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The Impact of Maternal Illness

on the Newborn
Julniar M. Tasli
Herman Bermawi
Indrayady
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 improved care
during pregnancy and during delivery

• In the new model of integrated perinatal care pediatric and


obstetric care occur collaboratively towards the common
goal of a safe delivery and improved neonatal survival
Learning Objectives
• Identify maternal conditions during pregnancy and
labor that can influence neonatal outcomes.

• Understand the association between specific conditions


and neonatal outcomes.

• Suspect and recognize neonatal clinical presentations


related to such conditions.

• Decide on management plan of the newborn based on


maternal presentation
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 morbid obesity)
• Appropriate weight gain and physical activity
• 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
Lack of compliance can be directly and
indirectly associated with :
• Prematurity and low birth weight and
complications associated with these
important contributors to infant mortality
and morbidity
• Higher incidence of specific neonatal
complications e.g. congenital anomalies
(neural tube defects) and in-utero growth
retardation
Prenatal care and its role:

• Prenatal care is designed to identify maternal complications


early and give pregnant mothers guidance to healthy
behaviors during pregnancy.

• Prenatal care should educate mothers and their community


on the identification of early danger signs during pregnancy

• Prenatal care should also help mothers prepare for the


arrival of the newborn, and give them basic education on
the early care of the neonate.
1. Early Identification of Pregnancy:

• Accurate gestational age determination

• Promotes the early adoption of healthy


behaviors and avoidance of unhealthy
behaviors and exposures

• Early screening for infections and other risks


• Enhances the ability for early diagnosis and treatment
of maternal diseases affecting pregnancy:
– Anemia
– Maternal malnutrition
– Pre-existing medical conditions (hypertension,
diabetes, TB, malaria, STI & urinary tract infections)
– Uterine conditions e.g. fibroids, and anatomic
abnormalities (bicornuate uterus)
– Maternal cardiac disease
– Thyroid disorders
A. Maternal Nutrition
• Evaluating nutritional status
– Low pre-pregnancy weight (less than 50Kg?)
– Adequate weight gain (10-15 Kg)
– Maternal anemia (Hgb =<10gm)
– Maternal obesity (screen for hypertension &
diabetes)
– Endemic iodine deficiency ( goiter)
– Diet evaluation especially vitamins
Recommendations
• Balanced dietary intake

• Vit. D supplementation (severe deficiency may be associated


with neonatal hypocalcemia).

• Adequate folic acid intake (starting before pregnancy)


reduces the risk for neural tube defects.

• Adequate iron supplementation especially in cases with


anemia.

• Avoiding Vit. A in high doses (teratogenic effects)


B. Perinatal Infection

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
• 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
• Herpes simplex (HSV)
– Ascending infection (intrapartum)
– Effects on the fetus/neonate include: IUGR,
Encephalitis/meningitis, seizures, retinitis,
mental retardation

• Varicella Zoster
– Transmitted transplacentally (<20 weeks, and
also by contact after birth)
– Congenital varicella; Microcephaly, retinitis, scars
on the skin
– Neonatal varicella
• HIV
– Transmitted transplacentally, during labor and in
breast milk
– Neonatal HIV/AIDS mostly asymptomatic in the
immediate neonatal period although some
manifest IUGR

• Hepatitis B
– Transmitted mainly as an ascending infection,
and through breast feeding, rarely
transplacentally.
– Associated with post-natal chronic hepatitis,
cirrhosis and hepatocellular carcinoma.
Non-viral infections:
• Treponema pallidum (syphilis)
– Transmitted transplacentally, anytime during
pregnancy (worst effects with early infection)
– Associated with fetal loss and still birth, and
congenital syphilis (skin and mucous membrane
lesions, hepato-splenomegaly, anemia and
thrombocytopenia, bone lesions)

• Neisseria Gonorrhoea
– Ascending infection intrapartum
– Ophthalmia neonatorum (early)
• 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.
C. Thyroid Diseases

Hypothyroidism

• Suspected after thyroid surgery, and in cases


with goiter (thyroid swelling)
• Associated with Hashimoto thyroiditis
• May cause still birth, IUGR, placental
abruption, and preeclampsia.
• Thyroxine replacement is indicated
Hyperthyroidism
• Much more common than hypothyroidism
• Should be suspected in cases with goiter
• Most commonly due to Grave’s disease
• If untreated can be dangerous to mother and fetus.
• Maternal complications include severe
preeclampsia and heart failure, and cardiac
arrythmias
• Fetal complications include preterm birth and
neonatal thyrotoxicosis
2. Identifications of Illnesses Complicating
of Pregnancy:
• Identification and early treatment of hypertension
in pregnancy as a continuum of Pre/eclampsia

• Identification and treatment of Gestational


Diabetes

• Identification and treatment of infections


complicating pregnancy (UTI, systemic, malaria, TB,
HIV)
A. Impact of maternal hypertension
• IUGR
• Asphyxia
• Prematurity and LBW/ SGA
• Congenital anomaly
• Multiple gestation
• Polycytemia + Hypebilirubinemia
B. Impact of maternal diabetes
• Maternal diabetes type A – C :
+ LGA
+ Birth injuries
+ Hyalin membran disease
+ Polycythemia
+ Hyperbilirubinemia
+ Hypoglycemia
+ Congenital anomaly
• Maternal diabetes type D – F&R :
+ LBW / SGA
+ Congenital anomaly
+ Hypoglcemia
+ Polycythemia
+ Hyperbilirubinemia

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