CH4: Prenatal Development, Birth, & the Newborn

PSYC 207 unit 2 exam material

prenatal development

Changes that occur in utero, divided into three periods

• Germinal

• Embryonic

• Fetal

germinal period

Begins with conception & ends with blastocyst implantation in uterine wall

conception

Occurs in the fallopian tube — sperm fuses with the egg, forming zygote. Cellular division occurs, until composed of 100 cells and then implantation in uterine lining (occurs during first 2 weeks)

zygote

Cell containing combined genetic information of both parent cells

blastocyst

Multi-cellular organism derived from the zygote, composed of 100 cells

• Embryonic disk — becomes the embryo

• Trophoblast — becomes the placenta

acrosome

Part of the sperm that contains the genetic information

embryonic period

Begins with the implantation of the blastocyst into the uterine wall, and ends with the formation of basic organs and systems.

Weeks 3-8

embryo

Multi-cellular organism implanted into the uterine lining

cephalocaudal

A principle of growth that states that physical development proceeds from the head down to the toes

proximodistal

A principle of growth that states that physical development proceeds from the center of the body (midline) outward toward the extremities.

umbilical vein

Blood vessel that carries oxygen and nutrient rich blood from the placenta directly to the growing fetus

arteries

Blood vessels that carry deoxygenated blood and waste away from the embryo and into the placenta.

fetal period

Begins with the formation of major organs/systems and ends with birth (weeks 9-delivery)

• Throughout this period…

  • Vital structures continue to develop

  • Major organs become functional

  • Cell differentiation continues

  • Sexual differentiation occurs

fetus

Organism with major structures formed, which experiences additional growth in size and function

month 3

Fetal Milestones

_____ -___:

• Hair, nails, and teeth

• Digestive development continues

month 4-6

Fetal Milestones

______ ___:

• Eyes more sensitive

• Hearing develops

• Respiratory development continues

Month 5:

• Reflexes emerge

  • Sucking

  • Swallowing

  • Sleep/wake cycle

Month __:

• Age of viability (24 weeks)

• Majority of neurons developed

  • Rudimentary

  • Glial cells still developing

• Pain perception

month 7-9

Fetal Milestones

_____ ___-___:

• Preparing for birth

  • Fat reserves grow

  • Subcutaneous fat

  • Increased motor activity

  • Lungs expand and contract

• 37 weeks

  • Organs sufficiently developed

neural plate

Location of the embryonic stem cells capable of producing all the different cells that make up the brain.

• Changes shape, folds inward, forming the neural groove

• Neural groove converges & fuses

neural tube

Early foundation of the nervous system, formed around 25 days after conception

endoderm

The innermost layer that becomes the internal (digestive & respiratory) tissue

mesoderm

The middle layer that becomes the muscular & connective tissue

ectoderm

The outermost layer that becomes the nervous system and outer tissue

neuron

Specialized cells which allow communication throughout the nervous system

neurogenesis

Begins week 9 & mostly complete by 20 weeks (exception = hippocampus)

The process of neural growth & development

neural migration

Begins week 9 & mostly complete by 24 weeks

Process of orderly migration by neurons of the neocortex

gray matter

Regions of the brain that contain the nerve cell bodies

white matter

Regions of the brain that contain axons, forming the neural pathways of the brain

teratogen

Environmental influences which hinder prenatal development

• Can disrupt embryo & fetal development

• Relevant Factors:

  • Species-specific vulnerability (between species differences)

  • Type of exposure (between factor differences)

  • Amount of exposure — greater exposure confers greater risk

  • Timing of exposure — depends on specific critical periods

  • Number of teratogens — additive or cumulative effects

  • Genotype — of both mother & offspring

congenital malformation

Structural defects or malformations present at birth

• Affects 1 in 33 U.S. live births

alcohol

The leading cause of preventable intellectual disabilities in the U.S.

• Confers risk of fetal alcohol spectrum disorders

  • Fetal Alcohol Syndrome (FASD): substantial risk among binge drinkers

• Psychological Symptoms:

  • Impaired judgement

  • Impulsivity

  • Learning disabilities

  • Increased ADHD risk

• Physical Characteristics:

  • Below average head circumference

  • Low nasal bridge

  • Flattened nose

  • small eye holes

  • thin upper lip

  • indistinct philtrum

• Adult Challenges:

  • Criminal behavior

  • Psychiatric issues

  • Unemployment

medication

Non-prescription substances which present the risk of teratogenic effects

• Herbal remedies, dietary supplements, over the counter medications

• Effects of prenatal exposure to ______ vary by substance, and include:

  • Pre-term birth

  • Behavioral disorders

  • Learning disorders

  • Low birthweight

  • Miscarriage & stillbirth

opioids

Drugs which work by agonizing endorphin system activity (ex. Oxycodone, Hydrocodone, Codeine, Fentanyl)

neonatal abstinence syndrome

Withdrawal syndrome related to prenatal substance exposure — most commonly associated w/ prenatal opioid exposure

• Symptoms:

  • Respiratory distress

  • Seizures

  • Diarrhea, fever, tremors, fussiness

    • Generally requires care in NICU

• Long-term Adverse Effects:

  • Respiratory issues

  • Behavioral issues & Developmental delays

  • Vision & Language issues

  • Sleep disturbances

Tobacco

____ smoke contain numerous teratogenic substances

• Nicotine, Carbon Monoxide, Tar, reduced o2 availability

• Adverse Effects:

  • Ectopic pregnancy

  • Placenta Previa/Abruption

  • Still birth

  • Pre-term birth

  • Learning disability

placental abruption

A condition in which the placenta lies low in the uterus, blocking the cervix

placenta previa

A condition in which the placenta detaches from the uterine wall prematurely

second; third

• ___ Hand Smoke: Indirect exposure/inhalation of ambient smoke

• ____ Hand Smoke: Indirect exposure to smoke lingering on clothes & furniture

illicit drugs

Consumption of illegal drugs has potential to harm the developing organism (ex. Heroin, Cocaine, Ecstasy)

• Maternal consumption increases the risk of issues across several broad domains — behavioral, academic, biological, developmental

  • Genetic & environmental effects are difficult to disentangle

• Increases risk of… stillbirth, low birth weight, spontaneous abortion

lead

Environmental Pollutants

• Found in paint, as well as contaminated soil

• Resembles vital minerals such as calcium

• Effects:

  • Hypertension

  • Low birth weight

  • Preterm birth

  • Infertility

  • Miscarriage

  • Neurodevelopmental delays

bpa

Environmental Pollutants

• Bisphenol: found in many commonly used plastics

  • Resembles hormones such as estrogen

• Effects:

  • Impacts function of Neural, Thyroid, Immune

  • Meta-analysis: impaired motor development

herbicides and pesticides

Environmental Pollutants

• Used to regulate growth of plants and pest populations

  • Glyphosate, found in roundup, is one example

• Effects:

  • Miscarriage

  • Congenital malformations: heart, oral cleft, limb

  • Neural tube defect

mercury

Environmental Pollutants

• Heavy metal associated with brain damage — damages cells & disturbs migration

• Effects:

  • Delayed sensory development: auditory, visual

  • Impaired motor development

radiation

Environmental Pollutants

• Disrupts typical cellular division processes via transmission of wave energy

• Effects:

  • Cancer

  • Failed implantation

  • Miscarriage

  • Motor, Growth, & Neural deficits

toxoplasmosis

Infection with protozoan parasite Toxoplasma Gondii — infection is typically asymptomatic

• Exposure Risk:

  • undercooked meat

  • unwashed produce

  • contaminated soil

  • cat litter

• Adverse Effects:

  • premature birth

  • visual malformation

  • neural malformation

  • stillbirth

zika virus

Viral infection often contracted through bodily fluids

• Effects:

  • Congenital malformations

  • Severe microencephaly

  • Subcortical calcification

  • Still birth

  • Club foot

  • Hypertonia

  • Neural effects:

    • Asymmetry

    • Atrophy

    • Seizures

    • Tremors

    • Irritability

gestational diabetes

Diabetes which develops during pregnancy

• Typical Course:

  • Develops ~20weeks (routine testing 24-28 weeks)

  • Resolves — Post pregnancy

• Risk Factors:

  • Family/Personal History

  • Age

  • Obesity/ Excessive Pregnancy Weight Gain

• Adverse Effects:

  • Jaundice

  • Low blood sugar

  • Respiratory Dysfunction

  • Birth Complications — Premature birth, stillbirth, preeclampsia, C-section

rubella

AKA German Measles — CDC recommends MMR (Measles, Mumps, Rubella) vaccines at least 1 month prior to conception

• Symptoms:

  • Rash

  • Flu-like symptoms

  • Only experienced by 50% of infected children

• Pre-natal Exposure — 1st trimester

  • Congenital malformations (heart, eyes, brain, ears)

  • Deafness almost certain if before week 11

    
    

hypertension

Gestational ______ develops over the course of pregnancy starting at ~20 weeks and resolves post pregnancy

• Associated with low birthweight, placental abruption, preeclampsia

• Risk factors:

  • Age > 35yrs.

  • Socioeconomic factors

  • Racial disparities

  • Psychosocial stress

  • Diet & Sedentary lifestyle

  • Poverty

  • Tobacco

covid 19

Infection with the SARS-CoV2 Virus; long-term effects are still unclear, but evidence of impaired neural development, speech, motor, and preterm birth

sexually transmitted infections

Highest risk of vertical transmission during childbirth (ex. chlamydia, gonnorrhea, herpes, syphilis, hep. B)

• Minimize Harm — pre-natal STI screening, C-section, Maternal STI treatments

vertical transmission

Viral or bacterial transmission between mother and fetus or neonate

• Effects vary, but include..

  • Premature rupture of amniotic sac

  • Premature birth

  • Pelvic inflammatory disease — stillbirth, congenital malformation, ectopic pregnancy

• Treatment:

  • maternal anti-retroviral medication

  • C-section

rh compatibility

• Rhesus factor: heritable blood protein (can be + or -)

  • Negative mother and positive offspring

    • Fetal blood cells enter maternal bloodstream

    • Maternal immune system creates antibodies

    • Maternal antibodies cross placenta & kill fetal red blood cells

    • Bilirubin buildup occurs as RBCs break down

  • High bilirubin levels = fluid buildup, swelling, brain damage & dysfunction, impaired speech, seizures, impaired hearing, impaired motor function

• Treatment = RhoGam Injection

weight gain

• Mothers should be consuming 300 more calories a day

• Ideally, ____ ____ is gradual

  • Excessive Weight Gain

    • Premature birth

    • Oversized infant

    • Blood clots

    • Gestational diabetes

    • Preeclampsia

stress

Chronic maternal ____ can harm development

• Can cause…

  • Birth complications

    • Low birthweight, preeclampsia

  • Childhood dysfunction

    • Inattention, fear, anxiety

maternal depression

Mood disorder characterized by feelings of worthlessness, sadness, guilt, and at least 2 weeks of impaired function

• 1 in 7 women experience depression surrounding birth (prior 7 subsequent year)

• Risk factors:

  • Prior complications & miscarriage

  • Domestic abuse

  • Chronic stress

  • Prior depression

• Risk of antidepressants:

  • Heart defect

  • Miscarriage

  • Low birthweight

  • Premature birth

  • Lung problems

advanced maternal age

Pregnancies after age 35 are classified as “______ _____ ____”

• If healthy, pregnancy is generally safe

• Increased risk of…

  • Diabetes & hypertension

  • Miscarriage, stillbirth, premature birth, C-section

  • Placenta previa

  • Fertility challenges

  • Congenital malformation & genetic disorder

• Has benefits as well…

  • Doubles likelihood of living to 95 after 33yrs.

  • Increase in 1% of lifetime income for each year delayed

teenage pregnancy

Pregnancy during adolescence caries unique risks

• Increased likelihood of complications — anemia, nutritional deficiencies, hypertension

• For mother >15yrs

  • Labor obstruction, premature birth, low birthweight

  • Underdeveloped organs

paternal; race

• _____ Age:

  • Over 40yrs.

    • Achondroplasia

    • Miscarriage

    • Congenital malformation

    • Psychopathology (schizophrenia, autism)

  • Mediated by accumulated sperm mutations

• Paternal ______:

  • Black = low birthweight, small for gestational age

  • Hispanic = small for gestational age

  • Mediated by psychosocial stress, socioeconomic status, utilization of healthcare

paternal; occupation

• ______ Education Level

  • High school or lower

    • Preterm birth & Low birthweight

    • Mediated by healthcare access, use of health information & health technology, openness to expert advice

• Paternal ______:

  • Hazardous chemical exposure (petrochemicals, lead, pesticides)

    • Adverse effects = miscarriage, cancer

    • Radiation exposure = cancer

ultrasound

A prenatal imaging test which relies on sound waves; typically at least once, more if possible issues detected

• Transvaginal — Early pregnancy

• Transabdominal — Weeks 16-20

• Can provide info on heart rate, motor activity, fetal positioning, number of fetuses, determine age

  • Monitor amniotic fluid levels, placental location, identifying malformations

chorionic villus sampling

A more intrusive prenatal assessment method that uses placental cell collection for genetic testing (~10-13 weeks)

Can increase risk of miscarriage

amniocentesis

A more intrusive prenatal assessment method that uses amniotic fluid collection for genetic testing (~14-20 weeks)

Can increase risk of miscarriage

infertility

A disease of the reproductive system resulting in failure to achieve pregnancy after a year of regular unprotected sex (10-15% U.S couples)

• Most common causes

  • Females

    • Failure to ovulate

    • Pelvic inflammatory disease (infection of female repro. organs)

    • STI complications

  • Males

    • Insufficient sperm production

• Treatment Options

  • Assisted reproductive technology

assisted reproductive technology

Techniques & procedures to assist couples struggling with infertility

• Examples:

  • In-Vitro Fertilization

  • Gamete Intra-Fallopian Tube Transfer

  • Zygote Intra-Fallopian Tube Transfer

in vitro fertilization

Procedure where eggs are removed from the ovaries and then fertilized in a laboratory before being implanted into the uterus

• Depends largely on quality of eggs

  • Fresh vs Frozen

  • Mother vs Donor

  • Maternal age

gamete; transfer

_____ Intra-Fallopian Tube _____

• Procedure where both the sperm and egg are implanted in the fallopian tube

• Higher rate of success than In-Vitro, but less common

zygote; transfer

_____ Intra-Fallopian Tube _____

• Procedure where the fertilized zygote is implanted into the fallopian tube

• Higher rate of success than In-Vitro, but less common

minor pregnancy complications

• Insomnia

• Back pain

• Heartburn

• Nausea

• Gas, hemorrhoids

• Varicose veins

• Shortness of Breath

severe pregnancy complications

• Ectopic Pregnancy

• Maternal Mortality

• Spontaneous abortion

preeclampsia

Characterized by hypertension, kidney dysfunction, and swelling of hands, feet, and face. Leading global cause of pregnancy complication (5-10% of all pregnancies; 40-60% of maternal death)

• Risk factors = 1st pregnancies, obesity, diabetes, twinning

• Treatment = bedrest, medication, anti-hypertensives, anti-convulsant, birth induction

• Related complication = eclampsia (seizures from preeclampsia)

preparing for childbirth

• Important factors to consider…

  • physical condition

  • social support

  • healthy environment

• Supportive, responsive environments increase resilience & eases the transition into parenthood

  • parenting classes

  • birthing classes

  • relationship classes

lamaze method

Originating in Russia, emphasizes gaining control over the delivery process

• Skills taught include…

  • muscle relaxation

  • attending to focal point

  • training of delivery coach

  • breathing through contractions

birthing locations

Traditions & practices vary by region & culture

• In Hospital Settings:

  • Expert supervision (nurses, midwives, doctors)

  • Reduces Mortality Risk

  • Recognition of Complications

  • Timely Intervention

• 1/3 non-hospital births occur in another type of medical facility

  • Physician’s office, Clinic, & Birthing Center

• In Home Settings:

  • 67% Midwife Supervised

  • Generally safe if healthy

  • More likely if white, over 25, & subsequent births

uterine contractions

The tightening/squeezing of the muscular wall in the uterus

• Duration = 30s ; Interval = 15-20min

  • Interval of 5 minutes — seek doctors

braxton hicks contractions

False uterine contractions; intermittent & often improve with movement

• Less common with subsequent deliveries

indicators of labor

• Uterine contractions w/ Duration = 1min ; Interval =3-4min

• Bloody cervical discharge

• Amniotic sac rupture (rare)

  • May lead to induction to decrease infection risk

stage 1

Stages of Vaginal Delivery…

• Buildup to delivery

• Typical Duration:

  • 1st Birth = 12-26 hrs

  • Subsequent = 6-9 hrs

• Key Events:

  • Cervix dilates to 4 inches

stage 2

Stages of Vaginal Delivery…

• Passage of the infant through the birth canal

• Typical Duration: 10-40min

• Key Events:

  • Contractions = 2-3min apart

  • Potential Episiotomy (cut made in perineum)

  • Guided pushing

  • Umbilical cord clamped & cut

stage 3

Stages of Vaginal Delivery…

• Typical Duration: 20min

• Key Events:

  • Placenta delivered

  • Episiotomy stitched

epidural block

Regional anesthetic which alleviates most lower body pain without impairing labor; typically safe w/ no adverse impacts on infant or mother

• Over 50% of hospital births utilize this

• May be used w/ other analgesics in case of…

  • Vaginal delivery w/ forceps

  • C-section

  • Vaginal delivery w/ vacuum

c section

Surgical delivery of infant through the abdomen — can be used in response to emergent issues (maternal health, breech birth, fetal distress, narrow birth canal, multiple infants)

• Prevalence = 1/3 U.S. births

• Varies globally, but more common in urban settings

• Generally safe but takes longer to heal & uterine wall weakness

induction

Methods which prompt uterine contractions before labor has begun

• Common Reasons:

  • Failure for labor to occur naturally w/in 2 weeks of projected due date

  • Amniotic sac has ruptured but contractions have not begun

  • Evidence that mother’s uterus has become infected

  • Disruptions in projected fetal growth pace

  • Insufficient amniotic fluid surrounding the fetus

  • Early placental abruption from inner uterine wall

  • Maternal medical conditions that threaten fetal wellbeing (hypertension, diabetes)

apgar

Neonatal assessment measuring five health signs ; standardized test to evaluate a newborn’s physical condition & immediate response to birth

• Conducted twice immediately following delivery (1min & 5min)

  • Neonatal Behavioral Assessment Scale (NBAS)

    • Motor development

    • Muscle tone

    • Stress response

      • Often used to further probe low APGAR infants

preterm birth

Describes infants delivered prior to 37 weeks of gestation; global leading cause of death in children younger than 5yrs

• Risk factors:

  • National poverty — more common in low-income nations 50% die due to lack of access to care

  • Anything that interferes w/ maternal processes

respiratory distress syndrome

Respiratory issue characterized by weak and irregular breathing

low birthweight

Describes infants weighing less than 5.5lbs

• Significant Risk Factor For…

  • Infant mortality in the 1st month

  • stunted growth

  • low IQ

  • premature birth

  • adult psychiatric disorders (ADHD, OCD, depression)

  • Chronic conditions (obesity, diabetes)

anoxia

Temporary lack of oxygen to the brain

• Adverse Outcomes:

  • Brain damage

  • Death in especially severe cases

small for date

Infant whose weight is below expectation based on gestational age

• Such infants can be full term or pre-term

• Must be smaller than 90% of infants the same gestational age

• 4x mortality risk

• Increased risk of cognitive impairments

baby blues

Characterized by feelings of sadness in the 3-5 days following birth; moodiness, difficulty sleeping, sense of being let down by birthing experience, typically resolve after 2 weeks

peripartum onset depression

Depressive mood disorder which occurs during or in the four weeks following pregnancy; maternal bonding issues, hopelessness, fear of maternal failure, intense irritability or anger, mood swings