PEDIATRIC NURSING

Seminar on

PRENATAL FACTORS INFLUENCING GROWTH

AND DEVELOPMENT OF FETUS

Presented by
Chinju Shaji
M. Sc. Nursing
1st year
PRENATAL
DEVELOPMENT

Embryo at 40 Days Embryo at 45 Days

• Prenatal or antenatal development is the

process in which a human embryo (or fetus)
gestates during pregnancy, from fertilization till
birth.
• After fertilization the embryogenesis starts.
• Embryogenesis finishes, by the end of the 10th
week of gestational age.
PRENATAL DEVELOPMENT
• The developing fetus depends on
mother for life.
• Mother must receive prenatal
care, medical care during
pregnancy to monitors the health
of both the mother and the fetus.
• According to the National
Institutes of Health ([NIH], 2013),
routine prenatal care can reduce
the risk of complications to the
mother and fetus during
pregnancy.
Prenatal period is divided into
following periods:
• Pre-embryonic period includes fertilization,
cleavage of oocyte, and formation of blastocyst.
Occurs on 7 post-conception day.
• Embryonic period - blastogenesis
• Fetal period - Gestational 11 to 26 weeks.
• During the fetal period, the total body weight (TBW)
increases from approximately 5 to 500 gm.
GROWTH RATE

• Growth rate of fetus is linear up to 37 weeks of

gestation, after which it plateaus.
• A baby born within the normal range of weight for
that gestational age is known as appropriate for
gestational age (AGA).
• A slow growth rate and preterm birth are the two
factors that can cause a low birth weight.
• Low birth weight (below 2000 grams) can
ultimately increase the likelihood of schizophrenia
by almost four times.
FACTORS INFLUENCING GROWTH AND
DEVELOPMENT
• Fetal growth is primarily influenced by fetal,
placental and maternal factors.

• 40% of the variations in the birth weight are due to

genetic factors, other due to environmental factors.

• Development depends on a variety of mutually

interactive factors such as hereditary endowment,
biological integrity, physical and psychosocial
milieu and emotional stimulation.
 FACTORS INFLUENCING
GROWTH AND DEVELOPMENT

Heredity and Environmental

genetic factors factors
• Genetic potential- The parental traits are usually
transmitted to the offspring.

• Genetic factors- for developmental delay and

subsequent mental retardation (MR).
• Prominent genetic factors include chromosomal
abnormality (e. g Down’s syndrome).

• The rate of prenatal growth depends on the

genotype of the fetus and maternal environment.
• Sex- Boys are generally longer and heavier
than girls at the time of birth.

• Size of parents. Big and tall parents may

have larger-than-average newborns; short
and petite parents may have smaller-than-
average newborns.

• Multiple births. If there are twins, triplets, or

more, babies will be relatively small.
Multiples not only have to share their growing
space in the uterus, they're also often born
early, which leads to small size at birth.

• Birth order. First babies are sometimes

smaller than brothers or sisters born later.
• Fetal hormones- Human fetus secrete thyroxin
from the 12th week of gestation onwards.
• Thyroxin and insulin have an important role in
regulation of tissue accretion and differentiation in
the fetus and required for normal growth and
development.
• They influence maturation of organs such as liver
and lungs and gastrointestinal tract in pre terms.
• Fetal growth factor- These factors can be both
growth promoting and inhibitory.

• The insulin like growth factor (IGF-I) and IGF-II are

the most expensively studied fetal growth factors.

• Identified in fetal tissues synthesized locally, they act

principally by autocrine and paracrine mechanism.

• Their prime action is on cell division, though they

also influence other aspect of tissue growth.
 Placental factors

• Fetal weight directly co-relate with placental weight

at term.

• Fetal growth is highly dependent on the structural

and functional integrity of placenta.
Prenatal factors

• Intelligence of parents has direct co-relation on the

final IQ of the child.
• Parental attitudes, involvement, education and
desire for the child also have an impact on the
development of the child.
• Prenatal doctor's visits are critical to follow the
growth of your baby.
• Regular monitoring by a professional will help
ensure that your baby will be born health.
• Maternal factors- The mothers
own fetal and childhood growth
and her diet, nutrient intake and
body composition at the time of
conception as well as during
pregnancy plays an important
role in determining the life long
well being of her children.

• Teenage or advanced age,

recent pregnancy, high parity
and anemia negatively
influence fetal size and health.
Maternal factors
• Maternal factors a host of factors which impair growth in
utero also can potentially affect brain growth, particularly if
they are severe/ sustained.

• Acquired infections e. g TORCH-, AIDS, rubella, CMV,

herpes can have a severe impact on fetal physical and
brain growth.

• Exposure to free radicals and oxidants in utero

(e g chorioamnionitis) has been incriminated in the
causation of cerebral palsy and developmental
impairment.
Maternal Characteristics
• Mothers over 35 or under 15 are
likely to experience more
problems during pregnancy and
difficulties during delivery.

• Young adolescents are less likely

to eat properly or to get prenatal
care.

• Older women are more likely to

have hypertension, diabetes,
alcoholism, and other problems
related to age.
• Poverty- Poverty has been linked to
poor prenatal care and has been an
influence on prenatal development.

• Women in poverty are more likely to

have children at a younger age, which
results in low birth weight.

• These mothers have little education

and are less aware of the risks of
smoking, alcohol, and drugs.

• Women in poverty are more likely to

have diseases that are harmful to the
fetus.
• Mother's age

• Women between the ages of 16 and 35 have a

healthier environment for a fetus than women
under 16 or over 35.

• Women under 16 and over 35 have a higher risk of

preterm labor (premature baby), and this risk
increases for women in poverty, African Americans,
and women who smoke.
 Mother's age

• Premature babies from young mothers are more likely

to have neurological defects that will influence their
coping capabilities - irritability, trouble sleeping, crying,
etc.

• There is a risk of mental retardation for infants over the

age of 40 - Down syndrome. Teen mothers and mother
over 35 are more exposed to the risks of miscarriages,
premature births, and birth defects.
Teratogens
• Teratogen is an environmental toxin agent that can
adversely affect a fetus's development.

Biological Chemical

Physical
• Teratogens include nicotine, caffeine,
pollution, cleaning products and drugs
(prescription, over the counter, and illegal).
• Drug use
• Eleven percent of fetuses are exposed to illicit drug
use during pregnancy.
• Maternal drug use occurs when drugs ingested by
the pregnant woman are metabolized in the
placenta and then transmitted to the fetus.
• Drugs (narcotics), leads to risk of birth defects, low
birth weight, and a higher rate of death in infants or
stillbirths.
• Drugs use will influence extreme irritability, crying,
and risk for SIDS once the fetus is born.
Drug use
• The chemicals in drugs can cause an addiction in
the babies once they are born.
• Marijuana will slow the fetal growth rate, cause
premature delivery, also lead to low birth
weight, a shortened gestational period and
complications in delivery.
• Heroin will cause interrupted fetal
development, stillbirths, and can lead to
numerous birth defects.
• Heroin can also result in premature delivery,
higher risk of miscarriages, facial abnormalities
and head size, and create gastrointestinal
abnormalities in the fetus.
• Drug use increases risk of SIDS, low birth weight
and respiratory problems, dysfunction in the central
nervous system, and neurological dysfunctions
including tremors, sleep problems, and seizures.

• Cocaine use results in a smaller brain, which

results in learning disabilities for the fetus.

• Cocaine puts the fetus at a higher risk of being

stillborn or premature, low birth weight, damage to
the central nervous system, and motor dysfunction.
• Prescription drugs taken during pregnancy such as
streptomycin, tetracycline, some
antidepressants, progestin, synthetic estrogen,
accutane, thalidomide, and diethylstilbestrol
(DES) as well as over-the-counter drugs such as
diet pills can also result in teratogenic outcomes for
the developing fetus.
• Thalidomide causes bodily deformities as well as
damage to internal organs.
• High doses of aspirin are known to lead to
maternal and fetal bleeding, although low-dose
aspirin is usually not harmful.
• Diazepam when taken late in
pregnancy, depression ,
irritability, shaking and
exaggeration reflexes occur in
newborn.
• Streptomycin causes damage
to the fetus’s ear, resulting in
deafness.
• Sulfonamides – when taken
late in pregnancy, jaundice and
possible brain damage in the
newborn can occur.
 Alcohol
• Leads to disruptions of the fetus's brain
development, interferes with the fetus's cell
development and organization, and affects the
maturation of the CNS.

• Causes behavioral problems in a child, mental

problems or retardation and facial abnormalities -
meaning smaller eyes, thin upper lip, and little
groove between the nose and lips.

• Also increase the risk of miscarriages and

stillbirths, or low birth weight.
 Fetal alcohol
syndrome (FAS)
is a
developmental
disorder that is a
consequence of
too much alcohol
intake by the
mother during
pregnancy.
 The effects of moderate alcohol consumption during
pregnancy on fetal growth and morphogenesis

• 163 infants examined, 11 were judged clinically to show signs

compatible with a prenatal effect of alcohol on growth and
morphogenesis.
• Nine -from the high-risk drinking group. Only two were classified as
having the fetal alcohol syndrome, and each of the mothers
was a very heavy drinker.
• Other seven showed lesser alterations of growth and
morphogenesis suggestive of fetal alcohol syndrome, born to
women who drinks on an average of one ounce or more of absolute
alcohol per day in the month prior to recognition of pregnancy.
These results indicate that both moderate and high levels of
alcohol intake during early pregnancy may result in alterations
of growth and morphogenesis in the fetus.
 Smoking and Nicotine
• The fetus is exposed to nicotine, tar, and carbon
monoxide. Nicotine results in less blood flow to the
fetus because it constricts the blood vessels.
• Carbon monoxide reduces the oxygen flow to the
fetus. The reduction of blood and oxygen flow
results in stillbirth, SIDS, low birth weight, and
ectopic pregnancy.
• Nicotine also increases the risk for miscarriages
and premature births or infant mortality.
• Causes asthma in childhood.
• Smoking tobacco is teratogen because nicotine
travels through the placenta to the fetus.
• According to the Centers for Disease Control and
Prevention (2013), smoking while pregnant can
result in premature birth, low-birth-weight infants,
stillbirth, and sudden infant death syndrome
(SIDS).
• Other issues by prenatal exposure to smoking are
inattentiveness, muscle tension, and colic.
Pregnant women should also avoid second hand
smoke.
• Exposure to chemicals – During pregnancy
reduce exposure to unnatural chemicals,
particularly pesticides in food.
• The simplest precaution to take before consuming
vegetables or fruits is to wash them thoroughly and
removing the outer surface of vegetables and fruits.
• If a mother is infected with a disease, the placenta
cannot filter out the virus carriers and infect the
fetus.
• Babies can be born with venereal diseases
transmitted by the mother.
 Mother's diet and physical health

• An adequate nutrition is needed for a healthy fetus.

• A lack of iron causes anemia in the fetus,

• The lack of calcium causes poor bone and teeth

formation

• The lack of protein causes smaller fetus and mental

retardation.
 Nutrition
Good nutrition is crucial to a developing child. Protects
against a variety of birth defects and lower the rate of
miscarriage.
• Protein is also extremely important for fetal brain
development.
• Folic acid is a vital nutrient during pregnancy. Lack of folic
acid can cause birth defects.
• At least 400-1000 micrograms of B vitamin is suggested
starting one month before pregnant and throughout the
entire pregnancy. Leafy vegetables, orange juice, and
beans are some natural sources of folic acid. Many stores
sell vitamins with folic acid.
Maternal diet
• Deficiencies causes prematurity, stillbirth, infant
mortality, physical and neural defects, and small
size.

• Dietary supplements provided during pregnancy and

after birth have been successful at reducing some of
these effects

• Continued ill effects – due to mother's history of

dietary deprivation, the length and severity of the
malnutrition, and continuing adverse nutritional,
social, and economic factors following birth.
 Mother's prenatal depression and stress
• Causes slower fetal growth rates.

• It appears that prenatal maternal cortisol levels

play a role in mediating these outcomes.

• Factors that can put a person at risk for prenatal

depression include unplanned pregnancy, difficulty
becoming pregnant, history of abuse, and
economic or family problems.
 Stress
• Maternal stress strongly affects fetal development.

• Leads to miscarriage, and women with anxiety

disorders may go into premature labor or give birth
to babies with birth defects.

• The stress of giving up caffeine can be more

damaging to a baby than the caffeine itself.
 Prenatal maternal stress: effects on
pregnancy and the (unborn) child

• Recent well-controlled human studies indicate that

pregnant women with high stress and anxiety levels
are at increased risk for spontaneous abortion
and preterm labor and for having a malformed
or growth-retarded baby (reduced head
circumference in particular).

• These problems might be reduced by specific

stress reduction in high anxious pregnant women.
 Environmental toxins
 Toxins lead to higher rates of miscarriage, sterility,
and birth defects.

 Toxins include fetal exposure to

• Lead,
• Mercury, and
• Ethanol or hazardous environments.
Low birth weight

• Low birth weight

increases an infant’s
risk of long-term growth
and cognitive and
language deficits.
• It also results in a
shortened gestational
period and can lead to
prenatal complications.
 Exercise
• Moderate exercise can make labor and delivery
easier and will help keep pregnant women healthy.
• Moderate exercise is helpful as it improves the
mother’s mental state and can increase oxygen
flow to the fetus.
• Excessive exercise, however, can deprive a fetus
of oxygen, particularly late in pregnancy.
• Activities like walking, swimming, and yoga are
popular for pregnant women.
 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.

• The result may be a miscarriage,

possible brain defects, or even death to
the fetus or newborn child.

• This condition in the child is called fetal

erythroblastosis.
• 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.

• If the fetus is not yet mature enough

to survive after birth, a blood
transfusion may be possible in utero.
Maternal size and uterine size

• Fetal growth constraint from the maternal

environment is a physiological process that
includes
• The maternal-specific capacity of uterine size,
• Placental implantation surface area of the uterus,
• Uterine circulation,
which together support the growth of the placenta
and its function.
 Patterns of gestational age

• Length of gestation is proportional to fetal weight

but is more strongly correlated to neural growth.

Fetal nutrient uptake and metabolism,

regulation of fetal growth
• Decreased rates of fetal growth
represent an adaptation to
inadequate nutrient supply
(intrauterine growth restriction).
 Glucose, amino acids, and fat transport across
placenta

• Intrauterine growth restricted infants have lower

glucose levels.

• Amino acids and energy supply are important for

fetal growth.

• Fat accumulation occurs predominantly in the third

trimester.
 Maternal and fetal endocrine
regulation

• Maternal growth hormone and

human placental lactogen increase
during pregnancy, which induces
insulin resistance and increased
facilitated glucose transport to fetus.

• In infants of diabetic mothers,

increased supply of glucose
stimulates fetal insulin and
promotes fetal adiposity
(macrosomia).
Repeated X-rays and other kind
of radiations

Radiation exposure can cause

• Miscarriage,
• Slow physical growth,
• An underdeveloped brain,
• Malformations of the skeleton
and eyes.
• Low-level radiation can increase
the risk of childhood cancer.
 Multiple sex partners
Multiple sex partners can increase risk of STD’s,
which in turn may lead to birth and pregnancy
complications, like low birth weight or premature
birth.

Father’s state
• Over 35: Increased number miscarriages, heart
defects, Down Syndrome,
• Over 50: Higher risk for schizophrenia.
• Exposure to environmental toxins
• Radiation, anesthetic gases, pesticides
• Damage to genetic material in sperm
 Caffeine
• The FDA warns against caffeine consumption
during pregnancy and suggests quitting or reducing
the caffeine.
• Caffeine has been shown to affect fetal heart rates
and awake time (fetuses grow when sleeping).
• Decaffeinated coffee can also be harmful since
producers often add additional chemicals to
remove the caffeine.
• Caffeine can also increase risk of stretch marks.
• Suddenly quitting coffee intake can cause
headaches
 Other factors

Other factors that affect fetal

development are

• Heart disease
• Mother’s age (before 15 years
and after 35 years is riskier),
• Asthma,
• Excessive stress or depression,
• Diseases, and bleeding.
• REFERENCES
• http://www.ehow.com/facts_4910127_factors-that-affect-fetal-development.html
• https://www.pediatriccareonline.org/pco/ub/view/AAP-Textbook-of-Pediatric
Definitions and Indicators in Family Planning. Maternal & Child Health and
Reproductive Health. By European Regional Office, World Health Organization.
Revised March 1999 & January 2001. In turn citing: WHO Geneva, WHA20.19,
WHA43.27, Article 23
• Singh, Meharban (2010). Care of the Newborn. p. 7. Edition 7. ISBN
9788170820536
• Moore L. Keith. (2008). Before We Are Born: Essentials of Embryology and Birth
Defects. Philadelphia, PA: Saunders/Elsevier. ISBN 978-1-4160-3705-7
• Stephen Jay Gould,. Ontogeny and Phylogeny. Cambridge, Mass: Belknap
Press. p. 206. ISBN 0-674-63941-3.
• William J. Larsen (2001). Human embryology. Edinburgh: Churchill
Livingstone. ISBN 0-443-06583-7.[
• Scott F. Gilbert; with a chapter on plant development by Susan R. Singer
(2000). Developmental biology Sunderland, Mass: Sinauer Associates. ISBN 0-
87893-243-7..
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SUMMARY

• Define antenatal development .

• Describe various factors that influence the

growth and development of the fetus.
QUESTIONS
CONCLUSION
ASSIGNMENT
• What are the measures to be taken during
pregnancy to avoid exposure of teratogens?