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Prenatal Factors Affecting Development ©Gallahue, D.L., Ozmun, J.C., & Goodway, J.D. (2012). Understanding Motor Development. Boston: McGraw-Hill. McGraw-Hill/Irwin © 2012 McGraw-Hill Companies. All Rights Reserved. A number of prenatal factors, many of which can be controlled, affect motor development during infancy and beyond. 5-2 Medical Conditions: Diseases Disorders Exposure to: Certain medications Pollutants Radiation Infections Use of: Alcohol Illicit Drugs Tobacco Medical History: Age Genetics Nutritional status Poverty 5-3 Types: Placental Malnutrition: supply transport issues Fetal Malnutrition: fetal metabolism complications Maternal Malnutrition: inadequate nutritional intake Reasons for Maternal Malnutrition: Dietary habits Poverty Stress Consequences: >Prematurity (LBW,VLBW & preterm) >Birth defects Maternal weight gain (table 5.2) General indicator of nutritional status 5-4 Considerations for Maternal Drug Use: Timing during pregnancy Dosage of the drug Length of consumption Genetic predisposition Interaction effects Common Drugs (table 5.3) Necessary Drugs (table 5.4) Illicit Drugs (table 5.5) 5-5 Fetal Alcohol Spectrum Disorder Occurrence: 40,000 FASD yearly in USA Consequences: FAS: Cognitive impairments; growth, physical and motor deficits; facial deformities FAE: attention deficit disorder Tobacco Use Occurrence: 13% USA pregnant women smoke Consequences: >LBW & VLBW >Cleft lip/palate >Cognitive deficits > Sudden Infant Death Syndrome (SIDS) 5-6 Union of Sperm & Egg: 23 + 23 = 46 total chromosomes 20,000 genes per chromosome Chromosome Based Disorders: Spontaneous abortion: Estimated 15-50% of all pregnancies Live births occur in 1% with damage Down syndrome: Most common Gene Based Disorders: Autosomal dominate gene mutations: Few developmental issues Autosomal negative gene mutations: Many developmental issues Talipes Sickle-Cell Disease Tay-Sachs Disease Phenylketonuria (PKU) Spina Bifida 5-7 Occurrence: About 1 in 800-1000 births Age-related: Age 35 = 1/400; 40 = 1/110; 45 1/35 Consequences: Frequent premature birth (LBW + YFD) Slower growth rate Slower development Delays in primitive & postural reflexes Hypotonia & hyperfexia Delays in attaining motor milestones Intervention Strategies: Infant/toddler stimulation programs Developmentally appropriate activities 5-8 Occurrence: About 1/700 2x more in males Types: (figure 5.1) Equinovarus: Foot twists in and down Calcaneal Valgus: Foot twists up and out Metatarsus Varus: Front of foot twists in Consequences: Untreated: Problems with upright locomotion Treated: Favorable outcomes 5-9 Occurrence: About 1/400 African-Americans 1/2 are carriers Consequences: Anemia, pain, organ damage Slow growth & motor development Possible death 5-10 Occurrence: Most prominent among European Jews Also found among French-Canadians & Cajuns Carriers in USA: About 1/30 2 parents = 25% chance 1 parent = 0% chance (but 50% chance of being a carrier) Consequences: Loss of motor control Paralysis Possible death 5-11 Phenylketonuria (PKU) Occurrence: Completely treatable metabolic disorder Inability to metabolize phenylalanine Check your diet soda Consequences: Untreated = severe mental retardation Treated at birth = favorable outcome Spina Bifida Occurrence: About 1/2000, Familial: 1/40 to 1/20 Folic acid and spina bifida Consequences: Loss of sensation in lower extremities Paralysis of the legs 5-12 Excess Radiation Occurrence: >25 rads during pregnancy Consequences: >incidence of microcephaly 7 other birth defects Chemical Pollutants: Occurrence: >lead and mercury Consequences: >birth defects 5-13 Occurrence: Chlamydia: Estimated 3 million yearly in USA Genital Herpes: Estimated 45 million in USA Gonorrhea: About 7000,000 yearly in USA Syphilis: On the decline in the USA Perinatal HIV: Estimated 6,000 births yearly in USA Consequences: Chlamydia: Prematurity, stillbirth, pneumonia, eye infections, blindness Genital Herpes: Brain damage, death Gonorrhea: Ectopic pregnancies, eye damage Syphilis: Severe illnesses, nervous system damage, death HIV/AIDS: Fever, weight loss, lethargy, diarrhea, pneumonia, death 5-14 Hormonal/Chemical Imbalances: Untreated Hypothyroidism: Cretinism Untreated Diabetes: Cognitive limitations; cardio/respiratory problems; possible death) Rh Incompatibility (Erythroblastosis Fetalis): Rh+ father & Rh- mother = Rh+ baby With first child mom builds antibodies = no problems Subsequent babies: Rhogam injection = no problems; without = severe problems 5-15 Cytomegalovirus (CMV) Occurrence: estimated 5% of newborns Consequences: Untreated: Mild to moderate deficits in speech, gross and fine motor control; possible cognitive deficits; blindness; deafness Treated: Positive outcome Rubella (three day measles) Occurrence: no new cases in the USA since 1994 Consequences: Untreated: Deafness; blindness, cognitive deficits Treated: Positive outcome 5-16 Teenage Pregnancy Consequences: >Maternal death rate < age 15 >LBW >Young for date Toxoplasmosis Occurrence: Protozoa found in 1/1000 infants 3000 infected each year in the USA Spore transmission (cat & mouse, meat) Consequences: Cognitive deficits Sensory and motor disabilities 5-17 Amniocentesis: Amniotic fluid sample analyzed between wk. 16-18 Chorionic Villus Sampling: Chorionic villi fragments analyzed prior to wk. 16 Ultrasound: Provides visual reference for above techniques & size/position data Fetoscopy: Fetoscope inserted into uterus, rarely used due to >risk of abortion 5-18 Maternal Affects; >Fitness <Weight gain & fat retention Easier labor Positive psychological & emotional benefits Fetal Affects: <Fat >Stress tolerance Delivery Affects: Easier labor Infant Development Affects: Leaner body composition 5-19 Pregnancy: 279 days +/- 2 weeks Labor: 1-24 hours (3 stages) Beginning labor (Stage 1): Dilation to 4 cm. Amniotic sac breaks Full labor & delivery (Stage 2): Dilation to 10cm., Primiparas: About 90 minutes to delivery Multiparas: About 45 minutes to delivery Delivery of Placenta (Stage 3) 5-20 Obstetrical Medications (table 5.8): Oxytocics: Initiate, augment labor Analgesics: Relieve pain Sedatives: Relieve anxiety Birth Entry: Breech: Feet first; 4/100 Transverse: Shoulder first; 1/100 Forceps: Used in emergencies only Cesarean deliveries: about 38% USA Prepared childbirth (Lamaze & Leboyer) 5-21 Both mother- and father-to-be have an obligation to their unborn child to ensure optimal development by monitoring those factors over which they can exercise control. 5-22