maternal & infant health

infertility

• not able to get pregnant or stay pregnant after 1 year (up to age 35)

• 9% men, 11% women

risk factors for infertility

• age

• chemical exposure including tobacco, alc, and certain meds

• stress

• chronic disease: diabetes, heart disease, obesity, high bp, autoimmune disorders

rates of involuntary pregnancy loss

• spontaneous abortion = miscarriage

• hard to assess

• approx. 40-60% of conceptions do not result in successful birth (not including intentional abortions

  • early embryo mortality

  • 10-15% of known pregnancies end in miscarriage

  • approx. 1% of pregnancies end in stillbirth

    • death of baby in utero after week 20

women’s age

• fertility drops after 35

• higher risk of chromosomal abnormality if you carry to term as an older mom

• having a pregnancy when you have high bp or heart disease increases risks when preg

  • chronic disease has an impact = more complications

men & age

• older fathers: several issues, including:

  • higher sperm mutation rate

  • increased risk of schizophrenia (in offspring)

  • increased risk of bipolar disorder

  • birth rates dropping around 20-24

plan ahead

• prenatal vitamins & healthy diet

• folic acid & neural tube defects

  • failure of neural tube closure by week 4 (day 28 after conception); often occurs before mother knows she is pregnant

    • may not have all the necessary vitamins

gestation period

40 weeks

• begin count from first day of last period

• end at birth

three trimesters

• 1st: weeks 0-13

  • morning sickness

• 2nd: weeks 14-26

  • less morning sickness, more prenatal checkups

• 3rd: weeks 27-40

  • higher risk of pre-eclampsia, gestational diabetes

prenatal health

occurring, existing, or performed prior to birth

• first visit:

  • review med history/pre-existing conditions

  • screening recommendations

  • medications/exposures

  • healthy lifestyle

factors that complicate pregnancy

• eating disorders

• epilepsy

• heart disease

• high bp

• kidney problems

• autoimmune disorders

• nicotine use

  • increases b.p, affects baby’s nervous system development

• STIs

factors pt.2

• thyroid disease

  • can take weeks to stabilize

  • below acting thyroid can affect the baby

• uterine fibroids

• diabetes

• cancer

• PCOS - hormonal imbalance

• HIV

  • can prevent baby from getting it

toxoplasmosis (toxoplasma gondii; protozoan parasite

• neuro damage, blindness, epilepsy

• avoid cat feces and handling/eating raw fish

rubella (measles)

• miscarriage/stillbirth, deafness, heart defects, intellectual disabilities, low birthweight

• get MMR vaccine BEFORE pregnancy

cytomegalovirus

common in daycares

• microcephaly (abnormal smallness of head, incomplete brain development), hearing loss, seizures, developmental delay

• avoid sharing foods/utensils w/ babies/children, good handwashing (endemic; no vaccine/treatment)

herpes simplex

• seizures, inflammation of brain, increased morbidity/mortality

• discuss during prenatal visits for appropriate management

HIV

• immune system damage

• discuss during prenatal visits for appropriate management

listeriosis

food-borne illness

avoid:

• recalled foods

• raw sprouts/seafood (smoked)

• unpasteurized milk, juice, cider

• soft cheeses/raw milk cheeses

• soft-serve ice cream

• pre-made meat or seafood salad/meat spreads

• undercooked/raw eggs

• hot dogs/lunch meat

  • more prone to pathogens

syphilis

sexually transmitted infection that can be fatal to fetus or newborn

• recommendation: test all women during pregnancy; treatment is available

• if the women has it, test partner too

infections during pregnancy - preventable

• HEP B (HBV): get tested; vaccinate

• influenza: vaccinate

• zika virus: can cause severe fetal brain defects (underdeveloped brain —> inadequate brain functions in babies)

  • don’t travel to areas w/ zika

  • use condoms if partner has lived in/traveled to area w/ zika (sexually transmitted)

environmental exposures

• environmental exposures

  • mercury

  • lead

  • excess Vitamin A

    • found in skin treatments

    • excess amounts of retinol during pregnancy affects molecular signaling —> birth defects, lower IQ

chemical exposures

• pharmaceuticals

• other chemical exposures (chemicals in paint, pesticides, lead dust)

• lifestyle factors

  • alc

    • fetal alc syndrome (≈1% of births)

  • nicotine

  • illegal drugs

  • opioids

• neonatal abstinence syndrome

  • born to mothers w/ drug dependence

physical defects

• distinctive facial features

• small head circumference/brain size

• heart defects

• vision/hearing problems

• slow physical growth

brain & central nervous system problems

• intellectual disability

• learning disorders

• poor memory

• trouble identifying consequences of choices

• difficulty w/ problem solving & reasoning

• rapidly changing moods

social/behavioral issues

• difficulty in school

• poor social skills

• trouble getting along w/ others

• difficulty planning or working toward a goal

• problems staying on task

• problems w/ behavior and impulse control

nicotine

• causes toxicity to the nervous system of the developing fetus

• animal studies suggest nicotine use during pregnancy plays a key role in offspring health effects including

  • type 2 diabetes

  • obesity

  • hypertension

  • neurobehavioral defects

vaping

• ur combusting the juices so you dk what u r actually inhaling

cigarette smoking

• associated in humans with:

  • miscarriage/stillbirth

  • placenta previa

  • pre-term birth

  • low birthweight

  • sudden infant death syndrome

timing of exposure

• when a body part is forming it is most sensitive to disruption/birth defects

• after diff time points u see diff defects in diff organs

• defects in hamster caused by excess retinoic acid (metabolic vit A)

  • causes birth defects & problems w/ signaling

gestational hypertension

• develops during pregnancy

• getting high bp as a result of pregnancy

preeclampsia

• high bp with protein in urine &/or edema after week 20

• signs of damage to other organ (s)

• potentially fatal for mother and child

• affects 4% of pregnancies in the US

Eclampsia

• more serious

• preeclampsia + seizures/convulsions

• may result in seizures and coma

• doctor is balancing the health of the baby and the mom

gestational diabetes

• those that didn’t have diabetes before pregnancy

• affects 2-10% of pregnancies in US

• test for it at 24-28 weeks

• increased risk for:

  • large size of baby (more likely to need C-section)

  • high bp

  • preeclampsia

  • 50% go on to have type 2 diabetes

• risk, excess weight gain by mother:

  • baby too large

  • obesity during childhood

pregnancy complications

• ectopic pregnancy: implantation in the fallopian tube

• placental abruption: placenta separates from uterine wall; fetus without enough oxygen/nutrients

• placenta previa: 3rd trimester bleeding, placenta covers the cervix; increases risk to baby & mother

other pregnancy complications

• placenta accreta: placenta attaches too deeply into wall of uterus (can have a lot of bleeding)

• premature rupture of membranes (PROM): amniotic sac ruptures before labor starts (water breaking)

  • preterm PROM: before 37 weeks; approx 5-7% pregnancies, and responsible for approx 1/3 preterm births

placenta accreta spectrum (PAS)

• placenta attaches too deeply into wall of uterus

• risk factors:

  • previous C-section or other uterine surgery

  • position of the placenta

  • mother > 35yrs

  • previous childbirth

• risks of placenta accreta:

  • severe maternal blood loss

  • blood transfusions

  • hysterectomy (unplanned, involuntary)

  • death

Cesarean sections

• some are medically necessary

• approx 9.6% in US not necessary (reduce the until medically necessary)

• each C-section increases risk of:

  • placenta previa

  • placenta accreta

  • gravid (related to pregnancy) hysterectomy

maternal morbidity

• conditions that result from or are aggravated by pregnancy

• proposed contributing factors for increase in severe maternal morbidity:

  • C-section deliveries

  • increases in maternal age

  • preexisting chronic disease

  • pre-pregnancy obesity

most common severe maternal morbidity procedures:

• blood transfusions

• hysterectomy

• ventilation/temporary tracheostomy

Leading causes globally/US

• WHO

  • hemorrhage (27%)

  • hypertension in pregnancy (14%)

  • infection (11%)

  • unsafe abortion (3%)

• US

  • heart conditions

  • infection

  • bleeding

  • blood clots

contributing factor

• reasons for increase is unclear

• increasing chronic disease

  • hypertension

  • diabetes

  • chronic heart disease

• maternal age

• access to care

• lots of issues related to policies

emotional health after birth

• baby blues: usually resolves on its own within a few days

• postpartum depression (1 in 9 women in US)

  • more intense/longer baby blues

  • risk factors:

    • low social support

    • difficulties with pregnancy

    • mother of mutltiples (twins etc)

pre-term birth

• btw 20-37 weeks of gestation

  • increased risk of live-threatening complications, long-term problems, & developmental delays

• weeks 37-39: significant lung, liver, and brain developments

low birth weight

• < 2500 mg

• very low (<1500g)

• Causes:

  • pre-term birth

  • intrauterine growth retardation (babies born full-term)

• Risk factors:

  • chemical exposures, smoking, alc, lead

  • lack of maternal weight gain

  • stress

  • mother <15 yrs or >35yrs

  • hypertension

• Effects:

  • increased risk of infant morbidity & mortality

disparities by edu levl

• PRMR = pregnancy-related mortality ratio

• PRMR for black women with at least a college degree 5 times high as white women with similar edu