Prenatal Factors Affecting Development

©Gallahue, D.L., Ozmun, J.C., & Goodway, J.D. (2012). Understanding Motor Development. Boston: McGraw-Hill.

McGraw-Hill/Irwin © 2012 McGraw-Hill Companies. All Rights Reserved.

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A number of prenatal factors, many of which can be controlled, affect

motor development during infancy and beyond.

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Medical Conditions: Diseases Disorders

Exposure to: Certain

medications Pollutants Radiation Infections

Use of: Alcohol Illicit Drugs Tobacco

Medical History: Age Genetics Nutritional

status Poverty

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Types: Placental Malnutrition: supply transport issues Fetal Malnutrition: fetal metabolism

complications Maternal Malnutrition: inadequate nutritional

intake Reasons for Maternal Malnutrition:

Dietary habits Poverty Stress

Consequences: >Prematurity (LBW,VLBW & preterm) >Birth defects

Maternal weight gain (table 5.2) General indicator of nutritional status

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Considerations for Maternal Drug Use: Timing during pregnancy Dosage of the drug Length of consumption Genetic predisposition Interaction effects

Common Drugs (table 5.3) Necessary Drugs (table 5.4) Illicit Drugs (table 5.5)

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Fetal Alcohol Spectrum Disorder Occurrence: 40,000 FASD yearly in USA Consequences:

FAS: Cognitive impairments; growth, physical and motor deficits; facial deformities

FAE: attention deficit disorder Tobacco Use

Occurrence: 13% USA pregnant women smoke Consequences:

>LBW & VLBW >Cleft lip/palate >Cognitive deficits > Sudden Infant Death Syndrome (SIDS)

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Union of Sperm & Egg: 23 + 23 = 46 total chromosomes 20,000 genes per chromosome

Chromosome Based Disorders: Spontaneous abortion: Estimated 15-50% of all

pregnancies Live births occur in 1% with damage Down syndrome: Most common

Gene Based Disorders: Autosomal dominate gene mutations: Few developmental

issues Autosomal negative gene mutations: Many

developmental issues Talipes Sickle-Cell Disease Tay-Sachs Disease Phenylketonuria (PKU) Spina Bifida

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Occurrence: About 1 in 800-1000 births Age-related: Age 35 = 1/400; 40 = 1/110; 45

1/35 Consequences:

Frequent premature birth (LBW + YFD) Slower growth rate Slower development

Delays in primitive & postural reflexes Hypotonia & hyperfexia Delays in attaining motor milestones

Intervention Strategies: Infant/toddler stimulation programs Developmentally appropriate activities

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Occurrence: About 1/700 2x more in males

Types: (figure 5.1) Equinovarus: Foot twists in and down Calcaneal Valgus: Foot twists up and out Metatarsus Varus: Front of foot twists in

Consequences: Untreated: Problems with upright

locomotion Treated: Favorable outcomes

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Occurrence: About 1/400 African-Americans 1/2 are carriers

Consequences: Anemia, pain, organ damage Slow growth & motor development Possible death

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Occurrence: Most prominent among European Jews Also found among French-Canadians & Cajuns Carriers in USA: About 1/30

2 parents = 25% chance 1 parent = 0% chance (but 50% chance of being

a carrier)

Consequences: Loss of motor control Paralysis Possible death

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Phenylketonuria (PKU) Occurrence:

Completely treatable metabolic disorder Inability to metabolize phenylalanine Check your diet soda

Consequences: Untreated = severe mental retardation Treated at birth = favorable outcome

Spina Bifida Occurrence:

About 1/2000, Familial: 1/40 to 1/20 Folic acid and spina bifida

Consequences: Loss of sensation in lower extremities Paralysis of the legs

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Excess Radiation Occurrence: >25 rads during pregnancy Consequences: >incidence of microcephaly 7

other birth defects Chemical Pollutants:

Occurrence: >lead and mercury Consequences: >birth defects

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Occurrence:

Chlamydia: Estimated 3 million yearly in USA Genital Herpes: Estimated 45 million in USA Gonorrhea: About 7000,000 yearly in USA Syphilis: On the decline in the USA Perinatal HIV: Estimated 6,000 births yearly in USA

Consequences: Chlamydia: Prematurity, stillbirth, pneumonia, eye

infections, blindness Genital Herpes: Brain damage, death Gonorrhea: Ectopic pregnancies, eye damage Syphilis: Severe illnesses, nervous system damage, death HIV/AIDS: Fever, weight loss, lethargy, diarrhea,

pneumonia, death

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Hormonal/Chemical Imbalances: Untreated Hypothyroidism: Cretinism Untreated Diabetes: Cognitive limitations;

cardio/respiratory problems; possible death) Rh Incompatibility (Erythroblastosis Fetalis):

Rh+ father & Rh- mother = Rh+ baby With first child mom builds antibodies = no problems Subsequent babies: Rhogam injection = no

problems; without = severe problems

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Cytomegalovirus (CMV) Occurrence: estimated 5% of newborns Consequences:

Untreated: Mild to moderate deficits in speech, gross and fine motor control; possible cognitive deficits; blindness; deafness

Treated: Positive outcome

Rubella (three day measles) Occurrence: no new cases in the USA since 1994 Consequences:

Untreated: Deafness; blindness, cognitive deficits Treated: Positive outcome

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Teenage Pregnancy Consequences:

>Maternal death rate < age 15 >LBW >Young for date

Toxoplasmosis Occurrence:

Protozoa found in 1/1000 infants 3000 infected each year in the USA Spore transmission (cat & mouse, meat)

Consequences: Cognitive deficits Sensory and motor disabilities

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Amniocentesis: Amniotic fluid sample analyzed between wk. 16-18

Chorionic Villus Sampling: Chorionic villi fragments analyzed prior to wk. 16

Ultrasound: Provides visual reference for above techniques & size/position data

Fetoscopy: Fetoscope inserted into uterus, rarely used due to >risk of abortion

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Maternal Affects; >Fitness <Weight gain & fat retention Easier labor Positive psychological & emotional benefits

Fetal Affects: <Fat >Stress tolerance

Delivery Affects: Easier labor

Infant Development Affects: Leaner body composition

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Pregnancy: 279 days +/- 2 weeks Labor: 1-24 hours (3 stages)

Beginning labor (Stage 1): Dilation to 4 cm. Amniotic sac breaks

Full labor & delivery (Stage 2): Dilation to 10cm., Primiparas: About 90 minutes to delivery Multiparas: About 45 minutes to delivery

Delivery of Placenta (Stage 3)

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Obstetrical Medications (table 5.8): Oxytocics: Initiate, augment labor Analgesics: Relieve pain Sedatives: Relieve anxiety

Birth Entry: Breech: Feet first; 4/100 Transverse: Shoulder first; 1/100 Forceps: Used in emergencies only Cesarean deliveries: about 38% USA Prepared childbirth (Lamaze & Leboyer)

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Both mother- and father-to-be have an obligation to their unborn child to ensure optimal development by

monitoring those factors over which they can exercise control.