Day in the Life of Nurse Al, Teratogen Information Specialist


A Birth Defects Insights Blog

By Alfred N. Romeo, RN, PhD MotherToBaby Utah and Society for Birth Defects Research and Prevention (BDRP) Communications Coordination Committee Member

This blog is also available on Medium at

As with many jobs, the day in the life of a teratogen information specialist is always interesting. I work with MotherToBaby Utah at the Utah Department of Health in our Title V Maternal and Child Health Block Grant agency. This means that our sister programs, such as Oral Health, the Office of Home Visiting, Utah Birth Defect Network, and others, are also working to improve the health of women and children. Many MotherToBaby affiliates in other states are located within universities, so we are a little different. But we do have a partnership with the University of Utah Department of Pediatrics where our Medical Director, Dr. John Carey (another BDRP member)is housed. OTIS is the professional society that provides the MotherToBaby service via affiliates across North America. To round out our staff, Lynn Martinez (past OTIS President) and Luisa Hansen work part-time on our MotherToBaby Utah team.

I’ve been with MotherToBaby UT for about 11 years now, but with the Utah Department of Health for almost 18 years. I got my start with MotherToBaby Utah when one of my part-time grants, working with young adults with special health care needs, ended and I needed more work to do. Before I was a nurse in public health, I worked in neonatal intensive care units caring for infants born prematurely or with birth defects. As I’ve worked with different populations, infants, young children, teens, and pregnant women. I’ve found a place where I can help two generations at the same time, keeping mom healthy and giving baby the best start possible.

About four days a week I answer telephone calls, texts, chat, and email from our Utah clients and answer their questions about a variety of exposures. Our service receives nearly 7,000 inquiries/contacts a year and we might have twenty to thirty contacts a day.

When we are not answering client questions, we keep busy with professional development, meetings, grant reports, and other activities. My degrees in literature, nursing, and health promotion help with the various roles and grant writing. I schedule and run the MotherToBaby Seminars twice a month, on the second and fourth Wednesdays at 12:30 pm Mountain Time. I’m scheduling speakers, setting up equipment, preparing my own presentations a few times a year, and putting recordings on our playlist. The articles that I like to review during the seminars might be related to a hot topic like air pollution; an exposure for a MotherToBaby fact sheet that I’m developing or editing like phenylephrine; an exposure for a manuscript that I’m working on like propylthiouracil; or an exposure for a MotherToBaby blog or podcast like diabetes.  All parts of the research cycle are important for our clients, from finding funding to do the studies, developing studies with good methods to answer gaps in the body of knowledge, recruiting participants, conducting the studies, developing the manuscripts, and finally translating the results for our clients. Our seminars and professional development help us improve our skills and propose research priorities to address the gaps in knowledge.

Technology is helping how we work to improve the health of women and their children. When teratogen information services first started in the 1980s, there were many trips to the library to answer client questions. Today, we have a custom database where we enter our contacts and look up summaries for exposures. It was fun working with the developer to build it and today I am responsible for maintaining it. With other databases such as LactMed®, Reprotox®, TERIS®, and Medications and Mothers’ Milk®, we can quickly find the answer to most questions during a conversation with a mother or provider. A few times a month, we have to search other databases, such as PubMed®, for original studies to piece together the best answer possible, in consultation with our colleagues.

Similar to making sure our database is operating, I’m responsible for making sure that our contracts are in place. We have funding contracts with OTIS, the University of Utah, and Utah Medicaid. We have purchasing contracts for our text tool, chat tool, and phone system. We have data contracts with OTIS and the companies that run our text and chat tools. Dealing with the business side of our service isn’t the most fun, but we have to pay the bills.

Speaking of paying the bills, MTB UT has been spending quite a bit of time on fundraising over the past two years. We lost two teratogen information specialist full-time employees to budget cuts over the past few years and a third in July, leaving us with one full-time and two part time staff. We are busier than ever, regrettably keeping women on hold on the phone more often. We have been writing grant applications, meeting with partners, and looking for new funding opportunities so that we can continue to operate and serve the women and providers in Utah that have relied upon us to answer their questions for more than 35 years. I wanted to remind my OTIS and BDRP colleagues to continue to donate to your professional societies. I’ve taken the opportunity to donate regularly to OTIS through AmazonSmile when I make online purchases. I have also donated directly to OTIS some years. Finally, I’ve set up my trust to donate 1% of my estate to OTIS upon my death. I don’t like to see our affiliate services close so I’ve decided to do something about it. I hope you will consider donation options that work for you.   

Like everyone, I have plenty of meetings beyond those with the boss and our team. I’ve been an OTIS member since 2009 and a BDRP member since 2014. I serve as the OTIS Research Committee Co-Chair so there are meetings to plan and projects to complete. I serve as one of the OTIS representatives on the BDRP Communications Coordination Committee. I also serve on the OTIS Meeting Planning Committee and help represent OTIS on the BDRP Program Committee where the work for the annual meeting continues all year long. I join other OTIS members in conference calls to support collaboration with the Association of Maternal and Child Health Programs (AMCHP) and the National Birth Defect Prevention Network (NBDPN). I help look for grant opportunities and help write grants when they are available, such as our recent collaborative effort with the Developmental Neurotoxicology Society (DNTS) for our conference grant from the National Institutes of Health.

My job gives me the regular opportunity to teach on a larger scale, something that I enjoy, beyond the one-on-one interactions with clients. A few times a year I provide lectures with pharmacy students, genetic counseling students, and medical residents. On an even larger scale, we work with our Medicaid agency and the outreach group for Medicaid for pregnant women, called Baby Your Baby in Utah. On the third Friday of the month at noon, I represent Baby Your Baby in a television news interview for a station which is broadcast across Utah. The news anchors know me as Nurse Al who wears the purple scrub top. It is a bit of work to pick a monthly topic, prepare my talking points, get edits from the team, and practice those talking points, never knowing what questions I might get on live television. I’ve been doing those regular interviews for few years. I still get nervous but it is fun. Those interviews can be found at

In addition to my full-time job, I have a part-time job, a few hours a month, working for the University of Utah on the Medical Home Portal website. I write and edit content and assist with the resources. The Medical Home Portal is designed for primary care providers, and their families, who care for children with special health care needs. Information is provided to help pediatricians screen for conditions and then manage those conditions that they may not see frequently, from arginase deficiency to fetal alcohol spectrum disorders to traumatic brain injury.

I’m cautiously looking forward to the next few years. I’m hoping we can find funding for our local program so I can keep doing the work that I love. I’m also looking forward to serving OTIS as the President Elect in January 2021. I’ll follow other recent OTIS Presidents who were also members of BDRP, such as Robert Felix, Kenneth Jones, Stephen Braddock, Christina Chambers, and Sarah Običan. I plan to continue to foster our joint work with BDRP and other organizations as we strengthen OTIS as an international organization.

There are many ways to get involved in researching and preventing birth defects and other adverse outcomes for mothers and their children. Some of our colleagues are doing research with animals to look for early warnings of possible birth defects; studying the placenta to determine how it responds to medications and various maternal conditions; watching for patterns of birth defects from pregnancy registries or birth defect registries; conducting clinical trials for various medications; and reviewing the studies to interpret those results for teratogen information specialists, public health professionals, and clinicians. Professionals from various disciplines are encouraged to become involved in research and in their professional societies to improve the health of women and children today and for future generations. 

Alfred N. Romeo, RN, PhD works at the Pregnancy Risk Line, MotherToBaby Utah, a partnership between the Utah Department of Health and the University of Utah. Visit the website at . The MotherToBaby Utah is an affiliate of the Organization of Teratology Information Specialists (OTIS) / MotherToBaby, a non-profit with affiliates across North America. Utah women with questions or concerns about pregnancy or breastfeeding exposures can call 1-800-822-2229.  Outside Utah, please call OTIS at 1-866-626-6847.  OTIS is conducting several studies, including studies for COVID-19. Women with or without study exposures can call OTIS to volunteer to participate or learn more by visiting

More about the Society for Birth Defects Research and Prevention (BDRP)

To understand and prevent birth defects and disorders of developmental and reproductive origin, BDRP promotes multi-disciplinary research and exchange of ideas; communicates information to health professionals, decision-makers, and the public; and provides education and training.

Scientists interested in or already involved in research related to topics mentioned in this blog are encouraged to join BDRP. BDRP is the premier source for cutting-edge research and authoritative information related to birth defects and developmentally mediated disorders. Our members include those specializing in cell and molecular biology, developmental biology and toxicology, reproduction and endocrinology, epidemiology, nutritional biochemistry, and genetics, as well as the clinical disciplines of prenatal medicine, pediatrics, obstetrics, neonatology, medical genetics, and teratogen risk counseling. In addition, BDRP publishes the scientific journal, Birth Defects Research. Learn more at Find BDRP on LinkedIn, Facebook, Twitter and YouTube.



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