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Animal study reveals how a fever early in pregnancy can cause birth defects

In chicken embryos, a rise in incubation temperature alone can disrupt normal development

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2:00pm, October 18, 2017
incubating chick

BASIC BEAK  The red- and blue-stained facial features of this chick, which was incubated under standard laboratory temperatures, reveal an upper beak that is developing properly.

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Certain birth defects of the face and heart can occur when babies’ mothers have a fever during the first trimester of pregnancy, a crucial time in an embryo’s development. Now scientists have figured out the molecular players that make it so.  

In an experiment with chicken embryos, a temporary rise in incubation temperature — meant to mimic feverlike conditions — was enough to produce defects to the face and heart. The elevation in a growing embryo’s temperature, called hyperthermia, impacts the activity of heat-sensitive channels that are present in cells necessary for an embryo’s development, researchers report online October 10 in Science Signaling.

Although a connection between fever and these birth defects has been known for decades, says coauthor Eric Benner, a neonatologist at Duke University School of Medicine, there has been some debate as to whether the fever itself or an infectious agent behind the fever is the culprit.

The new work shows that “hyperthermia in and of itself can cause these birth defects, and on a molecular level, here’s how it happens,” Benner says.

While birth defects of the heart and face can have a genetic cause, that doesn’t explain all cases of these common health problems. In the United States, more than 35,000 babies are born with congenital heart defects each year. Nearly 4,500 infants are born with a malformation of the lip called cleft lip, which can occur with or without a cleft palate, and more than 2,500 babies are born with a cleft palate only.

Although the face and heart don’t end up so close together, they arise from the same type of precursor cells called neural crest cells. These cells orchestrate the development of the jaws and other facial bones as well as the heart and its major vessels in a growing embryo, says Benner. The researchers discovered that two members of a class of ion channels that can sense a change in temperature were present in neural crest cells from chickens and mice. (Ion channels are passages through a cell’s membrane that allow charged particles, or ions, into or out of the cell.) A temperature change can affect the activity of these two channels, called TRPV1 and TRPV4.

The scientists heated chicken embryos to 40° to 41° Celsius for an hour and compared them with embryos incubated at a standard laboratory temperature of 37° C. Those chicks exposed to a high “fever” developed craniofacial defects, such as a shorter upper beak, and cardiovascular defects. Chicks that developed continuously at 37° C did not. What’s more, treating the embryos with a molecule that blocked TRPV1 before temporarily raising the temperature prevented craniofacial defects and reduced cardiovascular defects. And using a drug that activates TRPV4 in regular temperature conditions induced birth defects.

The research is the first to detail the mechanism that connects a fever to birth defects, “and it will hopefully get people thinking about this,” says medical geneticist Richard Finnell of Baylor College of Medicine in Houston, who was not involved in the study. “I was awfully impressed.”

Still, it’s unclear how high a fever has to be, how long it needs to last and exactly when within the first trimester it needs to occur to cause such birth defects, Benner says. “Fevers are very common in pregnancy, and the vast majority of the time, women who’ve had fevers are going to deliver healthy babies,” he says. Plus, he points to two clinical studies that have shown that the fever-reducer acetaminophen — commonly known as Tylenol — decreased fever-associated birth defects, and he suggests that doctors and patients consider the drug’s use to treat fevers early in pregnancy.

Citations

M. Hutson et al. Temperature-activated ion channels in neural crest cells confer maternal fever-associated birth defects. Science Signaling. Published online October 10, 2017. doi: 10.1126/scisignal.aal4055.

M. Oster et al. Associations between maternal fever and influenza and congenital heart defects. The Journal of Pediatrics. Volume 158, June 2011, p. 990. doi: 10.1016/j.jpeds.2010.11.058.

M. Feldkamp et al. Acetaminophen use in pregnancy and risk of birth defects: Findings from the National Birth Defects Prevention Study. Obstetrics & Gynecology. Volume 115, January 2010, p. 109. doi: 10.1097/AOG.0b013e3181c52616.

Further Reading

N. Seppa. Flu shot during pregnancy is safe, but flu isn’t. Science News. Vol. 183, February 23, 2013, p. 10.

N. Seppa. NSAIDs may be risky early in pregnancy. Science News. Vol. 180, November 5, 2011, p. 14.

N. Seppa. Pregnancy risk from blood pressure drugs? Science News. Vol. 170, July 1, 2006, p. 13.

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