Congenital rubella syndrome (CRS) can occur in children whose mothers contracted the rubella virus, sometimes called German measles, during pregnancy. Depending on the gestational period when the mother contracts rubella, an infant born with CRS may be unaffected by the virus or it may have severe developmental defects. The most severe effects of the virus on fetal development occur when the mother contracts rubella between conception and the first trimester. Defects from maternal rubella in the first trimester are included in the term congenital rubella syndrome, but physicians and researchers specifically refer to those defects as rubella embryopathy. Developmental defects are less severe if the mother contracts rubella in the second trimester, and they are generally negligible if the infection occurs in the third trimester. Prenatal rubella infection can cause birth defects which include deafness, compromised vision, abnormal heart development, and damage to the central nervous system which can lead to compromised cognition and learning disabilities.
James Graves Wilson's six principles of teratology, published in 1959, guide research on teratogenic agents and their effects on developing organisms. Wilson's six principles were inspired by Gabriel Madeleine Camille Dareste's five principles of experimental teratology published in 1877. Teratology is the study of birth defects, and a teratogen is something that either induces or amplifies abnormal embryonic or fetal development and causes birth defects. Detailed in his 1973 monograph, Environment and Birth Defects, Wilson's principles helped scientists research teratogens experimentally.
Vitamin A (retinol) is an essential vitamin in the daily functioning of human beings that helps regulate cellular differentiation of epithelial tissue. Studies have shown that an excess of vitamin A can affect embryonic development and result in teratogenesis, or the production of birth defects in a developing embryo. Excess intake of vitamin A and retinoids by pregnant women often results malformations to fetuses' skulls, faces, limbs, eyes, central nervous system. Additionally, doctors often use derivatives of vitamin A, known as retinoids, as medicine to treat a number of skin conditions and carcinomas, the most common form of human cancers.
Michael R. Harrison worked as a pediatric surgeon in the US throughout the late-twentieth century and performed many fetal surgeries, including one of the first successful surgeries on a fetus in utero, or while it is still in its gestational carrier’s body, also called open fetal surgery. A fetus is an organism developing inside of the uterus that is anywhere from eight weeks old to birth. Harrison hypothesized that open fetal surgery could correct developmental defects that may become fatal to the fetus at birth. After years of research, Harrison and his colleagues at the University of California, San Francisco, in San Francisco, California, performed surgery on the fetus of a woman in her seventh month of pregnancy to correct the fetus’s developmental defects. The surgery was successful, as the fetus developed into a healthy child. Harrison’s work led to advancements in fetal treatment techniques, such as a method to conduct open fetal surgery that will not harm the fetus or pregnant woman, as well as the establishment of one of the first fetal treatment centers in the US.
In 1996, Michael R. Harrison published “Fetal Surgery” in the American Journal of Obstetrics and Gynecology. In the article, Harrison describes the importance of fetal surgery and the techniques used to correct defects in fetuses. As a fetus develops in the uterus, it can develop abnormalities that may become debilitating or fatal. Harrison discusses cases that show how physicians can use fetal surgery to repair such abnormalities, including obstructions in the heart or urinary tract, or organs or muscles whose malformations impair function. Harrison states where knowledge is lacking within the field or where surgery would be inappropriate, such as in the modification of a cleft lip, which can be fixed after birth and as such does not merit the risks of surgery. In the article, Harrison provides a summary of what information existed about fetal surgeries in 1996, which helped physicians explore fetal surgery and make further advancements.
In June 2017, the Iowa Supreme Court decided the case Plowman v. Fort Madison Community Hospital, or Plowman v. FMCH, and ruled that women who gave birth to children with severe disabilities could sue for wrongful birth in Iowa. Specifically, after Plowman v. FMCH, a woman could sue for wrongful birth if she believed that her physicians failed to disclose evidence of fetal abnormalities that may have prompted her to terminate the pregnancy. Pamela and Jeremy Plowman filed the suit against the Fort Madison Community Hospital in Fort Madison, Iowa, alleging that hospital physicians failed to inform them that a prenatal test showed fetal abnormalities. Plowman v. FMCH gave women in Iowa the legal right to sue if physicians failed to tell them about fetal defects.
Thalidomide is a sedative drug introduced to European markets on 1 October 1957 after extensive testing on rodent embryos to ensure its safety. Early laboratory tests in rodent populations showed that pregnant rodents could safely use it, so doctors prescribed Thalidomide to treat morning sickness in pregnant women. However, in humans Thalidomide interfered with embryonic and fetal development in ways not observed in rodent tests. Pregnant women who take Thalidomide are at grater than normal risk for spontaneous abortion and for giving birth to children with developmental anomalies such as shortened, absent, or extra limbs, as well as a variety of heart, ear, and internal organ defects. The failure of rodent models to inform scientists of Thalidomide's teratogenicity in humans ignited debate about the proper use of cross-species testing during drug development.
Methylmercury (MeHg) is an organic form of mercury that can damage the developing brains of human fetuses. Women who consume methylmercury during pregnancy can bear children who have neurological issues because methylmercury has toxic effects on the nervous system during embryonic development. During the third week of gestation, the human nervous system begins to form in the embryo. During this gestational period, the embryo's nervous system is particularly susceptible to the influence of neurotoxins like methylmercury that can result in abnormalities. Furthermore, the fetal brain can incur damage despite the lack of signs of poisoning in the pregnant woman. In children, defects due to methylmercury can result in deficits in attention, behavior, cognition, and motor skills.
The article Experimental Studies on Congenital Malformations was published in the Journal of Chronic Diseases in 1959. The author, James G. Wilson, studied embryos and birth defects at the University of Florida Medical School in Gainesville, Florida. In his article, Wilson reviewed experiments on birds and mammals from the previous forty years to provide general principles and guidelines in the study of birth defects and teratogens, which are things that cause birth defects. Those principles included what species are convenient for conducting teratological research, what principles act in human embryological and fetal development, and what agents impact those processes. Wilson's article was one of the first attempts in the twentieth century to synthesize basic research conducted in the field of teratology. The article helped to establish teratology as a field in medicine during the twentieth century.
In 1861, William John Little published, “On The Influence of Abnormal Parturition, Difficult Labors, Premature Birth, and Asphyxia Neonatorum, on the Mental and Physical Condition of the Child, Especially in Relation to Deformities,” hereafter “Abnormal Parturition,” in the Transactions of the Obstetrical Society of London. In the article, Little discussed the causes and types of what he refers to as abnormal births, and theorized how those births affect an infant’s likelihood of exhibiting a deformity. Little defined abnormal births as those involving an atypical maternal or fetal presentation, such as a slow birthing process or a fetus exiting the birth canal feet first rather than head first. In his article, Little published one of the first definitional frameworks to describe a condition causing rigidity and stiffness in the limbs that is often associated with birth-related trauma, which was then called Little’s disease, but is modernly known as spastic Cerebral Palsy.