What are some influences that impact on healthy prenatal development?

Teratogens are the broad range of substances (such as drugs and pollutants) and conditions (such as severe malnutrition and extreme stress) that increase the risk of prenatal abnormalities. These abnormalities include obvious physical problems (such as missing limbs) and more subtle impairments such as brain damage that first appears in elementary school. A specific teratogen may damage the body structures, the growth rate, the neurological networks, or all three. Teratogens that harm the brain, and therefore make a child hyperactive, antisocial, retarded and so on, are called behavioural teratogens; their effects can be far more damaging over the life of a person than physical defects. (Berger, 2000) What are the factors that influence the degree of affect? One crucial factor is when the developing organism is exposed to which teratogen. Some teratogens cause damage only during specific days or weeks early in pregnancy, when a particular part of the body is undergoing formation. Others can be harmful at any time, but how severe the damage is depends on when the exposure occurred. The time of greatest susceptibility is called the critical period. Each body structure has its own critical period. As a general rule, for physical defects the critical period is the entire period of the embryo. (Berger, 2000) A second important factor is the dose and/or frequency of exposure to a teratogen. For most teratogens, experts are reluctant to specify a threshold below which the substance is safe. One reason is that many teratogens have an interaction effect; that is, one poison intensifies the effects of another. (Berger, 2000) A third factor that determines whether a specific teratogen will be harmful, and to what extent, is the developing organism's genes. In some cases, genetic vulnerability is related to the sex of the developing organism. Generally, male embryos (XY) embryos and fetuses are at a greater risk than female in that more male embryos are more often aborted spontaneously. In addition, newborn boys have more birth defects, and older boys have more learning disabilities and other problems caused by behavioural teratogens. (Berger, 2000) What are some of the specific influences that may affect prenatal development? Radiation, chemicals and other hazards in the environment can endanger the fetus. Chromosomal abnormalities are higher among the offspring of fathers exposed to high levels of radiation in their occupations. Environmental pollutants and toxic wastes are also sources of danger to unborn children. Among the dangerous pollutants and wastes are carbon monoxide, mercury and lead. Another environmental concern is toxoplasmosis, a mild infection that causes cold-like symptoms or no apparent illness in adults, but can cause eye defects, brain defects and premature birth. Cats are common carriers of toxoplasmosis, especially outdoor cats who eat raw meat. The expectant mother may pick up the virus through the cat litter box. (Santrock, 1999) In terms of the mothers age, two time periods are of special interest: adolescence and the thirties and beyond. Infants born to adolescents are often premature. The mortality rate of infants born to adolescent mothers is double that of infants born to mothers in their twenties. Down Syndrome, a form of mental retardation, is related to the mother's age. By age 40, the probability is slightly over 1 in 100. By age 50, it is almost 1 in 10. The risk is also higher before age 18. Women also have more difficulty in becoming pregnant after the age of 30. (Santrock, 1999) A developing fetus depends completely on its mother for nutrition, which comes from the mother's blood. Among the important factors are the total number of calories and the appropriate levels of protein, vitamins and minerals. The mother's nutrition even influences her ability to reproduce. In extreme instances of malnutrition, women stop menstruating. Also children born to malnourished mothers are more likely to be malformed. (Santrock, 1999) Another common reason for slow fetal growth - and hence low birthweight - is maternal malnutrition, a problem that has many specific causes. Women who begin pregnancy underweight, eat poorly during pregnancy, and consequently do not gain at least 1.5 kilograms per month in the second and third trimesters run a much higher risk than others of having a low-birthweight infant. Indeed, women who gain less than 7 kilograms, even if they are non-smokers who begin pregnancy overweight, still have a higher risk of preterm and smaller babies than those who gain at least 7 kilograms. (Berger, 2000) Maternal diseases and infections can produce defects by crossing the placental barrier. For example, the greatest damage to the fetus from the mother contracting German measles occurs during the 3rd and 4th weeks

of pregnancy. Syphilis is more damaging later in pre-natal development - 4 months or more after conception. Rather than affecting organ development as Rubella does, syphilis damages organs after they have formed. The importance of the mother's health to the health of their offspring is nowhere better exemplified than when the mother is infected with HIV. (Santrock, 1999) Drugs includes the use of tobacco, alcohol, prescription or illegal drugs. For example, the effects of thalidomide during the fourth week of development had devastating effects. Heavy drinking by an expectant mother can also be devastating. Fetal alcohol syndrome is a cluster of abnormalities that appear in the offspring of mothers who drink alcohol heavily during pregnancy. The abnormalities include facial deformities and defective limbs, face and heart. Most of these children are below average in intelligence. In one study, however, even mothers who drank moderately during pregnancy had babies who were less attentive and alert, with the effects still present at 4 years of age. Cigarette smoking by pregnant women can also adversely influence pre-natal development, birth and postnatal development. Fetal and neonatal deaths are higher among smoking mothers. Also prevalent are a higher incidence of preterm births and lower birthweights. Respiratory problems and sudden infant death syndrome are also more common among the offspring of mothers who smoked during pregnancy. Tranquilizers taken during the first three months may cause cleft palate or other congenital malformations. Mothers who take large amounts of barbituates may have babies who are addicted or may exhibit tremors, restlessness and irritability. (Santrock, 1999) Drug Alcohol Usage Effects 3 or more drinks daily, or binge Causes fetal alcohol syndrome (FAS). Symptoms include drinking of 5 or more drinks on one abnormal facial characteristics (small head, wide spacing occasion early in pregnancy between the eyes, a flattened nose, a narrow upper lip, unusual eyelids), overall growth retardation, learning disabilities and behaviour problems. More than ounce of absolute Causes fetal alcohol effects (FAE). FAE does not obviously alcohol a day affect facial appearance or physical growth, but it affects brain functioning. Moderate drinking: less than 1 or 2 Probably has no negative effects on prenatal development, servings of beer or wine or 1 mixed although this is controversial drink on a few days per week Maternal smoking early in pregnancyIncreases risk of abnormalities, including malformations of the limbs and the urinary tract Maternal smoking late in pregnancy Reduces birthweight and size. Babies born to habitual smokers weigh, on average, about 250 grams less than they would otherwise be expected, and they are shorter, both at birth and in the years to come. They may have childhood problems, particularly with respiration and, in adulthood, increased risk of becoming smokers themselves. Paternal smoking Reduces birthweight by about 45 grams on average

Tobacco

Compared with women of higher socioeconomic status, pregnant women at the bottom of the economic ladder are more likely to be ill, malnourished, teenaged, and stressed. Physical difficulty like malfunction of the placenta or the umbilical cord is likely when pregnancies are closely spaced and close spacing correlates with poverty. Poverty helps explain the wide national and international variations in the following statistics: Of the more than 25 million low-birthweight infants born worldwide each year, the overwhelming majority are in developing countries. Developing countries in the same geographic region, with similar ethnic populations, have markedly different low-birthweight rates when they have different average incomes. Within nations, differences in low-birthweight rates among ethnic groups follow socioeconomic differences among those groups.

 Within the United States, low birthweight rates in the poorest states are almost twice those in some richer states. (Berger, 2000) The mother's stress can be transmitted to the fetus. When a pregnant woman experiences intense fears, anxieties and other emotions, physiological changes occur in the fetus. These include changes in respiration and glandular secretions. For example, producing adrenaline in response to fear restricts blood flow to the uterine area and may deprive the fetus of adequate oxygen. Also, reassuring the mother of fetal well-being has positive outcomes for the infants in the study. (Santrock, 1999) Teratogens The scientific study of congenital abnormalities caused by prenatal environmental influences is known as teratology (from the Greek word teras, meaning "marvel" or "monster"), and the environmental agents that produce abnormalities in the developing fetus are called teratogens. Drugs Chemicals (over-the-counter and prescribed pharmaceuticals as well as illegal substances) can cause a wide range of congenital abnormalities that account for about 10 percent of birth defects. The severity of the abnormality depends on the amount of the chemical the mother is exposed to, the developmental stage of the fetus, and the period of time over which the mother's exposure to the chemical takes place. In terms of narcotics, women who are addicted to heroin, morphine, or methadone give birth to addicted babies. Soon after birth, the babies show symptoms of withdrawal, including tremors, convulsions, difficulty breathing, and intestinal disturbances. Smoking and Nicotine Cigarette smoking has already been shown to have dire consequences for the smoker, and it can be hazardous for the fetus and the newborn child. The results of studies of thousands of pregnancies in the United States and elsewhere, encompassing various ethnic, racial, and cultural groupings, indicate that the fetus and newborn are significantly affected by cigarette smoking during pregnancy. Maternal smoking increases the risk of spontaneous abortions, bleeding during pregnancy, premature rupture of the amniotic sac, and fetal deaths and deaths of newborns. Women who smoke during pregnancy give birth to babies who are about one-half pound (225 grams) lighter (on the average) and smaller in all dimensions (for example, length and head circumference) than babies of nonsmokers, are born prematurely, and have other health problems. Alcohol The effects of alcohol are almost undisputed. Fetal alcohol syndrome (FAS), identified in 1973, is perhaps one of the best known and best documented outcomes of drinking, affecting approximately one out of every 750 births. And it is not just the heavy drinker who may place her fetus in danger. It has been found that women having one or more drinks daily were three times more likely to miscarry than women who had less than one drink daily. FAS is a pattern of malformations in which the most serious effect is mental retardation. Other possible complications include permanent growth retardation, malformations of the face, brain damage, hyperactivity and learning disabilities, and heart defects. Even if a child does not suffer from FAS, the effects of alcohol consumption can be significant. Although these children do not manifest the characteristics discussed above, they are at high risk for such problems of children of alcoholics as hyperactivity and learning disabilities. Results of research also indicate that moderate drinking can affect the later development of a child's intelligence as measured by IQ scores at age four. The Mother

Since the mother's body is the chief element in the fetus' environment, the mother's physical condition can significantly affect the baby's development. Among the maternal factors known to influence the fetus are disease, age, diet, reactions associated with a certain blood component, and prolonged stress. Even a mother's knowledge of what is taking place in her body can be important. Some research has shown that mothers who consumed potentially teratogenic drugs during pregnancy had very little information about these drugs and even less information about their effect during pregnancy. Diseases Since the placenta cannot filter out extremely small disease carriers, such as viruses, children can be born with malaria, measles, chicken pox, mumps, syphilis, or other venereal diseases that have been transmitted from the mother. Rubella is the most widespread of the viruses that have a teratogenic effect. If a pregnant woman contracts rubella in the first three months of pregnancy, she is likely to give birth to a child with a congenital abnormality such as heart disease, cataracts, deafness, or mental retardation. Interestingly, there is not a direct relationship between the severity of the disease in the mother and its effect on the fetus. For example, women who have had mild attacks of rubella have given birth to babies with severe abnormalities. Although rubella might be the most widespread disease, acquired immunodeficiency syndrome (AIDS) is by far the most frightening and the one that has received the most publicity. The vast majority of children with AIDS contracted the disease sometime between early pregnancy and birth. The disease is usually transmitted from the mother through the uterus during pregnancy or is acquired by the off-spring at birth. As of the early twenty-first century, there was not a cure for AIDS, and the majority of efforts at controlling the disease focused on education in an effort to get potential female AIDS victims to take the proper precautions and avoid sexual relationships with high-risk males, usually those involved with drugs. Significant progress was being made, especially concerning children. Toxemia is a frightening condition that is potentially fatal for the mother and the fetus. It is characterized by high blood pressure, swelling, and weight gain due to a buildup of fluid in the body tissues, and the presence of protein in the mother's urine. In severe cases the woman may go into convulsions or coma, placing a tremendous strain on her, which is carried over to the fetus. Women with toxemia frequently give birth to premature babies or to babies smaller than average for their gestational age. Like many other types of blood-pressure disorders, however, toxemia can be treated through medication and diet. Anoxia is a condition in which the brain of the baby does not receive enough oxygen to allow it to develop properly. Anoxia can cause certain forms of epilepsy, mental deficiency, cerebral palsy, and behavior disorders. If the amount of brain damage is not too severe, however, it may be possible to compensate for the disorder to some extent. Epilepsy can often be controlled with drugs, for instance, and many children with cerebral palsy can learn to control their affected muscles. Age Teenage mothers and those over thirty-five years of age have a higher risk of miscarriage, premature birth, and some birth defects than mothers in the prime childbearing years. Some of the reasons are fairly obvious. Very young mothers have not yet completed their own development, and the reproductive system may not be quite ready to function smoothly or effectively. In older women the reproductive system may be past its most efficient functioning. In both cases, pregnancy puts an extra strain on a body that is not fully able to bear it. Furthermore, there is some reason to think that a woman's ova may deteriorate with age, leading to a greater risk of birth defects. Women have all their ova in partly developed form when they are born. So a woman who becomes pregnant at age thirty-seven, for example, is "using" an ovum that has been more or less exposed to thirty-seven years' worth of harmful chemicals, radiation, virus

infections, and whatever else has happened to her body. This may explain why, for instance, Down syndrome is most common in children born to mothers over forty years of age. It is quite possible that men's sperm may also be susceptible to chemicals and radiation effects over time. Furthermore, there may be genetic disorders that cause changes in sperm structure. Diet and Physical Condition Just as other aspects of physical health are important, so is the mother's diet. While physicians and researchers have long realized that pregnancy puts additional demands on the mother's body, they used to assume that the fetus' nutritional needs would be met first, even at the mother's expense. The current opinion, however, is that the prenatal development of the fetus and its growth and development after birth are directly related to maternal diet. Women who follow nutritionally sound diets during pregnancy give birth to babies of normal or above-normal size. Their babies are less likely to contract bronchitis, pneumonia, or colds during early infancy and have better developed teeth and bones. The mothers have fewer complications during pregnancy and, on the average, spend less time in labor. The less time in labor, the easier the birth and the less stress the mother and child experience. But if the mother's diet is low in certain vitamins and minerals when she is pregnant, the child may suffer from specific weaknesses. Insufficient iron may lead to anemia in the infant, and a low intake of calcium may cause poor bone formation. If there is an insufficient amount of protein in the mother's diet, the baby may be smaller than average and may suffer from mental retardation, with almost 20 percent fewer brain cells. Mothers who are also physically small (under 100 pounds [45 kilograms] in total body weight) are risky for pregnancy as well because of the stress that pregnancy can place on them. The Rh Factor The Rh-positive factor is an inherited genetically dominant trait in the blood that can result in a dangerous situation for the fetus. When blood containing the Rh factor (that is, Rh-positive blood) is introduced into blood without the Rh factor (Rhnegative blood), antibodies to combat the Rh factor are produced. If an Rh-negative woman mates with an Rh-positive man, the resulting child may have Rh-positive blood. Any small rupture in the capillaries of the placenta will release the Rh factor into the mother's bloodstream, causing her body to produce the antibodies needed to fight it. The antibodies in the mother's blood will then cross the placenta into the fetal bloodstream and attack its Rh-positive red blood cells, depriving the fetus of oxygen. The result may be a miscarriage, possible brain defects, or even death to the fetus or newborn child. Only in circumstances involving an Rh-negative mother and an Rh-positive child does this danger exist. This condition in the child is called fetal erythroblastosis. Firstborn children are not threatened, because the mother's blood has not had time to produce a large amount of antibodies, but the risk increases with each pregnancy. In the past, erythroblastosis was always fatal, but now medical techniques can minimize the harmful effects of Rh incompatibility. After the birth of an Rh-positive child, the Rh-negative mother can be given an injection of the drug Rhogam to reduce the buildup of antibodies in her blood. If this is not done, future Rh-positive children will be endangered by the high antibody level. A doctor who suspects an Rh incompatibility between mother and fetus can measure her antibody level and induce labor if the antibody count becomes too high. Immediate and complete blood transfusions to the newborn infant can then eliminate the mother's antibodies from its blood. If the fetus is not yet mature enough to survive after birth, a blood transfusion may be possible in utero. Environmental factors include what you inhale, are exposed to, consume or handle during the course of your pregnancy. It's possible to avoid some of these completely and considerably reduce your exposure to others. When pregnant, avoid exposure to: * Cigarette Smoke. If you smoke, stop. Ask others not to smoke around you. Inhaling passive smoke is almost as harmful as smoking yourself. * Lead: Stay away from lead paint, especially if repair work is being done or the paint is chipping off. You should be concerned if your house was built before 1978. Most companies stopped putting lead in paint in 1955, and the federal government banned lead in paint in 1978. Make sure the tap water you drink is lead free. Check with your local environmental group or the Environmental

Protection Agency (EPA). If you suspect that the water may not be safe, get it tested for lead and contaminants by the EPA or get more information from the Health Department. Use only cold water for drinking and cooking. If your plumbing is very old or contains lead, consider changing it. Always run the tap for a few minutes before filling your glass, especially if the tap has not been used for a few hours. * Manufacturing agents and chemicals: Those working in manufacturing or on a factory floor should avoid certain things when pregnant, as specified by the Occupational Safety and Health Administration. These include chemicals like alkylating agents, arsenic, benzene, carbon monoxide, chlorinated hydrocarbons, dimethyl sulfoxide, organic mercury compounds, lead, lithium, aluminum, ethylene oxide, dioxin and polychlorinated biphenyls. * Cleaning agents and strong fumes: There is no proven link between household cleaners and pregnancy complications, but it is better to use these with extra caution when pregnant since they contain very strong chemicals and emit unpleasant odors. Use rubber gloves. Do not use toxic cleaners such as oven cleaners. Avoid inhaling the fumes directly by covering your nose while spraying. Make sure the rooms you clean are well ventilated. * Continuous In-flight Radiation, especially at high altitudes, closer to the earth's poles: This is applicable to women working as pilots or flight crew members. It has been observed that those who often fly for long hours at very high altitudes, close to the poles are at a risk of exposure to solar radiation. Though the risk may be small, pregnant women are advised to avoid it. * Mercury-rich Fish: Though fish is considered one of the healthiest types of foods, pregnant women should avoid seafood with high mercury content. Shark, swordfish, King mackerel, tile fish are especially to be avoided. Similarly, raw fish could contain bacteria and parasites and should be avoided. *Microwave radiation: Although the benefits of the microwave far outweigh any risks it might pose, studies show that the fetus is especially vulnerable to being affected adversely. So, while you don't have to stop using the microwave, you should take some precautions while using it. Make sure the microwave has no leaks. Do not stand in front of the microwave or very close to it while it runs. * Air Pollution: Avoid or reduce the inhalation of polluted air and exhaust fumes. Keep your rooms well-ventilated, especially the ones with fireplaces, burners or stoves. * Paint fumes: Although lead based paints are no longer used, paint fumes are best avoided. Some paints have been shown to have unsafe amounts of mercury and other substances. * Noise: Continuous exposure to loud noise has been known to cause miscarriages in animals. There is no study to prove a similar correlation in humans, but it is known that continuous exposure to loud noise causes hearing loss. So, to be on the safer side, pregnant women might want to avoid working in an environment that is too noisy all the time.