For over the years, there is a relative increase in cases of children with birth defects. Recent statistics with regards to the American babies suffering from birth defects reveals that for every 4 and a half minutes, there is a new case of baby born with a birth defect, which can also be summarized as 120,000 incidents of child birth defects every year, and it is expected that the number of child victims will rise for the succeeding years (Center for Disease Control and Prevention). Birth defects on newborn babies may affect almost any part of their body system, either on internal or external part, including the limbs, hands, heart, brain, etc. Defects can also be distinguished as either mild or severe, depending on the general condition of the defected part of the body, for which it can or cannot estimate the expected lifespan of those babies.
Most birth defects on children are commonly identified at the early stages after birth. It generally occur during the mid-pregnancy stage where the body organs and systems of the babies are being formed and developed. Most of the causes for child birth defects are uncertain and doctors often assumes complex elements such as genes, behaviors, and the outside environment as the contributory factors for its existence (Center for Disease Control and Prevention).
There are also some research being studied as to how children are more susceptible to have various forms of birth defects. For instance, newborn babies have higher chances of having a birth defect if the mother is prone to smoking, drugs, and alcohol during the pregnancy period. Birth defects on babies may also be related to various medical conditions of the parents, such as obesity and diabetes. Even medical prescriptions may even cause birth defects on newborn babies. Furthermore, historical background of the family may also be a contributory factor, for which genetic deficiencies from the great grandmother with birth defects can be passed on to the succeeding generations. Seemingly, such circumstances for having birth defects may not always be the case since children can still suffer from the disease even after they are given birth.
The focus of this research paper is centered on the relationship between the different cases of child birth defects and the different medications that mothers ingest during their pregnancy stage, much of those are on the effects of Thalidomide, the Angiotensin-Converting Enzyme (ACE), and the Lithium element.
The first part of this paper focuses on how the intake of Thalidomide drug can cause certain birth defects on newborn babies. For a brief history, Thalidomide, also called as alpha-phthalimido-glutarimide, is an anticonvulsant drug that is used mainly as medication for asthma, hypertension, and migraine. However, when one patient is overdosed with this kind of drug, there is a higher tendency that the person will experience prolonged sleep or great relaxation all over the body, for which other people may consider it as “fashionable tranquilisers” because of its paralyzing effects that it can do to the body (Science Museum).
Thalidomide is generally used as a mild sleeping pill. At first, physicians believed that the drug does not pose much concern to human health, even pregnant women can take this drug for them to relax their bodies. However, such medical mistake had caused thousands of newborn babies to have malformed limbs and since then, this drug has been very suspicious and had undergone various testing and analysis to determine the main root of birth defects on babies. Statistics showed that there are over 10,000 children who were born with Thalidomide-related defects, and this number continues to increase with the rise in cases of newborn babies with birth defects, most especially in places like Germany and the United Kingdom (Science Museum).
Several medical trials in the United States were performed during 1960’s to test the side effects caused by taking the Thalidomide drug for pregnant women. Based from the actual results, an irreversible peripheral neuritis was discovered for over-dosage of the drug from pregnant women (Smithells & Newman). However, despite the warnings that would have occurred to the newborn babies, there were still several cases of child defects after the medical experiments. The lack of information dissemination all over the state with regards to the negative effects of Thalidomide resulted to an even increase in cases of babies with malformed limbs.
According to general studies, Thalidomide defects are not limited to the malformed limbs of the babies. It can also account into any part of the bodies, including the eyes, nose, ears, eye muscles, nerves, glands, etc. Furthermore, it can also affect the internal system of the babies such as the heart, kidneys, urinary and genital tracts, etc. (Smithells & Newman). Even so, the mortality rate of children suffering from Thalidomide defects is quite high, with a corresponding value of 40 percent, mainly because of the cases of malformations on the internal system of the babies. In addition with the observable effects caused by the drug, there were also cases of symptoms that resulted to spine, joints, and knee abnormalities few years after the birth of these newborn babies. Seemingly, it is as expected that children with a family history or background of taking Thalidomide drug during pregnancy is also prone to these symptoms associated with it.
After knowing the brief history of Thalidomide drug as well as the symptoms related to birth defects, we try to explain the general features of those children who were affected with such kind of disease. Basically, the most common part of the body that is affected by such kind of disease is the limbs. The upper limbs of the affected children have either an excess or insufficient number of bones, causing them to be malformed and distorted. The bones in the upper limbs are connected with each other; hence, it makes it more difficult for these children to move freely with their arms and limbs. Aside from that, most children with Thalidomide defects on their upper limbs have significantly normal condition in terms of their lower limbs. Also, few children have both upper and lower limbs affected by the defect and seemingly, it is very rare that lower limbs are affected while the upper limbs are (Smithells & Newman). The other parts of the body that can also be affected and create deformations include the hips, knees, and ankles. Aside from these, the second most affected part of the body which can provide various combinations and abnormal permutations are the eyes, ears, facial muscles, and the tear glands. Even the heart, kidneys, skeletal, neurodevelopmental, and orofacial problems have been directly associated with the occurrence of Thalidomide drug right after the birth of these children.
For over the 10,000 babies who have suffered from Thalidomide defects, one particular example of which is the case of Mandy Masters. Mrs. Masters was born without any upper limbs and uses her feet as her hands. As what she had recalled after her mother gave birth to her, her expected life expectancy shall be around 19 years old only, and since the outbreak of Thalidomide defects are very eminent at that period, the whole family found it difficult for them to accept her. The effects of the drug may come in different forms, such as shortened arms and legs, blindness, deafness, heart failures, and brain damage (Cawley). At the age of 51, she is starting to feel the pain all around her body - from the joints on her legs, her hearing incapacities, and her arthritis that prevented her from doing her daily activities. It is indeed very difficult for people who have such kind of disease, especially in times when their muscular-skeletal systems are way ahead of their current age. It is very difficult for them to move freely and effortlessly. However, Thalidomide survivors are still hoping that someday, the pain and agony that they endured all throughout their lives shall be gone forever in order for them to enjoy the remaining years of their existence. Despite the miseries that they have experienced for all those years, they still believe that everything happens for a reason and all they can do is to be stronger as always.
The second part of this paper deals with how Angiotensin-Converting Enzyme (ACE) inhibitors affect women’s pregnancy period, resulting to various types of birth defects on newborn babies. ACE inhibitors are said to be used as medications for regulating the blood pressure of pregnant women and is usually administered on the first three months of the pregnancy stage. However, what was supposedly a safe medication for pregnant women with regards to the dosage of ACE inhibitors had resulted to some serious birth defects on babies, usually around 7 percent of which are caused by this type of drug (Brown).
The Angiotensin-Converting Enzyme (ACE) inhibitors belonged to a class of anti-hypertensive medications used for the regulation of blood pressure for pregnant women. ACE inhibitors are also considered as the second-most prescribed blood pressure medications all over the United States, with an enormous 149 million prescriptions last 2006 (Brown). Also, “there was a three-fold increase in the overall risk of birth defects to infants whose mothers took ACE inhibitors for the first three months of pregnancy stage, in comparison to those newborn offspring whose mothers took no blood-pressure medications” (Natural News). According to the reports, the dosage of ACE inhibitors during the second and third semester of pregnancy stage is very crucial since it causes fatal toxicity to the babies and can lead to kidney damage and birth defects. However, experimental studies conveyed the increased risk of having congenital anomalies on the newborn babies when ACE inhibitors were taken at the first semester of pregnancy (Li, Yang, Andrade, Tavares, & Ferber).
Seemingly, a population-based study was conducted last 2011 covering the effects of this drug on the risks of having child defects during the intake of ACE inhibitors on the first semester of the pregnancy period. With a population of more than 450,000 mother-infant pairs during periods from 1995 to 2008, the study was enacted to evaluate the risks of malformations in offspring and found out that only 0.16 percent of the total respondents use ACE inhibitors as their medication during their pregnancy period, and around 0.09 percent of ACE users took it on the first three months of pregnancy and only 0.001 percent of women have undergone ACE medication during the second and third phase of pregnancy period. Furthermore, the prevalence of using other types of antihypertensive medications among pregnant women corresponds to about 0.24 percent last 1995 to an increased figure of 2.65 percent last 2008 (Li, Yang, Andrade, Tavares, & Ferber). Based from the obtained results, there is a relative increase in the number of pregnant women taking antihypertensive drugs other than the ACE inhibitors. Also, based from the data, pregnant women who took ACE inhibitors during pregnancy have shown signs of being overweight, have pre-existing diabetes, and have more children. Other pertinent information on the relationship between the periods of intake of ACE inhibitors and the occurrence of child defects showed that 20 percent of pregnant women taking ACE inhibitors have risks of having their newborn babies to have any malformations or defects, whereas 22 percent increased risk was observed for those who have taken other types of antihypertensive drugs. Hence, these data are quite alarming since different types of antihypertensive drugs other than ACE inhibitors are susceptible to child defects from those pregnant women suffering from hypertension and high blood pressure. Seemingly, “the potential teratogenic effects of ACE inhibitors during the first trimester of the pregnancy stage was raised in a global concern of increased risk of malformations of birth defects among offspring” (Li, Yang, Andrade, Tavares, & Ferber).
The effects of ACE inhibitors are not limited to malformation of the offspring. There are also serious risks of cardiovascular effects and central nervous system birth defects being observed on affected newborn babies which is actually four times higher as compared to pregnant women who do not take blood-pressure medications during their pregnancy (Natural News). These particular results are quite frightening because these potential risks of ACE inhibitors are very multifaceted especially considering the fact that the problem is with regards to the internal body system of newborn babies. The immune system of newborn babies are generally weaker and if the effects of this drug influenced the overall condition of the offspring’s body and the organ system, a greater chance is that they would have serious cases of child birth defects, and may even result to unexpected death of these affected babies.
The main reason for the occurrence of birth defects among newborn babies by the dosage of ACE inhibitors still seemed to be unidentified as of the moment. Basically, the ACE inhibitors play a regulatory role similar to that of an enzyme, for which it primarily affects the blood pressure of pregnant women. Also, this particular enzyme can also be found in fetal heart, kidney and brain during the early stages of pregnancy. Hence, the angiotensin enzyme function disrupts the formation of body organs among infants, leading to serious forms of birth defects on newborn babies such as cardiovascular defects, musculoskeletal defects such as upper limb difficulties, gastrointestinal problems, urologic defects, and central nervous system defects inside the body organ of the infants (Natural News). However, the lack of information on the extremely potential risks caused by ACE inhibitors made it difficult for researchers to conduct further studies about its side effects on pregnant women and on newborn babies as well.
For the last part of this paper, we explore how the Lithium element can be detrimental towards women’s pregnancy and we will cover the extremities brought about by these side effects to child defects. Lithium is a type of drug that is commonly used as an antimanic medication wherein it works by reducing the abnormal activity that is present in human brains. Many physicians believed that the Lithium element alleviates the membrane functions of the nerve cells present in the brain. These cell membranes are very important since it discharges neurotransmitters on human brain to allow the nerve cells to function and communicate with the other body organs. Seemingly, in terms of medications, the Lithium drug can be used as prescription for those who have bipolar disorder, a type of mental disorder that causes depression, mania, and other abnormal behaviors in the brain (Szalay). It is also used as medication for the prevention of different types of mania, which can be defined as an abnormal behavior or mood in the brain that causes different reactions and response on human body.
Seemingly, the occurrence of bipolar disorder among pregnant women is estimated to be around 2 to 3 percent, in which case there is still a possibility for them to be associated with congenital abnormalities in their offspring, for which pregnant women are forced to undergo the use of mood stabilizers just like any other medicine containing Lithium element (Watts). Most often, the lithium medication for pregnant women are usually a long-term prescription for them to stabilize their moods longer and fell much comfortable while being in the pregnancy period. It can help pacify the changing mood and behavior of pregnant women, especially on the latter stage of pregnancy period. However, with prolonged lithium medications, experts believed that it can contribute to cases of newborn babies with defects and malformations on their body parts.
According to a scientific study last 2014, pregnant women who have been exposed to lithium-related objects during their pregnancy period have been observed that they are nearly five times more likely to indicate marks of miscarriage or elective termination of pregnancy as compared to those who are not exposed to lithium-related objects (Watts). Furthermore, cardiovascular anomalies such as fetal echocardiography can also occur seven times more likely for pregnant women who take lithium products during the first three months of pregnancy period. However, with all the medical benefits that it can provide to pregnant women, lithium has still been considered as one of the most effective therapy for bipolar disorder among women under the pregnancy period since clinical alternative mood stabilizing medications, like valproic acid and carbamazepine, are tested to have teratogenic properties that can have questionable results to the body system of newborn offspring (Watts). Hence, mood swing and behavior relaxation medications for pregnant women seemed to be a bit of a challenge for most doctors and physicians mainly because of the positive and negative reinforcements that it can convey to the future of the newborn babies.
Lithium therapy has been a very effective medication for pregnant women with bipolar disorder. However, if too much dosage of lithium drug has been administered to women, there is a greater possibility that their offspring may have anomalies on their physical and cardiovascular health system. An experimental procedure was conducted to test the maximum allowable dosage of lithium drug to pregnant women for the treatment of bipolar disorder. Using a physiologically-based pharmacokinetic (PBPK) model, a time-dependent lithium concentration profiles were obtained to test the significance of the lithium drug dosage to the number of newborn babies suffering from child defects. Based from the obtained results and recommendations, the maximum allowable dosage of lithium drug among pregnant women shall not exceed 1,800 milligram (mg) per day. In short, a pregnant women can take at most 2 tablets of 900 mg of lithium drug per day (Horton, Tuerk, Cook, Cook, & Dhurjati). However, the allowable still depends and varies from person to person and from phase to phase illness (Szalay). Furthermore, the lithium still depends on the other medications prescribed by the doctor; thus, the prevention of bipolar disorder among pregnant women cannot be fully medicated by the drug. Meaning, the daily dosage being administered throughout their pregnancy period exceeds that of the estimated allowable maximum dosage of lithium concentration for pregnant women, thus, causes the fetus to obtain maximum amount of lithium drug during the 9-month pregnancy period. Since the maximum dosage of lithium concentration for pregnant women need to be monitored regularly, this drug shall not be administered at the same time with the other blood pressure and non-steroidal anti-inflammatory prescriptions, such as ACE inhibitors and Ibuprofen since it generally increase the lithium content present in the blood of humans, thereby resulting to higher possibility of having congenital heart and cardiovascular effect on newborn infants.
After knowing the different points to be considered with regards to the proper medications being administered to pregnant women, it is necessary for us to know how these medicines could affect the newborn babies. People should keep in mind that not all medicines are good to one’s health. Sometimes, the opposite case happens. It is also important for us to have a regular checkup to the doctor, especially the pregnant women, to ensure that a hundred percent safety is being considered always. Hence, people must be aware of the things that could happen in the future, and avoid becoming ignorant individuals, especially if the topic of concern is with regards to making a life - through the gift of these cute, little, newborn babies.
Works Cited
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Center for Disease Control and Prevention [CDC]. “Facts about Birth Defects”, 2015. Web. 21 April 2016.
Horton, S., Tuerk, A., Cook, D., Cook, J., & Dhurjati, P. “Maximum Recommended Dosage of Lithium for Pregnant Women based on a PBPK model for Lithium Absorption”. Advances in Bioinformatics. (2012).
Li, D. K., Yang, C., Andrade, S., Tavares, V., & Ferber, J. R. “Maternal Exposure to Angiotensin Converting Enzyme Inhibitors in the First Trimester and Risk of Malformations in Offspring: A Retrospective Cohort Study”. (2011). BMJ, 343.
Natural News. “Blood-Pressure Drugs Linked to Birth Defects”, 2006. Web. 21 April 2016.
Science Museum. “Thalidomide”. Web. 21 April 2016.
Smithells, R. W. & Newman, C. G. H. “Recognition of Thalidomide Effects”. Web. 21 April 2016.
Szalay, J. “Lithium Medication: Dosage and Side Effects”. Live Science, 2015. Web. 21 April 2016.
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