Organization of Teratogen Information Specialists (OTIS)

Organization of Teratogen Information Specialists (OTIS)

MotherToBaby Georgia

Over the past several decades, experts in the field of teratology have contributed to the study of birth defects and their causes. Although many causes remain unknown, it was the work of astute clinicians that provided a better understanding of how exposures to medications, drugs or environmental agents could have a harmful effect on human pregnancy. Teratogen information services staffed by specialists evolved in response to a growing need for accurate information.

It was once thought that a pregnancy was protected from outside influences, medications or environmental agents. Experiments in the 1930s showed that mammalian fetal development was not as protected since pregnant pigs fed a diet deficient in Vitamin A had offspring born with malformations. In 1941, a German measles epidemic demonstrated that an environmental agent, rubella virus, could produce severe birth defects in children whose mothers had rubella during early pregnancy (Finnell, R). Children were born with cataracts, cardiac defects, and deafness. Sensorineural deafness is the most common rubella-associated defect that can result when rubella infection occurs in the first 16 weeks of gestation (Webster, W).

The field of teratology was propelled forward during the 1960s. The drug thalidomide, manufactured by the German company Chemie-Gruenenthal, was used in Germany to treat nausea during pregnancy. In 1959, a German pediatrician presented a girl with phocomelia, an unusual limb reduction defect where a hand or foot arises close to shoulder or hip, whose mother used thalidomide. By 1961, 34 long bone malformations were reported in pregnancies exposed to thalidomide, and an association was made. Even though the drug was taken off the market in Germany, the manufacturer denied a causal association for years. Up until 1991, a total of 538 million deutsche marks were paid to families of 2,866 children (Lenz, W).

In 1973, an association was reported by Drs. Jones and Smith between maternal alcohol use and a pattern of malformations including prenatal and/or postnatal growth deficiency, abnormal brain function resulting in mental deficit, and a distinct pattern of facial features (Jones, K). A variation in timing and duration of exposure to alcohol produces a wide range of teratogenic effects, resulting in a spectrum of fetal alcohol effects (FASD). It is now well understood that prenatal exposure to a variety of substances can have negative consequences for the embryo, fetus and the developing child.

During the late 1970s, teratogen information services developed to educate the public and health care professionals by providing accurate information about medication, drugs, and environmental exposures during pregnancy. In 1987, the Organization of Teratogen Information Specialists (OTIS) was established and connected world-renowned experts in the field of birth defects research with the general public. In 2002, OTIS established a national call routing system so that anyone in North America could be routed to an affiliated service to speak with a teratogen information specialist.

In 2013, OTIS announced MotherToBaby, a name for its public service and research studies. Today MotherToBaby affiliates around the world provide evidence-based information and counseling primarily over the phone. For example, a physician may refer a woman who is anxious about an exposure to medication prescribed for her medical condition. In addition, she may be concerned about the effects of her medical condition on the developing fetus. A woman may call who has questions about an environmental exposure she had prior to confirmation of her pregnancy, or an exposure to an over-the-counter medication she is using. Adoption services often recommend a consultation to prospective families regarding the potential effects of exposures to help in decision making. Teratogen information specialists work together with healthcare providers, and do not take the place of medical care or advice.

The goals of a teratogen information service include the following:

Provide counseling to patients and health care professionals about exposures related to pregnancy and breastfeeding, so they can make informed treatment choices.

Reduce risks and decrease the number of preventable birth defects by educating the public and health care providers about specific agents of concern.

Empower patients with accurate information about the true risks of an exposure, thereby preventing unnecessary terminations of wanted pregnancies.

Facilitate communication and collaboration between affiliated services.

Contribute collectively to research and the worldwide literature in the field of teratology.

(www.mothertobaby.org)

In Georgia, referrals can be made by calling Toll Free 1-855-789-6222 or by sending an email: .

For further information regarding this article please contact Pat Olney, MS, CGC at the Maternal Substance Abuse and Child Development Project, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1256 Briarcliff Road, N.E., Suite 312W, Atlanta, Georgia, 30306, phone: 404-727-6101, email: .

References:

Finnell, R. J. Teratology: General considerations and principles. Allergy Clinical Immunology, February 1999

Jones KL, Smith DW, Ulleland CN, Streissguth A. Pattern of malformation in offspring of chronic alcoholic mothers. Lancet 1:1267-1271 (1973)

Jones KL, Smith DW. Recognition of the fetal alcohol syndrome in early infancy. Lancet 2:999-1001(1973).

Lenz, W. A short history of thalidomide embryopathy. Teratology 38:203-215(1988)

Webster, William S. Teratogen update: Congenital rubella. Teratology 58:13-23 (1998)

1