[8] It is considered to be one of the main targets of developmental toxicity and defects in neurulation is a common consequence of toxicant exposure and results in large proportion of human defects.[9] Neurulation exposure to developmental toxicity is caused by the increased rate of cell proliferation and the ventral to dorsal migration of neuroepithelial cells. Epigenetic factors disrupt the normal process of the formation of the neural tube causing Neural Tube Defects (NTD). This leads to spina bifida, a common human defect.[10]

Facial characteristics that suggest the diagnosis of FAS

Fetal alcohol spectrum disorders (FASD) is a term that constitutes the set of conditions that can occur in a person whose mother drank alcohol during the course of pregnancy. These effects can include physical and cognitive problems. FASD patient usually has a combination of these problems.[11] Extent of effect depends on exposure frequency, dose and rate of ethanol elimination from amniotic fluid. FAS disrupts normal development of the fetus, which may cause certain developmental stages to be delayed, skipped, or immaturely developed.[12] Since alcohol elimination is slow in a fetus than in an adult and the fact that they do not have a developed liver to metabolize the alcohol, alcohol levels tend to remain high and stay in the fetus longer. Birth defects associated with prenatal exposure to alcohol can occur in the first three to eight weeks of pregnancy before a woman even knows that she is pregnant.[13]

Diethylstilbestrol (DES) cervix. The cockscomb, collar, and pseudopolyp of cervix. Cockscomb (hoods) are markedly enlarged folds of cervical stroma and epithelium . Low, broad folds are collars (rims). A pseudopoly is that portion of the cervix which is medial to a constricting band (sulcus) and has on superficial examination the appearance of a polyp.

DES (diethylstilbestrol) is a drug that mimics estrogen, a female hormone. From 1938 until 1971, doctors prescribed this drug to help some pregnant women who had had miscarriages or premature deliveries on the theory that miscarriages and premature births occurred because some pregnant women did not produce enough estrogen naturally to sustain the pregnancy for full term. An estimated 5–10 million pregnant women and the children born during this period were exposed to DES. Currently, DES is known to increase the risk of breast cancer, and cause a variety of birth-related adverse outcomes exposed female offsprings such as spontaneous abortion, second-trimester pregnancy loss, preterm delivery, stillbirth, neonatal death, sub/infertility and cancer of reproductive tissues. DES is an important developmental toxicant which links the fetal basis of adult disease.[14]

Methylmercury and inorganic mercury is excreted in human breast milk and infants are particularly susceptible to toxicity due to this compound.[15] The fetus and infant are especially vulnerable to mercury exposures with special interest in the development of the CNS since it can easily cross across the placental barrier, accumulate within the placenta and fetus as the fetus cannot eliminate mercury and have a negative effect on the fetus even if the mother does not show symptoms.[16] Mercury causes damage to the nervous system resulting from prenatal or early postnatal exposure and is very likely to be permanent.[17]

It is an organophosphate insecticide that acts on the nervous system of insects by inhibiting acetylcholinesterase but are moderately toxic to humans. But it is known have developmental effects appear in fetuses and children even at very small doses. It has been shown to cause abnormal reflexes in neonates, poorer mental development in 2 and 3 year olds, poorer verbal IQ in 3+1⁄2 and 5 year old and pervasive developmental disorder in 2, 3 and 3+1⁄2 year olds.[18]

Endocrine disruptors are molecules that alter the structure or function of the endocrine system. These chemicals can act as a part of developmental toxicity because they can alter hormonal pathways in the endocrine system, leading to negative health effects. One of the most common endocrine disruptor is Bisphenol A (BPA). BPA is often found in human waste material, specifically plastics. This means that BPA is also used in water bottles, which can be dangerous when the chemicals from the plastics leach into the purified drinking water for human consumption.  More endocrine disrupting chemicals include forms of phthalic acid esters that are used as plasticizers. Both BPA and phthalic acid esters are found in waterways.[19] Prenatal BPA exposure is associated with aggression and neurobehaviour changes.[20] Another common toxin is pyrifluquinazon, which is an insecticide used to control pests. Vinclozolin is also an endocrine disrupting chemical; it is a fungicide used on produce to help them have a longer shelf life .[21] Endocrine disruptors may have different effects depending on the extent of the exposure.[22] Many endocrine disrupting chemicals are not only found in plastic, but also found in many hygiene products, cosmetics, cleaners, food, and much more. These toxins can have a lead role in human health as they can lead to metabolic diseases, infertility issues, and even neurodevelopmental disorders.[23]

Many dietary supplements are approved without FDA approval due to them being listed as "food" instead of drugs. However, many of them contain chemicals that have not been tested and approved for use of pregnant women. It is important to investigate and research any type of dietary supplement before taking it during pregnancy. Some dietary supplements that have been found to have harmful effects are listed below.