The nurse is educating a group of pregnant clients about substances and exposures that can harm fetal development. Which of the following are considered teratogens? (Select All that Apply.)

A. Coffee: Moderate caffeine intake (less than 200 mg per day) is generally considered safe during pregnancy. Excessive amounts may increase the risk of miscarriage or low birth weight, but caffeine itself is not classified as a teratogen. B. Alcohol: Alcohol is a well-known teratogen that can cross the placenta and disrupt fetal development. Prenatal alcohol exposure can cause fetal alcohol spectrum disorders (FASDs), leading to growth restriction, facial abnormalities, and neurodevelopmental impairments. C. Radiation exposure: High levels of radiation, especially during early pregnancy, can damage rapidly dividing fetal cells and cause congenital malformations, growth restriction, or pregnancy loss. Even diagnostic exposure should be carefully monitored and minimized. D. MMR vaccine: The MMR (measles, mumps, rubella) vaccine contains live attenuated viruses and is contraindicated during pregnancy due to potential teratogenic effects on the developing fetus. Women are advised to avoid conception for at least 4 weeks after receiving it. E. Folic acid: Folic acid is not a teratogen; it is protective against neural tube defects such as spina bifida and anencephaly. Supplementation before and during early pregnancy supports normal neural development and reduces major congenital anomalies.