Motherisk was a clinical and research program at The Hospital for Sick Children in Toronto, Ontario, Canada, established in 1985 as a teratogen information service to provide evidence-based safety information on exposures in pregnancy and lactation. [1] [2]
Motherisk had [3] two helplines available providing information and guidance to those planning a pregnancy, pregnant or lactating, and to health care professionals:
Independent of the Helplines, a drug testing laboratory (Motherisk Drug Testing Laboratory (MDTL)) was operating from the late 1990s until April 2015, at which time the laboratory was closed.
Gideon Koren and colleagues for the Motherisk team were recognized as one of the two highest-ranking winners of the 2011 CIHR/CMAJ competition for Top Achievements in Health Research. The CMAJ published their Essay for the 2011 award. [5]
An independent review commissioned by the Ontario Ministry of the Attorney General concluded in 2015 that "hair-strand drug and alcohol testing used by the Motherisk Drug Testing Laboratory between 2005 and 2015 was inadequate and unreliable for use in child protection and criminal proceedings and that the Laboratory did not meet internationally recognized forensic standards." [6] The US State of Colorado was one of the jurisdictions that in 1993 described the lab's results as "not competent evidence". [7] The report called for further investigation of some of the 16,000 child protection cases where testing by Motherisk had been requested and sometimes used as evidence in child protection and criminal proceedings, citing "serious implications for the fairness of those proceedings". [6]
In 2017, an investigation into Gideon Koren was commenced by the College of Physician and Surgeons in Ontario into whether he committed professional misconduct or was incompetent while he was in charge of the Motherisk Laboratory. As a result, Gideon Koren agreed to relinquish his license to practice medicine in Ontario in 2019. [8]
Meconium is the earliest stool of a mammalian infant resulting from defecation. Unlike later feces, meconium is composed of materials ingested during the time the infant spends in the uterus: intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile, and water. Meconium, unlike later feces, is viscous and sticky like tar – its color usually being a very dark olive green and it is almost odorless. When diluted in amniotic fluid, it may appear in various shades of green, brown, or yellow. It should be completely passed by the end of the first few days after birth, with the stools progressing toward yellow.
Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical loss. Once ultrasound or histological evidence shows that a pregnancy has existed, the used term is clinical miscarriage, which can be early before 12 weeks and late between 12-21 weeks. Fetal death after 20 weeks of gestation is also known as a stillbirth. The most common symptom of a miscarriage is vaginal bleeding with or without pain. Sadness, anxiety, and guilt may occur afterwards. Tissue and clot-like material may leave the uterus and pass through and out of the vagina. Recurrent miscarriage may also be considered a form of infertility.
Morning sickness, also called nausea and vomiting of pregnancy (NVP), is a symptom of pregnancy that involves nausea or vomiting. Despite the name, nausea or vomiting can occur at any time during the day. Typically the symptoms occur between the 4th and 16th week of pregnancy. About 10% of women still have symptoms after the 20th week of pregnancy. A severe form of the condition is known as hyperemesis gravidarum and results in weight loss.
The Hospital for Sick Children (HSC), corporately branded as SickKids, is a major pediatric teaching hospital located on University Avenue in Toronto, Ontario, Canada. Affiliated with the Faculty of Medicine of the University of Toronto, the hospital was ranked the top pediatric hospital in the world by Newsweek in 2021.
Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. Symptoms can include an abnormal appearance, short height, low body weight, small head size, poor coordination, behavioral problems, learning difficulties, and problems with hearing and sight. Those affected are more likely to have trouble with school, the legal system, alcohol, other drugs, and other areas of high risk. The several forms of the condition are: fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS), alcohol-related birth defects (ARBD), static encephalopathy, alcohol-related neurodevelopmental disorder (ARND) and neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE). As of 2016, the Swedish Agency for Health Technology Assessment and Assessment of Social Services accepted only FAS as a diagnosis, seeing the evidence as inconclusive with respect to other types.
Environmental toxicants and fetal development is the impact of different toxic substances from the environment on the development of the fetus. This article deals with potential adverse effects of environmental toxicants on the prenatal development of both the embryo or fetus, as well as pregnancy complications. The human embryo or fetus is relatively susceptible to impact from adverse conditions within the mother's environment. Substandard fetal conditions often cause various degrees of developmental delays, both physical and mental, for the growing baby. Although some variables do occur as a result of genetic conditions pertaining to the father, a great many are directly brought about from environmental toxins that the mother is exposed to.
Prenatal development includes the development of the embryo and of the fetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal development until birth.
Nutrition and pregnancy refers to the nutrient intake, and dietary planning that is undertaken before, during and after pregnancy. Nutrition of the fetus begins at conception. For this reason, the nutrition of the mother is important from before conception as well as throughout pregnancy and breast feeding. An ever-increasing number of studies have shown that the nutrition of the mother will have an effect on the child, up to and including the risk for cancer, cardiovascular disease, hypertension and diabetes throughout life.
Pyridoxine/doxylamine, sold under the brand name Diclectin among others, is a combination of pyridoxine hydrochloride (vitamin B6) and doxylamine succinate. It is generally used for nausea and vomiting of pregnancy (morning sickness); even though its efficacy has not been proven and subsequent research has led to the removal of recommendations in medical journals.
Gideon Koren, FACMT, FRCP(C) is an Israeli-Canadian pediatrician, clinical pharmacologist, toxicologist, and a composer of Israeli folk music. He was a doctor at the Hospital for Sick Children and a professor at the University of Toronto. In 1985, Koren founded the Motherisk Program in Toronto, which was later shut down amid controversy. Furthermore, multiple scientific papers authored by Koren have been subject to concerns regarding academic and research misconduct, leading to the retraction of six research articles and editorial expression of concerns on multiple others. Koren currently has relinquished his licence to practice medicine due to an ongoing investigation into whether he committed “professional misconduct or was incompetent” while he was in charge of the Hospital for Sick Children’s Motherisk laboratory.
Pre-conception counseling is a meeting with a health-care professional by a woman before attempting to become pregnant. It generally includes a pre-conception risk assessment for any potential complications of pregnancy as well as modifications of risk factors, such as increasing folic acid intake to reduce the risk of neural tube defects and counseling on smoking cessation, alcohol reduction, and medications that may compromise fetal development. Physicians, midwives and baby experts recommend that a woman visit them as soon as the woman is contemplating having a child, and optimally around 3 to 6 months before actual attempts are made to conceive. This time frame allows a woman to better prepare her body for successful conception (fertilization) and pregnancy, and allows her to reduce any health risks which are within her control. Agencies such as the March of Dimes have developed screening tools that healthcare providers can use with their patients. In addition, obstetricians or midwives have developed comprehensive check-lists and assessments for the woman who is planning to become pregnant.
The Canadian Mothercraft Society (Mothercraft) is a non-profit, charitable NGO that serves children ages 0 to 6, their families, their teachers, and their community.
Drugs and medications should be avoided while pregnant. Women should speak to their doctor or healthcare professional before starting or stopping any medications while pregnant. Tobacco, alcohol, marijuana, and illicit drug use while pregnant may be dangerous for the unborn baby and may lead to severe health problems and/or birth defects. Even small amounts of alcohol, tobacco, and marijuana have not been proven to be safe when taken while pregnant. In some cases, for example, if the mother has epilepsy or diabetes, the risk of stopping a medication may be worse than risks associated with taking the medication while pregnant. The mother's healthcare professional will help make these decisions about the safest way to protect the health of both the mother and unborn child. In addition to medications and substances, some dietary supplements are important for a healthy pregnancy, however, others may cause harm to the unborn child.
Tobacco smoking during pregnancy causes many detrimental effects on health and reproduction, in addition to the general health effects of tobacco. A number of studies have shown that tobacco use is a significant factor in miscarriages among pregnant smokers, and that it contributes to a number of other threats to the health of the foetus.
Prenatal cocaine exposure (PCE), theorized in the 1970s, occurs when a pregnant woman uses cocaine and thereby exposes her fetus to the drug. Babies whose mothers used cocaine while pregnant supposedly have increased risk of several different health issues during growth and development.
Prenatal memory, also called fetal memory, is important for the development of memory in humans. Many factors can impair fetal memory and its functions, primarily maternal actions. There are multiple techniques available not only to demonstrate the existence of fetal memory but to measure it. Fetal memory is vulnerable to certain diseases so much so that exposure can permanently damage the development of the fetus and even terminate the pregnancy by aborting the fetus. Maternal nutrition and the avoidance of drugs, alcohol and other substances during all nine months of pregnancy is important to the development of the fetus and its memory systems. The use of certain substances can entail long-term permanent effects on the fetus that can carry on throughout their lifespan.
Developmental toxicity is any structural or functional alteration, reversible or irreversible, which interferes with homeostasis, normal growth, differentiation, development or behavior. Developmental toxicity is caused by environmental insult, which includes drugs, alcohol, diet, toxic chemicals, and physical factors. More factors causing developmental toxicity are radiation, infections, maternal metabolic imbalances, drugs, and environmental chemicals .In addition, it is the study of adverse effects on the development of the organism that can result from exposure to toxic agents before conception, during fetal development, or even following birth.
Breastfeeding and medications is the description of the medications that can be used by a breastfeeding mother with no or few consequences and those medications which should be avoided. Some medications are excreted in breastmilk. Almost all medicines pass into breastmilk in small amounts. Some have no effect on the baby and can be used while breastfeeding. The National Institutes of Health (NIH) maintain a database containing information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. Some medications and herbal supplements can be of concern. This can be because the drug can accumulate in breastmilk or have effects on the infant and the mother. Those medications of concern are those medications used to treat substance and alcohol addiction. Other medications of concern are those that are used in smoking cessation. Pain medications and antidepressants need evaluation.
Alcohol use in pregnancy includes use of alcohol at any time during gestation, including the time before a mother-to-be is aware that she is pregnant. Alcohol use at some point during pregnancy is common and appears to be rising in prevalence.
Fetal programming, also known as prenatal programming, is the theory that environmental cues experienced during fetal development play a seminal role in determining health trajectories across the lifespan.