MATERNAL HEALTH AND ITS

INFLUENCE ON CHILD HEALTH

ANTENATAL ASPECTS OF
PREVENTIVE PEDIATRICS

-DHARA JOSHI
[Link]. Nursing
Batch :2010-2011
Antenatal aspects of preventive
paediatrics includes..
Recognize and describe causes and risk factors of the
major disabling conditions of children.
Demonstrate the most common risk factors and causes of
disabilities during the early childhood period.
Describe the role of social and environmental barriers in the
disability process.
Recognize important preventive measures of important
disabling conditions.
Early recognition and intervention for prevention of disability
and its complications.
Recognize and describe the role of parents and care takers
as primary actors and communities in the rehabilitation
process.
 CAUSES OF DISABILITIES
Causes of Disabilities

Prenatal Perinatal Childhood

• Chromosomal Drugs during • Injuries

• Genetic labor & delivery • Childhood disease
• Rh factor • Rh factor
Premature • Environmental
• Maternal stress
• Environmental causes: infants causes
– External agents Oxygen • Childhood
– Drugs deprivation disease
– Alcohol Infections • Environmental
– Maternal Nutrition causes
– Some infections
• Maternal diseases
• Mother’s age
Conti..
There are two main reasons that professionals strive to find
the causes of disabilities: first, the identification of a specific
cause can help in treating the condition, and second
identification of the cause of a disability may help prevent the
occurrence of such disabilities in future generations.
Biomedical or constitutional causes have a basis in the body
of the individual; there is a biological aspect to the condition.
Most severe and multiple handicaps include conditions which
fall into this category. Congenital disabilities, those present at
birth, are constitutional conditions.
Socio-cultural and environmental causes of disabilities are
those which originate outside the individualʹs body. This
includes not only those causes which stem from the social,
cultural, and physical environments, but also those causes
which result from the individualʹs life-style and behavior.
PRENATAL CAUSES OF DISABILITIES

[Link] causes of disability

Chromosomal abnormalities can involve the loss, gain,
or exchange of genetic material from a chromosome
pair. Such abnormalities often cause miscarriages, but
may occasionally result in a baby with some kind of
disability. Down Syndrome, a congenital condition
which usually includes health problems and mental
retardation, is caused by an abnormality of the
chromosomes. The twenty-first chromosome set is a
triplet instead of a pair, hence the other name of this
syndrome, Trisomy 21. Down Syndrome is associated
with the motherʹs age. The incidence rate is high when
mothers are extremely young, low for mothers in early
adulthood, and increases with the mother’s age after
35.
[Link] causes of disability

Chromosomes are made up of genes which, alone or

in combination, govern all our inherited
characteristics. Some disabilities are caused by
specific genes that create damaging biomedical
conditions. There are over 3,000 different genetic
causes of disability. There are definite patterns of
inheritance which govern whether or not various traits
affect us. An example of a genetic defect is Sickle
Cell Disease, a blood disorder caused by recessive
genes. Children only have the disorder if they receive
the gene from both parents. If the gene is paired with
a normal one, the individual does not have the
condition, but can pass it on to his or her
descendants. These individuals are called ʺcarriersʺ.
3. Rh factor
When an Rh-positive man and an Rh-negative
woman have children together, there can
sometimes be adverse consequences for their
offspring. If their baby has Rh-positive blood, the
mother’s blood may begin to form antibodies
against the “foreign” positive Rh factor. During the
next pregnancy the antibodies in the mother’s
blood may attach the Rh-positive blood of the
unborn infant. The resulting destruction may be
limited, causing only mild anemia, or excessive,
causing cerebral palsy, deafness, mental
retardation, or even death.
Fortunately, a way of preventing these
consequences has been developed. The blood
of the newborn infant is tested immediately after
birth, using a blood sample from the umbilical
cord. If an Rh-positive child has been born to an
Rh-negative mother, the mother is given a
vaccine that will seek out and destroy the baby’s
Rh-positive blood cells before the mother’s body
begins producing many antibodies. The red cells
of later children will not be attached because the
blood of the mother was never allowed to
develop the antibodies.
4. Maternal stress
Even though there are no direct connections between the
maternal and foetal nervous systems, the mother’s
emotional state can influence the foetus’s reactions and
development. This is true because emotions like rage,
fear, and anxiety bring the mother’s autonomic nervous
system into action, liberating certain chemicals (e.g.,
acetylcholine and epinephrine) into the bloodstream. In
addition, under certain conditions the endocrine glands,
particularly the adrenals, secrete different kinds and
amounts of hormones. As the composition of the blood
changes, new substances are transmitted through the
placenta, producing changes in the foetus’s circulatory
system. These changes may be irritating to the foetus.
Bodily movements of the foetuses increase by several
hundreds while their mothers are undergoing emotional
stress.
Conti..
If the mother’s emotional upset last several weeks,
fetal activity continue at an exaggerated level
throughout the entire period. When the upset is
brief, heightened irritability usually last several
hours. Prolonged emotional stress during
pregnancy may have lasting consequences for the
child. Infants born to upset, unhappy mothers are
more likely to be premature or have low birth
weights; to be hyperactive and irritable; and to
manifest difficulties such as irregular eating,
excessive bowel movements, gas pains, sleep
disturbances, excessive crying, and excessive
need to be held.
Prenatal environmental
causes of disability

The prenatal environment is almost

always a safe and nourishing one for a
developing baby, but there are some
environmental influences, which can
damage a foetus. These influences
include external agents, infections,
toxins, and maternal health.
 External agents
External agents which can cause prenatal damage
include injury and radiation. Seatbelts done up across
the mother's abdomen can injure the baby in an
accident. Any violent blow to the motherʹs abdomen
can also hurt her child. Radiation such as X-rays can
affect the foetus. This can result from treatment of
pelvic cancer, from diagnostic testing, or from
exposure to atomic energy sources, occupational
hazards, or fallout. Although the hazards of radiation
are not fully understood, it is clear that radiation can
have a wide range of effects on unborn children,
including death, malformation, brain damage,
increased susceptibility to certain forms of cancer,
shortened life span, and various mutations.
Radiation that occurs between the
time of fertilization and the time when
the ovum becomes implanted in the
uterus is thought to destroy the fertilized
ovum in almost every case. The
greatest danger of malformations
comes between the second and sixth
weeks after conception. Although the
effects of X rays may be less dramatic
later in pregnancy, there is still some
risk of damage, particularly to the brain
and other body systems.
Many prescription and non-
prescription drugs
These drugs can cross the placenta and adversely
affect the developing child. Physicians and parents
have become increasingly concerned about the
potentially harmful effects of drugs on the
developing embryo and fetus. One of the most
dramatic reasons for this concern was the
discovery around 1960 of the gross anatomical
defects caused by a drug, thalidomide, that many
women had taken during pregnancy. Thalidomide
was introduced as a medication to control nausea
in pregnant women, but it turned out to cause
severe malformations in the legs and/or arms of the
developing child.
Conti..
Many other drugs are suspected of producing
birth defects when taken during pregnancy;
substances that produce such effects are called
teratogens. There is a long list of substances
known or suspected to be teratogens, including
legal drugs (alcohol, nicotine, caffeine),
prescription drugs (some antibiotics, hormones,
steroids, anticoagulants, anticonvulsants,
tranquilizers, methadone), illegal drugs (cocaine,
heroin, marijuana), and environmental pollutants
(including lead, methylmercury, and
polychlorinated biphenyls, or PCBs).
Alcohol
Alcohol crosses the placenta easily and stays in
the baby's system longer than it does in the
mothers (FAS Symposium, 1993). Alcohol can
create a spectrum of effects on the baby. These
may include any or all of the following: various
degrees of mental retardation, physical
abnormalities, hyperactivity, autistic tendencies,
and failure to thrive. 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.
 Maternal Nutrition
Maternal nutrition affects the developing child. Deficiencies
in iron, vitamins, and calorie intake can place the baby at
risk. Some aspects of diet are especially important in the first
few weeks of pregnancy, before many women know they are
pregnant at all. For instance, not having adequate levels of
folic acid is a risk factor for having a baby with spina bifida.
Adequate levels are vital in the first weeks after conception
and are difficult to get from diet alone. Babies born to
mothers with nutritionally deficient diets are more likely to
have low birth weights, to suffer from impaired brain
development, to be less resistant to illnesses such as
pneumonia, and bronchitis, and to have a higher risk of
mortality in the first year of life. Severe maternal malnutrition
may impair the child’s intellectual development in addition to
having adverse effects on physical development.
 Infections
Some infections that the mother suffers can damage
the infant when the disease organisms cross the
placental barrier. Viral diseases such as
cytomegalovirus (which affects 5 to 6 percent of
pregnant women), rubella (German measles), chicken
pox, and hepatitis are particularly dangerous during
the embryonic and early fetal periods. One of the most
serious viral diseases during the first three months of
pregnancy is rubella, which may produce heart
malformations, deafness, blindness, or mental
retardation. A pregnant woman can be tested to see
whether she has already had rubella, but if she has
not, she cannot be given vaccine for rubella because it
contains the live virus.
Thus, it is best for a woman who is considering
pregnancy to ascertain whether she has had
rubella before she becomes pregnant, and to
receive vaccine at that time if she has not had it.
The rapid spread of the genital herpes virus
among young adults poses another danger.
Infection of the foetus with this virus usually occurs
late in pregnancy, probably during delivery, and
can result in severe neurological damage. When
infection occurs several weeks prior to birth, a
variety of congenital abnormalities can result.
Prompt medical intervention is necessary if the
presence of herpes during pregnancy is
suspected.
 Maternal diseases and
disorders during pregnancy

Some general disturbances of the mother during

pregnancy may also affect the fetus. One of the
most common of these is toxemia. Children
whose mothers had severe toxemia during
pregnancy run a risk of lowered intelligence.
Illness of the mother, especially long-term illness,
can also affect the child. Good prenatal medical
care reduces these risks and increases the
likelihood of having a healthy infant.
 The age of the mother
It is another factor associated with an increased
risk of impairment. Teen-age mothers, especially
those under 15 years of age, have a greater risk
of having babies with low birth weight as well as
neurological defects and childhood illnesses.
Women with over 30 have a lower fertility rate
than those in their twenties, and fertility continues
to decline with age. They are also more likely than
younger women to experience illnesses during
pregnancy and to have longer and more difficult
labour. Mothers over 40 run a sharply increased
risk of having a child with a chromosomal
abnormality, particularly Down syndrome.
Prevention of disability
 Every human society requires that its
future generation be healthy. This depends
on the birth and rearing of healthy children.
To this end, preventive screening for
genetic disorders, including developmental
disabilities, is an essential component in
uncovering possible disorders early, thus
enabling timely medical intervention.
Stages of prevention
 Endeavours for controlling disability can be
categorized as primary, secondary and
tertiary prevention.
Primary prevention efforts
include:
●
Genetic counseling
●
Prepregnancy planning

●
Improved prenatal, perinatal and postnatal care
●
Immunization programs

●
Primary prevention in the
environment
2. SECONDARY PREVENTION

Secondary prevention strategies aim at

reducing the duration or severity of disability.
These activities provide early identification of
the disabling condition followed by prompt
treatment and intervention to minimize the
development of disability. These strategies
can be applied either at the prenatal or
neonatal level. Some of the conditions can be
diagnosed during the prenatal and neonatal
stages.
Early intervention methods vary
widely depending on the nature of
the disability and its etiology but
include the following

Genetic counselling to prevent further cases

Specific treatment of underlying conditions, as in congenital

hypothyroidism

Treatment of specific contributory disabilities, e.g., hearing, vision

3. Tertiary prevention
Tertiary prevention aims at limiting or
reducing the effects of a disorder or disability
that is already present. It involves long-term
care and management of a chronic condition,
e.g. rehabilitation or correction of the
disability by surgical measures or by adopting
strategies by which the disabled person can
lead a normal or near normal life.
The main aims of rehabilitation of
the disabled are:
To increase awareness of disabilities
and the needs of disabled people;
To encourage their full integration in
society; and
To improve prevention and stimulate a
more sensitive and understanding
attitude.