Teratogens: a public health issue – a Brazilian overview

Abstract

Congenital anomalies are already the second cause of infant mortality in Brazil, as in many other middle-income countries in Latin America. Birth defects are a result of both genetic and environmental factors, but a multifactorial etiology has been more frequently observed. Here, we address the environmental causes of birth defects – or teratogens – as a public health issue and present their mechanisms of action, categories and their respective maternal-fetal deleterious effects. We also present a survey from 2008 to 2013 of Brazilian cases involving congenital anomalies (annual average of 20,205), fetal deaths (annual average of 1,530), infant hospitalizations (annual average of 82,452), number of deaths of hospitalized infants (annual average of 2,175), and the average cost of hospitalizations (annual cost of $7,758). Moreover, we report on Brazilian cases of teratogenesis due to the recent Zika virus infection, and to the use of misoprostol, thalidomide, alcohol and illicit drugs. Special attention has been given to the Zika virus infection, now proven to be responsible for the microcephaly outbreak in Brazil, with 8,039 cases under investigation (from October 2015 to June 2016). From those cases, 1,616 were confirmed and 324 deaths occurred due to microcephaly complications or alterations on the central nervous system. Congenital anomalies impact life quality and raise costs in specialized care, justifying the classification of teratogens as a public health issue.

Perfil das anomalias congênitas em nascidos vivos de Tangará da Serra, Mato Grosso, 2006-2016*

“…2 Between 1980 and 2007, there was a large proportional reduction of secondary infant deaths due to infectious and respiratory causes, while CA remained stable, these being the second cause of infant mortality in Brazil. 1,4 A similar phenomenon was described in another Latin American country, Chile, between 2001 and 2010. 5 The Brazilian Live Birth Information System (SINASC) was established in 1990 by the Brazilian Ministry of Health with the goal of providing data on live births retrieved from Statements of Live Birth (SLB).…”

“…Their causes may be genetic, environmental, or multifactorial. 1,2 In most cases, their etiology remains unknown and environmental causes (teratogens) are still little studied, especially in developing countries like Brazil. 1,3 It is estimated that congenital anomalies are present in 2 to 3% of live births, and can reach 5% if alterations diagnosed later, such as cardiac, renal and pulmonary anomalies, are taken into account.…”

“…1,2 In most cases, their etiology remains unknown and environmental causes (teratogens) are still little studied, especially in developing countries like Brazil. 1,3 It is estimated that congenital anomalies are present in 2 to 3% of live births, and can reach 5% if alterations diagnosed later, such as cardiac, renal and pulmonary anomalies, are taken into account. 2 Between 1980 and 2007, there was a large proportional reduction of secondary infant deaths due to infectious and respiratory causes, while CA remained stable, these being the second cause of infant mortality in Brazil.…”

The Politics of Disease Epidemics: a Comparative Analysis of the SARS, Zika, and Ebola Outbreaks

“…Among the poor populations, women who were either pregnant or considering pregnancy were also more vulnerable to the effects of Zika, as the virus is considered to be a teratogen (Mazzu-Nascimento et al 2017). Government programs in Brazil that intend to provide free mosquito repellent to pregnant women do not consistently reach some of the poorest communities, such communities are remote and often lack accessible quality health care facilities due to distance and poor physical infrastructure (Hennigan 2016).…”

Review on Mineral Malabsorption and Reducing Technologies

“…Alkaloids are also reported to cause alteration of normal foetaldevelopments resulting in foetal malformation in ewes. These are caused by teratogenic alkaloids [39]. Glycoalkaloids are reported to cause haemolysis and toxicity to humans [6].…”