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?