Duke researchers make important link between birth defects and fever

Excerpted from the Spring 2018 Duke Children's Stories, from an article written by Bernadette Gillis

When a woman first becomes pregnant or is thinking about becoming pregnant, her doctor will make certain recommendations— like taking multivitamins with folic acid and not drinking alcohol—all in the hopes of having a healthy baby and avoiding birth defects. Researchers at Duke hope the results of a new study will encourage doctors to add another item to their list of recommendations during prenatal counseling: treating fevers with acetaminophen (Tylenol). 

Scientists have known for some time that fevers can cause birth defects. But what they haven’t been able to answer with certainty is the question of whether it is the fever itself or an infection (of which fever is a symptom) that is the true cause of birth defects. 

The findings of this research study, which appear in the October 10 issue of Science Signaling, give greater insight into this question, suggesting that the fever itself leads to heart defects and facial deformities such as cleft lip or palate. 


The amount of heart defects that affect live births in the U.S.


The number of infants affected by cleft lip or palate per year


The study also suggests that some congenital birth defects could be prevented if fevers are treated with acetaminophen during the first trimester—when the heart and jaw are first developing. Doctors generally advise women to avoid medication during pregnancy or when trying to get pregnant. But Eric Benner, MD, PhD, a neonatologist and assistant professor of pediatrics at Duke, says judicious use of acetaminophen for an acute problem such as fever is safe.


In the study, Benner, along with Mary Hutson, PD, and other researchers, used zebrafish and chicken embryos to demonstrate how fever affects a developing fetus. Using the animal models, they discovered that neural crest cells—the cells that contribute to the development of the heart, face, and jaw—contain temperature-sensitive ion channels. These are the same channels that let you know when you’ve touched something too hot.

The researchers created a magnet-based technology that allowed them to control the activity of these channels in neural crest cells and simulate fever-induced activity. Using this technology, they discovered that increased activity in two specific ion channels on the neural crest cells, called TRPV1 and TRPV4, caused embryos to develop facial and heart defects. 

Hutson, an assistant professor in pediatrics at Duke who studies congenital heart defects, says the results of the study are especially important because a fever could cause birth defects before a woman realizes she is pregnant, leaving her with few options. 

“Obstetricians should consider telling (women) that if they get a cold and develop a fever, acetaminophen is a safe drug to take during pregnancy.”

Eric Benner, MD, PhD

If we understand how things work, we can better understand the types of things we can do to make things better when they don’t work.

- Mary Hutson, PhD


We appreciate every gift of every size, making sure that your generosity is used to advance medical care and provide a better tomorrow for our children. You can choose a dollar amount to give now, or continue exploring more ways that you can support Duke Children’s.