3 the impact of maternal illness on the newborn final 1

7/29/2019 3 the Impact of Maternal Illness on the Newborn Final 1

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The Impact ofMaternal Illness on

the NewbornJulniar M. Tasli

Herman BermawiAfifa Ramadanti


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Background Improvements in obstetric care can directly influence

neonatal survival

Prevention of neonatal asphyxia, sepsis, preterm birth

and low birth weight can be achieved through improvedcare during pregnancy and during delivery

In the new model of integrated perinatal care pediatricand obstetric care occur collaboratively towards thecommon goal of a safe delivery and improved neonatal

survival


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Learning Objectives

Identify maternal conditions during pregnancyand labor that can influence neonataloutcomes.

Understand the association between specificconditions and neonatal outcomes.

Suspect and recognize neonatal clinical

presentations related to such conditions.

Decide on management plan of the newbornbased on maternal presentation


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Maternal Well-being in Pregnancy:

Spacing of pregnancy

Adequacy of prenatal care including

immunizations (4 visits or more) Avoiding pregnancy at extremes of maternal

age

Avoidance of extremes of maternal pre-

pregnancy weight (under-weight and morbidobesity)

Appropriate weight gain and physical activity


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Balanced nutrition (micronutrient intake;iron, zinc, folic acid, iodine, calcium)

Avoidance of environmental exposures(nicotine, other drugs, medications,pesticides)

Mental health including stress and

depression


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Lack of compliance can be directly andindirectly associated with :

Prematurity and low birth weight and

complications associated with these

important contributors to infantmortality and morbidity

Higher incidence of specific neonatal

complications e.g. congenital anomalies

(neural tube defects) and in-utero

growth retardation


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Prenatal care and its role: Prenatal care is designed to identify maternal

complications early and give pregnant mothers guidanceto healthy behaviors during pregnancy.

Prenatal care should educate mothers and their

community on the identification of early danger signsduring pregnancy

Prenatal care should also help mothers prepare for thearrival of the newborn, and give them basic education onthe early care of the neonate.


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1. Early Identification of Pregnancy:

Accurate gestational age determination

Promotes the early adoption of healthybehaviors and avoidance of unhealthybehaviors and exposures

Early screening for infections and otherrisks


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Enhances the ability for early diagnosis andtreatment of maternal diseases affectingpregnancy: Anemia

Maternal malnutrition

Pre-existing medical conditions

(hypertension, diabetes, TB, malaria, STI &urinary tract infections)

Uterine conditions e.g. fibroids, and anatomicabnormalities (bicornuate uterus)

Maternal cardiac disease Thyroid disorders


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A. Maternal Nutrition Evaluating nutritional status

Low pre-pregnancy weight (less than 50Kg?)

Adequate weight gain (10-15 Kg)

Maternal anemia (Hgb =


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Recommendations Balanced dietary intake

Vit. D supplementation (severe deficiency may beassociated with neonatal hypocalcemia).

Adequate folic acid intake (starting before pregnancy)reduces the risk for neural tube defects.

Adequate iron supplementation especially in cases withanemia.

Avoiding Vit. A in high doses (teratogenic effects)


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B. Perinatal Infections


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Viral Infections:

Cytomegalovirus

Transmitted trans-placentally, breast milk

Associated with IUGR, hepatosplenomegaly,

microcephaly, retinopathy, and hydrops

May present in the neonate also with:

Jaundice, LBW, thrombocytopenia with skin

petechiae, and hearing loss


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Rubella:

Transplacentally transmitted

Dangerous effects on the fetus in the first

trimester Effects on the fetus include congenital heart

disease, IUGR, retinopathy, auditory nerve

hearing loss, cataract, purpura, and

hepatosplenomegaly


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Herpes simplex (HSV)

Ascending infection (intrapartum)

Effects on the fetus/neonate include: IUGR,Encephalitis/meningitis, seizures, retinitis,

mental retardation


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Varicella Zoster

Transmitted transplacentally (


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HIV

Transmitted transplacentally, during labor and

in breast milk Neonatal HIV/AIDS mostly asymptomatic in

the immediate neonatal period although some

manifest IUGR


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Hepatitis B

Transmitted mainly as an ascending

infection, and through breast feeding, rarely

transplacentally.

Associated with post-natal chronic hepatitis,

cirrhosis and hepatocellular carcinoma.


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Non-viral infections:


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Neisseria Gonorrhoea

Ascending infection intrapartum

Ophthalmia neonatorum (early)


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Treponema pallidum (syphilis)

Transmitted transplacentally, anytime during

pregnancy (worst effects with early infection)

Associated with fetal loss and still birth, andcongenital syphilis (skin and mucous

membrane lesions, hepato-splenomegaly,

anemia and thrombocytopenia, bone lesions)


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Toxoplasma gondii

Transplacentally transmitted with the worst

effects in early transmission

Associates with

Hydrocephalus/microcephaly, brain

calcifications, hepatosplenomegaly,

retintis/blindness hearing loss and mental

retardation.


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C. Thyroid Diseases


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Hypothyroidism

Suspected after thyroid surgery, and incases with goiter (thyroid swelling)

Associated with Hashimoto thyroiditis

May cause still birth, IUGR, placentalabruption, and preeclampsia.

Thyroxine replacement is indicated


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Hyperthyroidism Much more common than hypothyroidism

Should be suspected in cases with goiter

Most commonly due to Graves disease

If untreated can be dangerous to mother andfetus.

Maternal complications include severepreeclampsia and heart failure, and cardiacarrythmias

Fetal complications include preterm birth andneonatal thyrotoxicosis


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2. Identifications of IllnessesComplicating of Pregnancy:

Identification and early treatment ofhypertension in pregnancy as a continuum ofPre/eclampsia

Identification and treatment of GestationalDiabetes

Identification and treatment of infectionscomplicating pregnancy (UTI, systemic,malaria, TB, HIV)


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A. Impact of maternalhypertension

IUGR

Asphyxia

Prematurity and LBW/ SGA Congenital anomaly

Multiple gestation

Polycytemia + Hypebilirubinemia


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B. Impact of maternal diabetes

Maternal diabetes type A C :

+ LGA

+ Birth injuries+ Hyalin membran disease

+ Polycythemia

+ Hyperbilirubinemia

+ Hypoglycemia

+ Congenital anomaly


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Maternal diabetes type D F&R :

+ LBW / SGA

+ Conenital anomaly

+ Hypoglcemia

+ Polycythemia

+ Hyperbilirubinemia

3 the impact of maternal illness on the newborn final 1

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