The Prenatal Environment

1. The Prenatal Environment Psy 274 – Spencerian College Stephen Landman, Ph.D.

2. Environmental Factors Affect: Gametes – Sperm or Egg Cells Zygote – Fertilized Egg that Divides for Two Weeks Embryo – From Conception to 8 Weeks Fetus – 8 Weeks Until Birth

3. Teratogens – An Agent That Can Cause Malformations of An Embryo or Fetus Some Common Teratogens: STDs Alcohol Drugs Smoking Infections Hypertension Diabetes Rh Factor Environmental Toxins Acute Surgical Problems Maternal & Paternal Age Maternal Malnutrition Chronic Stress Multifetal Pregnancy The effects, if any, from these risk factors depends largely on the degree of exposure and the age of the fetus at the time it comes under attack.

4. Sexually Transmitted Diseases HIV – Transmission is preventable, with medication. Otherwise HIV may be transmitted, with catastrophic results. Herpes – Usually transmitted during delivery, so a cesarean section delivery is usually done. Human Pappiloma Virus (HPV; genital warts) – Can block birth canal, requiring a C-Section Gonorrhea – Increased risk of miscarriage, or baby has increased risk of blindness, joint infection, or life threatening blood infection. Mother should be treated. Chlamydia – Increased chance of miscarriage and preterm delivery; eye infections, pneumonia. Mother should be cured. Syphilis – may cause fatal infection in fetus, prematurity, problems with brain, eyes, heart, ears, skin, and bones. Mother should be treated. Trichomoniasis – associated with prematurity. Treatment: mother can be cured. Hepatitis B – Baby can be born with Hepatitis B; associated with prematurity. Treatment: Baby can be injected with antibodies.

5. Alcohol & Pregnancy Drinking alcohol can cause many different physical and mental birth defects. No level of alcohol use is now considered to be safe. Alcohol passes quickly into the fetus, and produces a high blood alcohol level in the fetus, and the level remains elevated for a longer period of time than it does in the mother. Fetal Alcohol Syndrome – low birth weight, facial characteristics (small eyes, thin upper lip, smooth skin between nose and upper lip), mental retardation, impaired heart and other organs, poor coordination, emotional and behavioral problems.

6. Drugs – Prescribed, OTC, and Illicit Unless absolutely necessary, drugs should not be used during pregnancy. The doctor and expectant mother need to do a risk-benefit analysis before any drugs are taken. Click Here: From the Merck Manual web site. The use of illicit drugs during pregnancy can cause too many problems to list. Caffeine – intake should be discontinued or limited to equivalent of one cup of coffee per day especially during the first trimester. Higher doses are associated with miscarriage.

7. Smoking and Pregnancy Smoking while pregnant associated with many increased risks, including ectopic pregnancy, placental complications, stillbirth, miscarriage, low birth weight, prematurity, cleft lip and palate, cerebral palsy, mental retardation, learning problems, SIDS, asthma, and behavioral problems, to name a few. Exposure to second-hand smoke by the mother, while pregnant,may have ill effects on the fetus – same as mother smoking. The baby, exposed to smoke after birth is at risk for many problems. Smoking may reduce quantity and quality of breast milk, sometimes producing illness in the baby.

8. Infections STD Infections – Previously discussed Urinary Tract Infection – Common in pregnancy, and can be treated safely with antibiotics if treated early. Untreated can cause kidney infection, and can lead to early labor. Rubella (German Measles) – Carries risk of major birth defects. Mother should be tested and if necessary vaccinated before becoming pregnant. Chicken Pox – Mother should be tested, and if necessary vaccinated before becoming pregnant. If contracted during pregnancy, various birth defects can result. Cytomegalovirus (CMV) – A herpes virus which may be sexually transmitted or can be acquired through sharing eating utensils or coming into contact with another’s bodily fluids by other means. Fetus can be affected leading to CNS abnormalities, a small head, enlarged spleen and/or liver, hearing loss, visual impairment, mental retardation, and other birth defects. This is the most common virus transmitted to a pregnant woman’s unborn child. Pregnant women should practice good hygiene to prevent contracting the virus.

9. Hypertension Pregnancy Induced Hypertension (PIH) – formerly known as Pre-eclampsia, Eclampsia or Toxemia. The cause is unknown. Occurs in 5-10% of all pregnancies, in the second trimester. Includes high blood pressure, swelling (edema), and the spilling of protein into the urine (proteinuria). Can effect mother’s kidneys, liver, lungs, and can involve seizures or stroke. Can interfere with blood supply to the fetus, interfering with good nutrition. Treatment may involve induced delivery, or medications to prevent brain hemorrhage, lung, and intestinal problems in the baby. Also medications to treat symptoms in the mother.

10. Gestational Diabetes Diabetes develops in 1-3% of pregnancies. Hormones in the placenta that help the fetus develop also block the action of the mother’s insulin within her body. Can lead to large baby, causing problems with delivery. Other problems for the baby can include premature birth, low birth weight, miscarriage, stillbirth, maldeveloped organs, problems with blood sugar. Treatment involves diet, exercise, and perhaps medication or insulin. If a woman has Type 1 or Type 2 diabetes, she should work to get it well controlled before becoming pregnant.

11. Rh Incompatibility May occur is the mother has Rh negative blood, and the father has Rh positive blood. 50% of the time the baby will have Rh positive blood. If during delivery the mother’s and the baby’s blood intermingles, the mother’s blood can produce antibodies. Then, in a second pregnancy, the mother’s blood will identify the baby’s blood cells as being foreign, and pass into the baby’s bloodstream and attack the baby’s blood cells. The problem can be prevented by giving the mother immune globulin shots during the first pregnancy to prevent the formation of antibodies. Otherwise the baby might need a blood transfusion. Untreated, the baby can have anemia, jaundice, heart failure, and death.

12. Environmental Toxins Second hand smoke has already been mentioned. Inhalation of toxic vapors, such as in glue or paint sniffing. Cleaning solvent methyl ethyl ketone (MEK) used in many workplaces interferes with normal fetal growth and development, and is a neurotoxin affecting mental processes. Mercury poisoning from eating contaminated fish can cause mental retardation and deformities. The new energy-saving compact fluorescent light bulbs contain mercury, and a broken one constitutes a real health hazard, and should be cleaned up only by trained persons. Lead (from paint, water pipes, ceramics, etc), polychlorinated biphenyls (PCBs) which in the past were widely used in many products, and DDT, a synthetic pesticide, are prenatal toxins. These substances can affect the fetus, and also appear in breast milk. These substances are now banned as far as original widespread use, but are now permanent parts of the environment. Poor air quality in urban industrialized areas negatively affects fetal development.

13. Surgery During Pregnancy About 2% of pregnant women have surgery during pregnancy. One concern is the effects of anesthesia on the fetus. Special precautions are used and the fetus is monitored during surgery. When all precautions are taken, the risk to the fetus is minimal. Where possible, surgery should be postponed until at least the second trimester. Aside: Operating room nurses, anesthetists, and physicians, have a significantly higher percentage (3 to 4 times higher) of miscarriages than do the general population.

14. Maternal & Paternal Age More women are having their first babies later in life. They have an increased risk of gestational diabetes, low lying placenta, premature birth, miscarriage, and stillbirth. There is a higher chance of having a child with Down Syndrome (1 in 500 between the ages of 35-39; 1 in 250 between the ages of 40-44; 1 in 70 over the age of 45, but such estimates vary widely). Down syndrome is also associated with paternal age, as is miscarriage.

15. Maternal Malnutrition Maternal malnutrition during pregnancy is associated with low birth weight and heart disease in the newborn. Also the ability to produce a good quantity and quality of breast milk is affected. Children born to malnourished mothers have a higher rate of infections and chronic diseases in later life. New research suggests that malnourishment of the pregnant mother is associated with obesity in the child. Children born to malnourished women are more sedentary, and this persists throughout life, with obesity appearing after puberty. Pregnant women should practice good nutrition and are often advised to take vitamin supplements.

16. Chronic Stress Stress hormones (cortisol, for one) cross through the placenta to the fetus. Pregnant women with chronic depression and anxiety have smaller babies. One study at the U. of Kentucky suggested that maternal stress can affect fetal brain development. Other studies have shown relationships between maternal stress and temperamental difficulties in infants, and may be related to later ADHD and depressive illness. http://www.biology-online.org/articles/study_suggests_maternal_stress.html

17. Multifetal Pregnancy Multifetal pregnancies are associated with preterm labor, preterm delivery and abnormal presentation. There may be placental shearing after delivery of the first child, presenting a risk for the remaining child or children. Low birth weight is common. Pregnancy Induced Hypertension and Gestational Diabetes are more common. Over the past 20 years there are more mutlifetal pregnancies due to assisted reproduction for infertility treatment.

18. Prematurity As we have seen, there are many factors that are related to premature births. New research (March 2008) indicates that the effects of prematurity may affect an individual throughout life. Click here for a report of this research.

19. The Mozart Effect? Some researchers suggested that pregnant women who listen to classical music have smarter babies. As a result many parents bought classical music CDs so as to get little geniuses in their nurseries. Later research did not show that the Mozart Effect lived up to its promise. However it is safe to say that women who are concerned enough about providing their children with all the advantages before giving birth will also provide their born children with a favorable post-natal environment, so those children are in good places.

20. Bottom Line Pregnant women should take good care of themselves, and everybody else should treat them extremely well also.