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World Infant Mortality Rates
Historical Perspective on
Pregnancy
n
For much of history it was
thought that anything a pregnant mother did could effect
the developing infant.
n
For Example: Strawberry Marks
n
With the discovery of the
“Placental Barrier” it was thought that fetus was protected from
teratogens
Placental Barrier
Impact of Thalidomide
n
In Europe, Thalidomide was
commonly prescribed for morning sickness
n
It had been tested and found
safe with pregnant rats
n
In this country, F.D.A.
approval was pending
Impact of Thalidomide
When at a medical meeting in
Europe there was
discussion about:
Three major stages of
prenatal development
n
1. Germinal
Stage: conception to 2 weeks
n
Formation of
Blastocyst and Attachment to Uterine Wall
Three major stages of
prenatal development
n
2. Embryonic
Period: 2nd to 8th Week
n
Formation of
all basic structures
n
Only ¼” in
size
Three major stages of
prenatal development
n
Fetal Stage:
8 to 39 weeks
n
Differentiation and Details
n
Significant
Growth
Prenatal Growth
Impact of Teratogens
n
Maybe “Dose
Specific”
n
Depends on
Genetic make-up of mother and child
n
Depends on
the Stage of Prenatal Development
Effects of Alcohol
n
Heavy
Drinking can result in children born with Fetal Alcohol Syndrome
n
Or, Fetal
Alocohol Effects
n
What about
casual drinking?
Effects of Smoking
n
Small for
date babies
n
Typically
about 1 ½ pounds smaller
Effect of Mother’s Age
n
For older women, the risk of
Down’s Syndrome
n
Rises very quickly past age of
40
n
Can be detected with
Amniocentesis or Villi Sampling
n
At what age should these be
done?
n
For younger teens, primary
risk is premature and/or small for age infant
Effect of Prescription and
Over-the-Counter Drugs
n
Drugs can have very
significant effects
n
Even common non-prescription
drugs can be dangerous
n
For example, aspirin in later
pregnancy
n
Are animal tests adequate?
n
Very few drugs have been
tested for long-term effects
n
Drugs can have a cumulative
effect
Impact of Nutrition
n
Baby does not automatically
get what if needs from the mother
n
Is important, not only during
pregnancy but during first two years for brain growth
n
Half the calories in first
year go for brain growth
n
Folic Acid (vitamin B complex)
is particular important to prevent Neural Tube Defects
n
Happens 8 days after
conception so nutrition prior to birth is important
Impact of Viruses and
Bacterial Infections
n
Cytomegalovirus (CMV)
n
Member of herpes family
n
Leading cause of deafness and
mental retardation
n
50% to 80% get in childhood
and are protected, if not, is often caught from young children
n
There is no vaccine
n
Toxoplasmosis
n
Caught from cat liter or in
gardens
n
Sanitary behaviors are
important
Public Health Policy in
U.S.
n
Are we targeting the most
important behaviors?
n
Teenage
Health Education?
Birth Controversies
n
Cesarean
Section
n
Is used in
approximately 20% of U.S. births a rate that is much higher than in most
countries
n
What accounts
for this high rate?
Birth Controversies
n
Fetal
Monitoring
n
Is it related
to birth risk?
Birth Controversies
n
Use of
Analgesics and Anesthetics
n
General
anesthetics
n
Epidurals
n
Natural
births
Birth Controversies
n
Alternative
and Home Births
n
Accounts for
very few birth in the
U.S., this
contrasts with other countries where most infants are born at home
n
Is it safe?
n
Why use an
alternative center?