Human Behavior and the Social Environment I Part V Chapter 9 Heredity, Prenatal Development, & Birth

PART PRENATAL DEVELOPMENT Learning Objectives Explore and connect a Theory , Approach , or Perspective to work in critical thinking skills for client assessments Explore important aspects of a persons experience and ability to justify why they are important Vignette Sabrina is a 28 Caucasian female . She has chosen to share some of her journal entries to provide information with the Family Planning worker she is meeting with . Sept Why is this so hard ?

miscarriages before we Photo on had Carly , I got through that and Prenatal Development 275 have so loved being a mom why does it have to keep happening ?

more miscarriages since trying again will it always be this way ?

Will I ever get to have anymore children ?

Whats wrong with me ?

Oct PREGNANT ! I know its early but I still get SO excited ! I havent told Mark yet since its only weeks I dont want him to get his hopes up and get disappointed AGAIN . Keeping my fingers crossed ! weeks and everything is going great ! I finally told Mark and he was SO excited too we both want a big family and we get to add another baby ! Even though Ive been feeling good we ve decided to keep the news to ourselves for a while longer , just to make sure Dec 11 weeks and OF COURSE something had to go wrong . We had the First Trimester Combined test done and the news isn great . Why do bad things have to keep happening when I try and have a baby ?

Why is it so hard ?

They said the baby is at risk of having Trisomy 13 severe development delays , that all I keep hearing in my head over and over Im so scared of whats going to happen They said not to worry , we still have more testing to do , but how can I not worry ?

I not even sure what it all means ! I trying to tell myself to stay calm and hope for the best but with all that happened before , how can I not worry ?

Dec It Christmas time but how can I be happy ?

We just got the results back yesterday . 50 chance the baby will have Trisomy 18 . WHY ?

Why cant it be easy and normal ?

I heartbroken and SO SO angry ! And I have no idea what Mark thinking . I know he said before he does believe in abortion and neither do I , but how can we take care of a baby that will have so many severe needs ?

I know how awful that sounds and maybe Im an awful person . I ve prayed for another baby for so long and God finally answered my prayers , but how am I supposed to handle all of this ?

Taking care of Carly , the house , the dogs , EVERYTHING ! What ifI have to quit my job to stay home and take care of this baby ?

How will we make it ?

We cant afford for me to stop working we barely make it as it is now ! And what would our friends and family think ?

They would never allow it , or never talk to us again but they re not the ones who will have to take 276 I Prenatal Development care of this baby ! I feel so alone in this right now dont know what to do Critical Thinking What theory , approach , or perspective from previous Dimensions ( PIE , Sociocultural , or Social Change ) would you use to assess this client ?

Why ?

What do you feel are the most important aspects ( physical development , attachment , sexual development , etc ) to consider for this client ?

Why ?

References , 2019 ) Dimensions of human behavior ( Sixth edition ) Sage Publications , Prenatal Development 277 Chapter Heredity , Prenatal Development , Birth Distinguish between mitosis and meiosis , genotype and phenotype , homozygous and heterozygous , and dominant and recessive . Describe some genetic disorders , due to a gene defect , and chromosomal disorders . Define behavioral genetics , describe environment correlations and environmental interactions , and define . Describe the changes that occur in the three periods of prenatal development Describe what occurs during prenatal brain development Define and describe the factors that influence their effects Explain maternal and paternal factors that affect the developing fetus Explain the types of prenatal assessment Describe both the minor and major complications of pregnancy Describe how expectant parents prepare for Chapter Heredity , Prenatal Development , Birth 279

childbirth Describe the stages of vaginal delivery Explain why a cesarean or induced birth is necessary Describe the two common procedures to assess the condition of the newborn Describe problems newborns experience before , during , and after birth Heredity As you recall from chapter one , nature refers to the contribution of genetics to ones development . The basic building block of the nature perspective is the gene . Genes are a specific sequence of nucleotides and are recipes for making proteins . Proteins are responsible for influencing the structure and functions of cells . Genes are located on the chromosomes and there are an estimated genes for humans , according to the Human Genome Project ( Figure ( Scum 280 Chapter Heredity , Prenatal Development , Birth

Normal human cells contain 46 chromosomes ( or 23 pairs one from each parent ) in the nucleus of the cells . After conception , most cells of the body are created by a process called mitosis . Mitosis is defined as the cells nucleus making an exact copy of all the chromosomes and splitting into two new cells . However , the cells used in sexual reproduction , called the ( sperm or ova ) are formed in a process called meiosis . In meiosis , the gamete chromosomes duplicate and then divide twice resulting in four cells containing only half the genetic material of the original gamete . Thus , each sperm and egg possesses only 23 chromosomes and combine to produce the normal 46 . Given the amount of genes present and the unpredictability of the meiosis process , the likelihood of having offspring that are genetically identical ( and not twins ) is one in trillions ( Gould , 1997 ) Of the 23 pairs of chromosomes created at conception , 22 pairs are similar in length . These are called . The remaining pair , or sex chromosomes , may differ in length . If a child receives the combination of XY the child will be genetically male . If the child receives the combination the child will be genetically female . Chapter Heredity , Prenatal Development , Birth 281

hum ' and The word genotype refers to the sum total of all the genes a person inherits . The word phenotype refers to the features that are actually expressed . Look in the mirror . What do you see , your genotype or your phenotype ?

What determines whether or not genes are expressed ?

Because genes are inherited in pairs on the chromosomes , we may receive 282 Chapter Heredity , Prenatal Development , Birth either the same version of a gene from our mother and father , that is , be homozygous for that characteristic the gene influences . If we receive a different version of the gene from each parent , that is referred to as heterozygous . In the homozygous situation , we will display that characteristic . It is in the heterozygous condition that it becomes clear that not all genes are created equal . Some genes are dominant , meaning they express themselves in the phenotype even when paired with a different version of the gene , while their silent partner is called recessive . Recessive genes express themselves only when paired with a similar version gene . Geneticists refer to different versions of a gene as alleles . Some dominant traits include having facial dimples , curly hair , normal vision , and dark hair . Some recessive traits include red hair , being nearsighted , and straight hair . Most characteristics are not the result of a single gene they are polygenic , meaning they are the result of several genes . In addition , the dominant and recessive patterns described above are usually not that simple either . Sometimes the dominant gene does not completely suppress the recessive gene this is called incomplete dominance . An example of this can be found in the recessive gene disorder sickle cell disease . The gene that produces healthy shaped red blood cells is dominant . The recessive gene causes an abnormality in the shape of red blood cells they take on a sickle form , which can clog the veins and deprive vital organs of oxygen and increase the risk of stroke . To inherit the disorder a person must receive the recessive gene from both parents . Those who have inherited only one are called carriers and should be unaffected by this recessive trait . Yet , carriers of the sickle cell have some red blood cells that take on the sickle pattern . Under circumstances of oxygen deprivation , such as high altitudes or physical exertion , carriers for the sickle cell gene may experience some of the symptoms of sickle cell ( Berk , 2004 ) Many students are interested in twins . Monozygotic or identical twins occur when a fertilized egg splits apart in the first two weeks of development . The result is the creation of two separate , but Chapter Heredity , Prenatal Development , Birth 283

genetically identical offspring . That is , they possess the same genotype and often the same phenotype . About of twins are monozygotic twins . Sometimes , however , two eggs or ova are released and fertilized by two separate sperm . The result is dizygotic or fraternal twins . These two individuals share the same amount of genetic material as would any two children from the same mother and father . In other words , they possess a different genotype and phenotype . Older mothers are more likely to have dizygotic twins than are younger mothers , and couples who use fertility drugs are also more likely to give birth to dizygotic twins . Consequently , there has been an increase in the number of fraternal twins recently ( et , 1999 ) Genetic Disorders Most of the known genetic disorders are dominant however , the vast majority of dominant gene linked disorders are not serious or debilitating . For example , the majority of those with Tourette Syndrome suffer only minor tics from time to time and can easily control their symptoms . Huntington Disease is a dominant gene linked disorder that affects the nervous system and is fatal , but does not appear until midlife . Recessive gene disorders , such as cystic fibrosis and anemia , are less common , but may actually claim more lives because they are less likely to be detected as people are unaware that they are carriers of the disease . Some genetic disorders are the defective gene is found on the ) Males have only one chromosome so are at greater risk for disorders due to a recessive gene , such as hemophilia , and baldness . For females to be affected by the genetic defects , they need to inherit the recessive gene on both , but if the defective gene is dominant , females can be equally at risk . 284 Chapter Heredity , Prenatal Development , Birth

III . ennui ! In . A , an , a , at ' Ia Ii I Vi ! un ' nu I I ! I Chromosomal Abnormalities A chromosomal abnormality occurs when a child inherits too many or too few chromosomes . The most common cause of chromosomal abnormalities is the age of the mother . As the mother ages , the ovum is more likely to suffer abnormalities due to exposure to environmental factors . Consequently . some Chapter Heredity , Prenatal Development , Birth 285

do not divide evenly when they are forming . Therefore , some cells have more than 46 chromosomes . In fact , it is believed that close to half of all have an odd number of chromosomes . Most of these fail to develop and are spontaneously aborted by the mother body . One of the most common chromosomal abnormalities is on pair 21 . Trisomy 21 or Down syndrome occurs when there are three rather than two chromosomes . A person with Down syndrome typically exhibits an intellectual disability and possesses certain physical features , such as short fingers and toes , folds of skin over the eyes , and a protruding tongue . There is as much variation in people with Down syndrome as in most populations , and those differences need to be recognized and appreciated . Other less common chromosomal abnormalities of infants occur on chromosome 13 and chromosome nu . III In Iowa syn In sum Age , 286 Chapter Heredity , Prenatal Development , Birth

When the abnormality is on the pair the result is a chromosomal abnormality . A person might have , Two of the more common chromosomal disorders are Turner syndrome and syndrome . Turner syndrome occurs when part or all of one of the chromosomes is lost and the resulting zygote has an composition . This occurs in of every live female births ( Carroll , 2007 ) and affects the individuals cognitive functioning and sexual maturation . The external genitalia appears normal , but breasts and ovaries do not develop fully and the woman does not menstruate . Turner syndrome also results in short stature and other physical characteristics . syndrome ( results when an extra chromosome is present in the cells of a male and occurs in out of 650 live male births . The chromosome stimulates the growth of male genitalia , but the additional chromosome inhibits this development . An individual with syndrome typically has small testes , some breast development , infertility , and low levels of testosterone ( National Institutes of Health , 2019 ) mu ad mimic I 44 I In I I . in . nun mu . run . gnu um In un ( mu 51 xiv III hood mum mama . lurid Italian ) Junk ! run put nth nu nun Turk ! mum . a nun turn ( mum . mun . an InA nAn my all . mum in an . on Genetic Counseling A service that assists individuals identify , test for , and explain potential genetic conditions that could adversely Chapter Heredity , Prenatal Development , Birth 287

affect themselves or their offspring is referred to as genetic counseling ( The common reasons for genetic counseling include Family history of a genetic condition Membership in a certain ethnic group with a higher risk of a genetic condition Information regarding the results of genetic testing , including blood tests , amniocentesis , or ultra sounds Learning about the chances of having a baby with a genetic condition if the parents are older , have had several miscarriages , have offspring with birth defects , experience infertility , or have a medical condition Behavioral Genetics Behavioral Genetics is the scientific study of the interplay between the genetic and environmental contributions to behavior . Often referred to as debate , 1998 , 2000 , 2002 ) suggests an analytic framework for this debate that recognizes the interplay between the environment , behavior , and genetic expression . This bidirectional interplay suggests that the environment can affect the expression of genes just as genetic predispositions can impact a persons potentials . Additionally , environmental circumstances can trigger symptoms of a genetic disorder . For example , a person who has sickle cell anemia , a recessive gene linked disorder , can experience a sickle cell crisis under conditions of oxygen deprivation . Someone predisposed genetically for diabetes can trigger the disease through poor diet and little exercise . Research has shown how the environment and genotype interact in several ways . Environment Correlations refer to the processes by which genetic factors contribute to variations in the 288 Chapter Heredity , Prenatal Development , Birth

environment ( 2013 ) There are three types of correlations Passive correlation occurs when children passively inherit the genes and the environments their family provides . Certain behavioral characteristics , such as being athletically inclined , may run in families . The children have inherited both the genes that would enable success at these activities , and given the environmental encouragement to engage in these actions . Evocative correlation refers to how the social environment reacts to individuals based on their inherited characteristics . For example , whether one has a more outgoing or shy temperament will affect how he or she is treated by others . Active correlation occurs when individuals seek out environments that support their genetic tendencies . This is also referred to as niche picking . For example , children who are musically inclined seek out music instruction and opportunities that facilitate their natural musical ability . Conversely , Interactions involve genetic susceptibility to the environment . Adoption studies provide evidence for interactions . For example , the Early Growth and Development Study ( Leve , 81 , 2010 ) followed 360 adopted children and their Chapter Heredity , Prenatal Development , Birth 289

adopted and biological parents in a longitudinal study . Results have shown that children whose biological parents exhibited psychopathology , exhibited significantly fewer behavior problems when their adoptive parents used more structured parenting than unstructured . Additionally , elevated psychopathology in adoptive parents increased the risk for the children development of behavior problems , but only when the biological parents psychopathology was high . Consequently , the results show how environmental effects on behavior differ based on the genotype , especially stressful environments on genetically children . Lastly , studies modifications in DNA that affect gene expression and are passed on when the cells divide . Environmental factors , such as nutrition , stress , and are thought to change gene expression by switching genes on and off . These gene changes can then be inherited by daughter cells . This would explain why monozygotic or identical twins may increasingly differ in gene expression with age . For example , et al . 2005 ) found that when examining differences in DNA , a group of monozygotic twins were indistinguishable during the early years . However , when the twins were older there were significant discrepancies in their gene expression , most likely due to different experiences . These differences included to disease and a range of personal characteristics . The Human Genome Project In 1990 the Human Genome Project ( an international scientific endeavor , began the task of sequencing the billion base pairs that make up the human genome . In April of 2003 , more than two years ahead of schedule , scientists gave us the genetic blueprint for building a human . Since then , using the information from the , researchers have discovered the genes involved in over 1800 diseases . In 2005 the amassed a large database called that catalogs the genetic variations in 11 global populations . Data on genetic variation can improve our understanding of differential risk for disease and reactions to medical treatments , such as drugs . researchers have already developed tests to determine whether a patient will 290 Chapter Heredity , Prenatal Development , Birth

respond favorably to certain drugs used in the treatment of breast cancer , lung cancer or HIV by using information from ( 2015 ) Future directions for the include identifying the genetic markers for all 50 major forms of cancer ( The Cancer Genome Atlas ) continued use of the for creating more effective drugs for the treatment of disease , and examining the legal , social and ethical implications of genetic knowledge ( 2015 ) From the outset , the made ethical issues one of their main concerns . Part of the budget supports research and holds workshops that address these concerns . Who owns this information , and how the availability of genetic information may influence healthcare and its impact on individuals , their families , and the greater community are just some of the many questions being addressed ( 2015 ) Prenatal Development Now we turn our attention to prenatal development which is divided into three periods The germinal period , the embryonic period , and the fetal period . The following is an overview of some of the changes that take place during each period . Chapter Heredity , Prenatal Development , Birth 291

The Germinal Period Figure ) Sperm and in Conception The germinal period ( about 14 days in length ) lasts from conception to implantation of the fertilized egg in the lining of the uterus . At ejaculation , millions of sperm are released into the vagina , but only a few reach the egg and typically only one fertilizes the egg . Once a single sperm has entered the wall of the egg , the wall becomes hard and prevents other sperm from entering . After the sperm has entered the egg , the tail of the sperm breaks off and the head of the sperm , containing the genetic information from the father , unites with the nucleus of the egg . It is typically fertilized in the top section of the fallopian tube and continues its journey to the uterus . As a result , a new cell is formed . This cell , containing the combined genetic information from both parents , is referred to as a zygote . During this time , the organism begins cell division through mitosis . After five days of mitosis , there are 100 cells , which is now 292 Chapter Heredity , Prenatal Development , Birth

called a blastocyst . The blastocyst consists of both an inner and an outer group of cells . The inner group of cells or embryonic disk will become the embryo , while the outer group of cells , or trophoblast , becomes the support system that nourishes the developing organism . This stage ends when the blastocyst fully implants into the uterine wall ( US . National Library of Medicine , Approximately of do not implant in the uterine wall ( et , 2019 ) Mitosis is a fragile process and fewer than of all survive beyond the first two weeks ( Hall , 2004 ) Some of the reasons for this include the egg and sperm do not join properly , thus their genetic material does not combine , there is too little or damaged genetic material , the zygote does not replicate , or the blastocyst does not implant into the uterine wall . The failure rate is higher for in vitro conceptions . Figure Period ' nun . I IV . I an on ' mum . Chapter Heredity , Prenatal Development , Birth 293

The Embryonic Period Starting the third week the blastocyst has implanted in the uterine wall . Upon implantation , this organism is called an embryo . Now blood vessels grow forming the placenta . The placenta is a structure connected to the uterus that provides nourishment and oxygen from the mother to the developing embryo via the umbilical cord . During this period , cells continue to differentiate . Growth during prenatal development occurs in two major directions from head to tail called development and from the midline outward referred to as development . This means that those structures nearest the head develop before those nearest the feet and those structures nearest the torso develop before those away from the center of the body ( such as hands and fingers ) The head develops in the fourth week and the precursor to the heart begins to pulse . In the early stages of the embryonic period , gills and a tail are apparent . However , by the end of this stage , they disappear and the organism takes on a more human appearance . Some organisms fail during the embryonic period , usually due to gross chromosomal abnormalities . As in the case of the germinal period , often the mother does not yet know that she is pregnant . It is during this stage that the major structures of the body are taking form making the embryonic period the time when the organism is most vulnerable to the greatest amount of damage if exposed to harmful substances . Potential mothers are not often aware of the risks they introduce to the developing embryo during this time . The embryo is approximately inch in length and weighs about grams at the end of eight weeks ( et , 2019 ) The embryo can move and respond to touch at this time . 294 Chapter Heredity , Prenatal Development , Birth

Figure The Embryo Photo by Lunar Caustic The Fetal Period From the ninth week until birth , the organism is referred to as a fetus . During this stage , the major structures are continuing to develop . By the third month , the fetus has all its body parts including external genitalia . In the following weeks , the fetus will develop hair , nails , teeth and the excretory and digestive systems will continue to develop . The fetus is about inches long and weighs about 28 grams . During the months , the eyes become more sensitive to light and hearing develops . The respiratory system continues to develop , and reflexes such as sucking , swallowing and hiccupping , develop during the month . Cycles of sleep and wakefulness are present at this time as well . The first chance of survival outside the womb , known as the age of viability is reached at about 24 weeks ( Morgan , 81 , 2008 ) Many practitioners hesitate to resuscitate before 24 weeks . The majority of the neurons Chapter Heredity , Prenatal Development , Birth 295

in the brain have developed by 24 weeks , although they are still rudimentary , and the glial or nurse cells that support neurons continue to grow . At 24 weeks the fetus can feel pain ( Royal College of Obstetricians and Gynecologists , 1997 ) Figure Fetus Between the months , the fetus is primarily preparing for birth . It is exercising its muscles and its lungs begin to expand and contract . The fetus gains about pounds and inches during this last trimester of pregnancy , and during the month , a layer of fat develops under the skin . This layer of fat serves as insulation and helps the baby regulate body temperature after birth . At around 36 weeks the fetus is almost ready for birth . It weighs about pounds and is about inches long . By week 37 all of the 296 Chapter Heredity , Prenatal Development , Birth

fetus organ systems are developed enough that it could survive outside the mother uterus without many of the risks associated with premature birth . The fetus continues to gain weight and grow in length until approximately 40 weeks . By then the fetus has very little room to move around and birth becomes imminent . Figure ! Prenatal Development Age Prenatal Brain Development Prenatal brain development begins in the third gestational week Chapter Heredity , Prenatal Development , Birth 297

with the differentiation of stem cells , which are capable of producing all the different cells that make up the brain ( Stiles , 2010 ) The location of these stem cells in the embryo is referred to as the neural plate . By the end of the third week , two ridges appear along the neural plate first forming the neural groove and then the neural tube . The open region in the center of the neural tube forms the brains ventricles and spinal canal . By the end of the embryonic period , or week eight , the neural tube has further differentiated into the forebrain , midbrain , and hindbrain . Brain development during the fetal period involves neuron production , migration , and differentiation . From the early fetal period until , most of the 85 billion neurons have been generated and many have already migrated to their brain positions . Neurogenesis , or the formation of neurons , is largely completed after five months of gestation . One exception is in the hippocampus , which continues to develop neurons throughout life . Neurons that form the neocortex , or the layer of cells that lie on the surface of the brain , migrate to their location in an orderly way . Neural migration is mostly completed in the cerebral cortex by 24 weeks ( 2018 ) Once in position , neurons begin to produce dendrites and axons that begin to form the neural networks responsible for information processing . Regions of the brain that contain the cell bodies are referred to as the gray matter because they look gray in appearance . The axons that form the neural pathways make up the white matter because they are covered in myelin , a fatty substance that is white in appearance . Myelin aids in both the insulation and efficiency of neural transmission . Although cell differentiation is complete at birth , the growth of dendrites , axons , and synapses continue for years . Good prenatal care is essential . The developing child is most at risk 298 Chapter Heredity , Prenatal Development , Birth

for some of the severe problems during the first three months of development . Unfortunately , this is a time at which many mothers are unaware that they are pregnant . Today , we know many of the factors that can jeopardize the health of the developing child . The study of factors that contribute to birth defects is called teratology . are environmental factors that can contribute to birth defects , and include some maternal diseases , pollutants , drugs and alcohol . Factors prenatal risks There are several considerations in determining the type and amount of damage that might result from exposure to a particular ( Berger , 2005 ) These include The timing of the exposure Structures in the body are vulnerable to the most severe damage when they are forming . If a substance is introduced during a particular critical period ( time of development ) the damage to that structure may be greater . For example , the ears and arms reach their critical periods at about weeks after conception . If a mother exposes the embryo to certain substances during this period , the arms and ears may be malformed . The amount of exposure Some substances are not harmful unless the amounts reach a certain level . The critical level depends in part on the size and metabolism of the mother . The number of Fetuses exposed to multiple typically have more problems than those exposed to only one . Genetics Genetic also plays a role in the impact a particular might have on the child . This is suggested by fraternal twins exposed to the same prenatal environment , but they do not experience the same teratogenic effects . The genetic up of the mother can also have an effect some mothers may be more resistant to teratogenic effects than others . Being male or female Males are more likely to experience Chapter Heredity , Prenatal Development , Birth 299

damage due to than are females . It is believed that the chromosome , which contains fewer genes than the , may have an impact . mini ! Alcohol One of the most commonly used is alcohol , and because half of all pregnancies in the United States are unplanned , it is recommended that women of age take great caution against drinking alcohol when not using birth control or when pregnant ( 2005 ) Alcohol use during pregnancy is the leading preventable cause of intellectual disabilities in children in the United States ( West , 2001 ) Alcohol consumption , particularly during the second month of prenatal development but at any point during pregnancy , may lead to and behavioral difficulties that can last a lifetime . In extreme cases , alcohol consumption during pregnancy can lead to fetal death , but also can result in Fetal Alcohol Spectrum Disorders ( which is an umbrella term for the range of effects that can occur due to alcohol consumption during pregnancy 300 Chapter Heredity , Prenatal Development , Birth

( March of Dimes , The most severe form of is Fetal Alcohol Syndrome ( FAS ) Children with FAS share certain physical features such as flattened noses , small eye holes , and small heads . Cognitively , these children have poor judgment , poor impulse control , higher rates of , learning issues , and lower IQ scores . These developmental problems and delays persist into adulthood ( 81 , 1996 ) and can include criminal behavior , psychiatric problems , and unemployment ( Based on animal studies , it has been hypothesized that a mother alcohol consumption during pregnancy may predispose her child to like alcohol ( Spear , 2007 ) Binge drinking , or or more drinks in to hours , during pregnancy increases the chance of having a baby with ( March of Dimes , no nun Soul um I ) nu Fuel sun can ! ovum undo us up no manor Ia , manna Tobacco Another widely used is tobacco as more than of pregnant women smoked in 2016 ( 2019 ) According to Tong et al . 2013 ) in conjunction with the Centers for Disease Control and Prevention , data from 27 sites in 2010 representing 52 of live births , showed that among women with recent live births About 23 reported smoking in the months prior to Chapter Heredity , Prenatal Development , Birth 301

pregnancy . Almost 11 reported smoking during pregnancy . More than half ( reported that they quit smoking by the last months of pregnancy . Almost 16 reported smoking after delivery . When comparing the ages of women who smoked Women 20 , smoked during pregnancy Women smoked during pregnancy Women , smoked during pregnancy Women 235 , smoked during pregnancy The findings among racial and ethnic groups indicated that smoking during pregnancy was highest among American Natives ( and lowest among Pacific Islanders ( When a pregnant woman smokes the fetus is exposed to dangerous chemicals including nicotine , carbon monoxide , and tar , which lessen the amount of oxygen available to the fetus . Oxygen is important for overall growth and development . Tobacco use during pregnancy has been associated with low birth weight , ectopic pregnancy ( fertilized egg implants itself outside of the uterus ) placenta previa ( placenta lies low in the uterus and covers all or part of the cervix ) placenta abruption ( placenta separates prematurely from the uterine wall ) preterm delivery , stillbirth , fetal growth restriction , sudden infant death syndrome ( birth defects , learning disabilities , and early puberty in girls ( Center for Disease Control , A woman being exposed to secondhand smoke during pregnancy has also been linked to birth weight infants . In addition , exposure to smoke , or toxins from tobacco smoke that linger on clothing , furniture , and in locations where smoking has occurred , results in a negative impact on infants lung development . and ( 2011 ) found that prenatal exposure to 302 I Chapter Heredity , Prenatal Development , Birth

smoke played a greater role in altered lung functioning in children than exposure . Drugs About 70 of pregnant women take at least one prescription drug ( March of Dimes , A woman should not be taking any prescription drug during pregnancy unless it was prescribed by a health care provider who knows she is pregnant . Some prescription drugs can cause birth defects , problems in overall health , and development of the fetus . drugs are also a concern during the prenatal period because they may cause certain health problems . For example , the pain reliever ibuprofen can cause serious blood flow problems to the fetus during the last three months . Figure Illicit Drugs Common illicit drugs include cocaine , ecstasy and other club drugs , heroin , marijuana , and prescription drugs that are abused . It is difficult to completely determine the effects of a particular illicit drug on a developing child because most mothers who use , use more than one substance and have other unhealthy Chapter Heredity , Prenatal Development , Birth 303

behaviors . These include smoking , drinking alcohol , not eating healthy meals , and being more likely to get a sexually transmitted disease . However , several problems seem clear . The use of cocaine is connected with low birth weight , and spontaneous abortion . Heavy marijuana use is associated with problems in brain development ( March of Dimes , If a baby mother used an addictive drug during pregnancy that baby can get addicted to the drug before birth and go through drug withdrawal after birth , also known as neonatal abstinence syndrome ( March of Dimes , Other complications of illicit drug use include premature birth , smaller than normal head size , birth defects , heart defects , and infections . Additionally , babies born to mothers who use drugs may have problems later in life , including learning and behavior difficulties , slower than normal growth , and die from sudden infant death syndrome . Children of substance abusing parents are also considered at high risk for a range of biological , developmental , academic , and behavioral problems , including developing substance abuse problems of their own ( Conners , et , 2003 ) 304 Chapter Heredity , Prenatal Development , Birth

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curd Pollutants There are more than chemicals used in the United States with little information on the effects of them during pregnancy ( March of Dimes , Lead An environmental pollutant of significant concern is lead poisoning , which has been linked to fertility problems , high blood pressure , low birth weight , prematurity , miscarriage , and slowed neurological development . and ( 2017 ) found that babies born in Flint Michigan , an area identified with high lead levels in the drinking water , were premature , Chapter Heredity , Prenatal Development , Birth 305

weighed less than average , and gained less weight than expected . Pesticides The chemicals in certain pesticides are also potentially damaging and may lead to birth defects , learning problems , low birth weight , miscarriage , and premature birth ( March of Dimes , 2014 ) A Prenatal exposure to A ( a chemical commonly used in plastics and food and beverage containers , may disrupt the action of certain genes contributing to certain birth defects ( March of Dimes , Radiation If a mother is exposed to radiation , it can get into the bloodstream and pass through the umbilical cord to the baby . Radiation can also build up in body areas close to the uterus , such as the bladder . Exposure to radiation can slow the baby growth , cause birth defects , affect brain development , cause cancer , and result in a miscarriage . Mercury , a heavy metal , can cause brain damage and affect the baby hearing and vision . This is why women are cautioned about the amount and type of fish they consume during pregnancy . The tiny parasite , causes an infection called . According to the March of Dimes ( infects more than 60 million people in the United States . A healthy immune system can keep the parasite at bay producing no symptoms , so most people do not know they are infected . As a routine prenatal screening frequently does not test for the presence of this parasite , pregnant women may want to talk to their provider about being tested . 306 Chapter Heredity , Prenatal Development , Birth

Figure Toxoplasmosis can cause premature birth , stillbirth , and can result in birth defects to the eyes and brain . While most babies born with this infection show no symptoms , ten percent may experience eye infections , enlarged liver and spleen , jaundice , and pneumonia . To avoid being infected , women should avoid eating undercooked or raw meat and unwashed fruits and vegetables , touching cooking utensils that touched raw meat or unwashed fruits and vegetables , and touching cat feces , soil or sand . If women think they may have been infected during pregnancy , they should have their baby tested . Sexually Transmitted Diseases Gonorrhea , syphilis , and chlamydia are sexually transmitted infections that can be passed to the fetus by an infected mother . Mothers should be tested as early as possible to minimize the risk of spreading these infections to their unborn child . Additionally , the earlier the treatment begins , the better the health outcomes for mother and baby ( Sexually transmitted diseases ( can cause premature birth , premature rupture of the amniotic sac , an ectopic pregnancy , birth defects , miscarriage , and still births ( March of Dimes , 2013 ) Most babies become infected with while passing through the birth Chapter Heredity , Prenatal Development , Birth 307

canal during delivery , but some can cross the placenta and infect the developing fetus . Human Immunodeficiency Virus ( HIV ) One of the most potentially devastating is HIV . HIV and Acquired Immune Deficiency Syndrome ( AIDS ) are leading causes of illness and death in the United States ( Health Resources and Services Administration , 2015 ) One of the main ways children under age 13 become infected with HIV is via transmission of the virus prenatally , during labor , or by breastfeeding ( There are some measures that can be taken to lower the chance the child will contract the disease . HIV positive mothers who take antiviral medications during their pregnancy greatly reduce the chance of passing the virus to the fetus . The risk of transmission is less than percent in contrast , it is 25 percent if the mother does not take drugs ( However , the risks of prenatal exposure to the medication are not known . It is recommended that women with HIV deliver the child by , and that after birth they avoid breast feeding . German measles ( or rubella ) Rubella , also called German measles , is an infection that causes mild symptoms and a rash on the skin . However , only about half of children infected have these symptoms , while others have no symptoms ( March of Dimes , Rubella has been associated with a number of birth defects . If the mother contracts the disease during the first three months of pregnancy , damage can occur in the eyes , ears , heart or brain of the unborn child . Deafness is almost certain if the mother has German measles before the week of prenatal development and can also cause brain damage . Women in the United States are much less likely to be afflicted with rubella , because most women received childhood vaccinations that protect her from the disease . 308 Chapter Heredity , Prenatal Development , Birth

Maternal Factors Mothers over 35 Most women over 35 who become pregnant are in good health and have healthy pregnancies . However , according to the March of Dimes ( women over age 35 are more likely to have an increased risk of Fertility problems High blood pressure Diabetes Miscarriages Placenta Previa Cesarean section Premature birth Stillbirth A baby with a genetic disorder or other birth defects Because a woman is born with all her eggs , environmental can affect the quality of the eggs as women get older . Also , a womans reproductive system ages which can adversely affect the pregnancy . Some women over 35 choose special prenatal screening tests , such as a maternal blood screening , to determine if there are any health risks for the baby . Chapter Heredity , Prenatal Development , Birth 309

Figure Although there are medical concerns associated with having a child later in life , there are also many positive consequences to being a more mature parent . Older parents are more confident , less stressed , and typically married providing family stability . Their children perform better on math and reading tests , and they are less prone to injuries or emotional troubles ( Albert , 2013 ) Women who choose to wait are often well educated and lead healthy lives . According to Gregory ( 2007 ) older women are more stable , demonstrate a stronger family focus , possess greater confidence , and have more money . Having a child later in one career equals overall higher wages . In fact , for every year a woman delays motherhood , she makes more in lifetime earnings . Lastly , women who delay having children actually live longer . Sun et al . 2015 ) found that women who had their last child after the age of 33 doubled their chances of living to age 95 or older than women who had their last child before their birthday . A woman natural ability to have a child at a later age indicates that her reproductive system is aging slowly , and consequently so is the rest of her body . 310 Chapter Heredity , Prenatal Development , Birth

Teenage Pregnancy A teenage mother is at a greater risk for having pregnancy complications including anemia , and high blood pressure . These risks are even greater for those under age 15 . Infants born to teenage mothers have a higher risk for being premature and having low or other serious health problems . Premature and low babies may have organs that are not fully developed which can result in breathing problems , bleeding in the brain , vision loss , and serious intestinal problems . Very low babies ( less than pounds ) are more than 100 times as likely to die , and moderately low babies ( between and pounds ) are more than times as likely to die in their first year , than normal weight babies ( March of Dimes , Again , the risk is highest for babies of mothers under age 15 . Reasons for these health issues include that teenagers are the least likely of all age groups to get early and regular prenatal care . Additionally , they may engage in negative behaviors including eating unhealthy food , smoking , drinking alcohol , and taking drugs . Additional concerns for teenagers are repeat births . About 25 of teen mothers under age 18 have a second baby within years after the first baby birth . Gestational Diabetes Seven percent of pregnant women develop gestational diabetes ( March of Dimes , Diabetes is a condition where the body has too much glucose in the bloodstream . Most pregnant women have their glucose level tested at 24 to 28 weeks of pregnancy . Gestational diabetes usually goes away after the mother gives birth , but it might indicate a risk for developing diabetes later in life . If untreated , gestational diabetes can cause premature birth , stillbirth , the baby having breathing problems at birth , jaundice , or low blood sugar . Babies born to mothers with gestational diabetes can also be considerably heavier ( more than pounds ) making the labor and birth process more difficult . For expectant mothers , untreated gestational diabetes can cause ( high blood pressure and signs that the liver and kidneys may not be working properly ) discussed later in the chapter . Risk factors for gestational diabetes include age ( being over age 25 ) being overweight or Chapter Heredity , Prenatal Development , Birth 311

gaining too much weight during pregnancy , family history of diabetes , having had gestational diabetes with a prior pregnancy , and race and ethnicity ( Native American , Hispanic , Asian , or Pacific Islander have a higher risk ) Eating healthy and maintaining a healthy weight during pregnancy can reduce the chance of gestational diabetes . Women who already have diabetes and become pregnant need to attend all their prenatal care visits , and follow the same advice as those for women with gestational diabetes as the risk of , premature birth , birth defects , and stillbirth are the same . High Blood Pressure ( Hypertension ) Hypertension is a condition in which the pressure against the wall of the arteries becomes too high . There are two types of high blood pressure during pregnancy , gestational and chronic . Gestational hypertension only occurs during pregnancy and goes away after birth . Chronic high blood pressure refers to women who already had hypertension before the pregnancy or to those who developed it during pregnancy and it continued after birth . According to the March of Dimes ( about in every 100 pregnant women have high blood pressure . High blood pressure during pregnancy can cause premature birth and low birth weight ( under five and a half pounds ) placental abruption , and mothers can develop . Disease is a protein found in the blood . Most people are positive , meaning they have this protein . Some people are negative , meaning this protein is absent . Mothers who are negative are at risk of having a baby with a form of anemia called disease ( March of Dimes , 2009 ) A father who is and mother who is can conceive a baby who is positive . Some of the fetus blood cells may get into the mothers bloodstream and her immune system is unable to recognize the factor . The immune system starts to produce antibodies to fight off what it thinks is a foreign invader . Once her body produces immunity , the antibodies can cross the placenta and start to destroy the red blood cells of the developing fetus . As this process takes time , often the first positive baby is not harmed , but as the 312 Chapter Heredity , Prenatal Development , Birth

mother body will continue to produce antibodies to the factor across her lifetime , subsequent pregnancies can pose greater risk for an positive baby . In the newborn , disease can lead to jaundice , anemia , heart failure , brain damage and death . Weight Gain during Pregnancy According to March of Dimes ( during pregnancy most women need only an additional 300 calories per day to aid in the growth of the fetus . Gaining too little or too much weight during pregnancy can be harmful . Women who gain too little may have a baby who is weight , while those who gain too much are likely to have a premature or large baby . There is also a greater risk for the mother developing and diabetes , which can cause further problems during the pregnancy . Putting on the weight slowly is best . Mothers who are concerned about their weight gain should talk to their health care provider . nu . nu . ma . nu um . mom are uni sun ( a , i . uv . ma . mi um um . mu . nu ma nu ma yr aid in warn mo In ! an nu nu an . Stress Feeling stressed is common during pregnancy , but high levels of stress can cause complications including having a premature baby or a baby . Babies born early or too small are at an increased risk for health problems . hormones may cause these complications by affecting a immune systems resulting in an infection and premature birth . Additionally , some women deal with stress by smoking , drinking alcohol , or taking drugs , which can lead to problems in the pregnancy . High levels of stress in pregnancy have also been Chapter Heredity , Prenatal Development , Birth 313

correlated with problems in the baby brain development and immune system functioning , as well as childhood problems such as trouble paying attention and being afraid ( March of Dimes , Depression Depression is a significant medical condition in which feelings of sadness , worthlessness , guilt , and fatigue interfere with one daily functioning . Depression can occur before , during , or after pregnancy , and in women is treated for depression sometime between the year before pregnancy and year after pregnancy ( March of Dimes , Women who have experienced depression previously are more likely to have depression during pregnancy . Consequences of depression include the baby being born premature , having a low , being more irritable , less active , less attentive , and having fewer facial expressions . About 13 of pregnant women take an antidepressant during pregnancy . It is important that women taking antidepressants during pregnancy discuss the medication with a health care provider as some medications can cause harm to the developing organism . In fact , birth defects happen about to times more often in women who are prescribed certain Selective Serotonin Reuptake Inhibitors ( for their depression . Paternal Impact The age of fathers at the time of conception is also an important factor in health risks for children . According to ( 2015 ) offspring of men over 40 face an increased risk of miscarriages , autism , birth defects , achondroplasia ( bone growth disorder ) and schizophrenia . These increased health risks are thought to be due to accumulated chromosomal aberrations and mutations during the maturation of sperm cells in older men ( Bray , Smith , 2006 ) However , like older women , the overall risks are small . 314 Chapter Heredity , Prenatal Development , Birth

Figure Occupations at In addition , men are more likely than women to work in occupations where hazardous chemicals , many of which have teratogenic effects or may cause genetic mutations , are used ( 2008 ) These may include , lead , and pesticides that can cause abnormal sperm and lead to miscarriages or diseases . Men are also more likely to be a source of secondhand smoke for their developing offspring . As noted earlier , smoking by either the mother or around the mother can hinder prenatal development . Prenatal Assessment A number of assessments are suggested to women as part of their routine prenatal care to find conditions that may increase the risk of complications for the mother and fetus ( 1996 ) These can include blood and urine analyses and screening and diagnostic tests for birth defects . Chapter Heredity , Prenatal Development , Birth 315

Preparing for an Ultrasound Ultrasound is one of the main screening tests done in combination with blood tests . The ultrasound is a test in which sound waves are used to examine the fetus . There are two general types . ultrasounds are used in early pregnancy , while ultrasounds are more common and used after 10 weeks of pregnancy ( typically , 16 to 20 weeks ) Ultrasounds are used to check the fetus for defects or problems . It can also find out the age of the fetus , location of the placenta , fetal position , movement , breathing and heart rate , amount of amniotic , and number of fetuses . Most women have at least one ultra sound during pregnancy , but if problems are noted , additional ultrasounds may be recommended . 316 Chapter Heredity , Prenatal Development , Birth

! When diagnosis of a birth defect is necessary , ultrasounds help guide the more invasive diagnostic tests of amniocentesis and chorionic villus sampling . Amniocentesis is a procedure in which a needle is used to withdraw a small amount of amniotic fluid and cells from the sac surrounding the fetus and later tested Chorionic Villus Sampling is a procedure in which a small sample of cells is taken from the placenta and tested . Both amniocentesis and chorionic villus sampling have a risk of miscarriage , and consequently they are not done routinely . Chapter Heredity , Prenatal Development , Birth 317

no 021543 Cami 101 1011 It not it Complications of Pregnancy Minor complications There are a number of common side effects 318 Chapter Heredity , Prenatal Development , Birth of pregnancy . Not everyone experiences all of these , nor to the same degree . And although they are considered minor this is not to say that these problems are not potentially very uncomfortable . These side effects include nausea ( particularly during the first months of pregnancy as a result of higher levels of estrogen in the system ) heartburn , gas , hemorrhoids , backache , leg cramps , insomnia , constipation , shortness of breath or varicose veins ( as a result of carrying a heavy load on the abdomen ) Major Complications The following are some serious complications of pregnancy which can pose health risks to mother and child and that often require hospitalization . Ectopic Pregnancy occurs when the zygote becomes attached to the fallopian tube before reaching the uterus . About in 50 pregnancies in the United States are tubal pregnancies and this number has been increasing because of the higher rates of pelvic inflammatory disease and Chlamydia ( Carroll , 2007 ) Abdominal pain , vaginal bleeding , nausea and fainting are symptoms of ectopic pregnancy . also known as Toxemia , is characterized by a sharp rise in blood pressure , a leakage of protein into the urine as a result of kidney problems , and swelling of the hands , feet , and face during the third trimester of pregnancy . is the most common complication of pregnancy . It is estimated to affect to 10 of all pregnancies globally and accounts for 40 to 60 of maternal deaths in developing countries ( National Institute of Child Health and Development , 2013 ) Rates are lower in the United States and affects about to of pregnant women . occurs most frequently in first pregnancies , and it is more common in women who are obese , have diabetes , or are carrying twins . When causes seizures , the condition is known as eclampsia , which is the second leading cause of maternal death in the United States . is also a leading cause of fetal complications , which include low birth weight , premature Chapter Heredity , Prenatal Development , Birth 319

birth , and stillbirth . Treatment is typically bed rest and sometimes medication . If this treatment is ineffective , labor may be induced . Maternal Mortality to the ( 2019 ) about 700 American women die from complications related to pregnancy each year , and this number is rising . Further , 60 of those deaths could have been prevented . Bleeding , infections , and problems are the main causes . Possible contributing factors include the high caesarean section rate and obesity . Compared to other developed nations , this number is considered high . Approximately 1000 women die in childbirth around the world each day ( World Health Organization , 2010 ) Rates are highest in Africa and South Asia , although there has been a substantial decrease in these rates . The campaign to make childbirth safe for everyone has led to the development of clinics accessible to those living in more isolated areas and training more midwives to assist in childbirth . Spontaneous abortion is experienced in an estimated percent of undiagnosed pregnancies and in another 10 percent of diagnosed pregnancies . Usually the body due to chromosomal abnormalities , and this typically happens before the week of pregnancy . Cramping and bleeding result and normal periods return after several months . Some women are more likely to have repeated miscarriages due to chromosomal , amniotic , or hormonal problems , but miscarriage can also be a result of defective sperm ( et . 2003 ) Birth Preparation for Childbirth Prepared childbirth refers to being not only in good physical condition to help provide a healthy environment for the baby to 320 Chapter Heredity , Prenatal Development , Birth

develop , but also helping individuals to prepare to accept their new roles as parents . Additionally , parents can receive information and training that will assist them for delivery and life with the baby . The more future parents can learn about childbirth and the newborn , the better prepared they will be for the adjustment they must make to a new life . One of the most common methods for preparing for childbirth is The Lamaze Method . This method originated in Russia and was brought to the United States in the by Lamaze . The emphasis of this method is on teaching the woman to be in control in the process of delivery . It includes learning muscle relaxation , breathing though contractions , having a focal point ( usually a picture to look at ) during contractions and having a support person who goes through the training process with the mother and serves as a coach during delivery ( 1996 ) Choosing Where to Have the Baby and Who Will Deliver The vast majority of births occur in a hospital setting . However , one percent of women choose to deliver at home ( Martin , Hamilton , 2015 ) Women who are at low risk for birth complications can successfully deliver at home . More than half ( 67 ) of home deliveries are by certified nurse . Midwives are trained and licensed to assist in delivery and are far less expensive than the cost of a hospital delivery . However , because of the potential for a complication during the birth process , most medical professionals recommend that delivery take place in a hospital . Despite the concerns , in the United States women who have had previous children , who are over 25 , and who are white are more likely to have births ( 2010 ) In addition to home births , of births occur in freestanding clinics , birthing centers , in physician offices , or other locations . Chapter Heredity , Prenatal Development , Birth 321

Stages of Birth for Vaginal Delivery 322 Chapter Heredity , Prenatal Development , Birth The First Stage of labor begins with uterine contractions that may initially last about 30 seconds and be spaced 15 to 20 minutes apart . These increase in duration and frequency to more than a minute in length and about to minutes apart . Typically , doctors advise that they be called when contractions are coming about every minutes . Some women experience false labor or contractions , especially with the first child . These may come and go . They tend to diminish when the mother begins walking around . Real labor pains tend to increase with walking . Labor may also be signaled by a bloody discharge being expelled from the cervix . In one out of pregnancies , the amniotic sac or water in which the fetus is suspended may break before labor begins . In such cases , the physician may induce labor with the use of medication if it does not begin on its own in order to reduce the risk of infection . Normally this sac does not rupture until the later stages of labor . The first stage of labor is typically the longest . During this stage the cervix or opening to the uterus dilates to 10 centimeters or just under inches . This may take around hours for first children or about hours for women who have previously given birth . Labor may also begin with a discharge of blood or amniotic fluid . The Second Stage involves the passage of the baby through the birth canal . This stage takes about minutes . Contractions usually come about every minutes . The mother pushes and relaxes as directed by the medical staff . Normally the head is delivered first . The baby is then rotated so that one shoulder can come through and then the other shoulder . The rest of the baby quickly passes through . At this stage , an episiotomy or incision made in the tissue between the vaginal opening and anus , may be performed to avoid tearing the tissue of the back of the vaginal opening ( Mayo Clinic , 2016 ) The baby mouth and nose are suctioned out . The umbilical cord is clamped and cut . The Third Stage is relatively painless . During this stage , the placenta or afterbirth is delivered . This is typically within 20 minutes after delivery . If an episiotomy was performed it is stitched up during this stage . Chapter Heredity , Prenatal Development , Birth 323

More than 50 of women giving birth at hospitals use an epidural anesthesia during delivery ( American Pregnancy Association , 2015 ) An epidural block is a regional analgesic that can be used during labor and alleviates most pain in the lower body without slowing labor . The epidural block can be used throughout labor and has little to no effect on the baby . Medication is injected into a small space outside the spinal cord in the lower back . It takes 10 to 20 minutes for the medication to take effect . An epidural block with stronger medications , such as anesthetics , can be used shortly before a section or if a vaginal birth requires the use of forceps or vacuum extraction . A Cesarean section ( is surgery to deliver the baby by being removed through the mother abdomen . In the United States , about one in three women have their babies delivered this way ( Martin et , 2015 ) Most are done when problems occur during delivery unexpectedly . These can include Health problems in the mother Signs of distress in the baby Not enough room for the baby to go through the vagina The position of the baby , such as a breech presentation where the head is not in the downward position are also more common among women carrying more than one baby . Although the surgery is relatively safe for mother and baby , it is considered major surgery and carries health risks . Additionally , it also takes longer to recover from a than from vaginal birth . After healing , the incision may leave a weak spot in the wall of the uterus . This could cause problems with an attempted vaginal birth later . However , more than half of women who have a can have a vaginal birth later . Induced birth Sometimes a baby arrival may need to be induced or delivered before labor begins . Inducing labor may be recommended for a variety of reasons when there is concern for the health of the mother or baby . For example The mother is approaching two weeks beyond her due date and labor has not started naturally 324 Chapter Heredity , Prenatal Development , Birth

The mothers water has broken , but contractions have not begun There is an infection in the mothers uterus The baby has stopped growing at the expected pace There is not enough amniotic fluid surrounding the baby The placenta peels away , either partially or completely , from the inner wall of the uterus before delivery The mother has a medical condition that might put her or her baby at risk , such as high blood pressure or diabetes ( Mayo Clinic , 2014 ) Assessing the Neonate The assessment is conducted one minute and five minutes after birth . This is a very quick way to assess the newborns overall condition . Five measures are assessed Heart rate , respiration , muscle tone ( assessed by touching the baby palm ) response ( the reflex is tested ) and color . A score of to is given on each feature examined . An of or less is cause for concern . The second should indicate improvement with a higher score . Chapter Heredity , Prenatal Development , Birth 325

Figure ! AKBAR Scorn Another way to assess the condition of the newborn is the Neonatal Behavioral Assessment Scale ( The baby motor development , muscle tone , and stress response are assessed . This tool has been used around the world to further assess the newborn , especially those with low scores , and to make comparisons of infants in different cultures ( Nugent , 1995 ) 326 Chapter Heredity , Prenatal Development , Birth

Problems of the Newborn Anoxia Anoxia is a temporary lack of oxygen to the brain . Difficulty during delivery may lead to anoxia which can result in brain damage or in severe cases , death . Babies who suffer both low birth weight and anoxia are more likely to suffer learning disabilities later in life as well . Figure Newborn In Neonatal Low Birth weight We have been discussing a number of associated with low birth weight such as alcohol , tobacco , etc . A child is considered low birth weight if he or she weighs less than pounds ounces ( 2500 grams ) About percent of babies born in the United States are of low birth weight ( Center for Disease Control , A low birth weight baby has difficulty maintaining adequate body temperature because it lacks the fat that would otherwise provide insulation . Such a baby is also at more risk for infection , and 67 percent of these babies are also preterm which can make them more at risk for respiratory infection . Very low birth Chapter , Prenatal Development , Birth 327

weight babies ( pounds or less ) have an increased risk of developing cerebral palsy . Additionally , and ( 2019 ) analyzed fetal growth and found that reduced birth weight was correlated with a small , but significant increase in several psychiatric disorders in adulthood . These included disorder , autism , depression , and disorder . et al . theorized that reduced fetal growth compromises brain development during a critical period , which in turn slightly increases the risk not only for disorders but also for virtually all mental health conditions ( 540 ) An insufficient supply of oxygen and nutrients for the developing fetus are proposed as factors that increased the risk for disorders . Preterm A newborn might also have a low birth weight if it is born at less than 37 weeks gestation , which qualifies it as a preterm baby ( Early birth can be triggered by anything that disrupts the mother system . For instance , vaginal infections can lead to premature birth because such infection causes the mother to release chemicals which , in turn , can trigger contractions . Smoking and the use of other can lead to preterm birth . The earlier a woman quits smoking , the lower the chance that the baby will be born preterm ( 2019 ) A significant consequence of preterm birth includes respiratory distress syndrome , which is characterized by weak and irregular breathing ( United States National Library of Medicine , name given to her by the hospital ) a baby girl born in San Diego , California is now considered the worlds smallest baby ever to survive ( Chiu , 2019 ) She was born in December 2018 at 23 weeks and days weighing only ounces ( same size as an apple ) After five months in the hospital , went home in May 2019 weighing pounds . 328 Chapter Heredity , Prenatal Development , Birth

Figure Infants Infants that have birth weights that are below expectation based on their gestational age are referred to as . These infants may be full term or preterm , but still weigh less than 90 of all babies of the same gestational age . This is a very serious situation for newborns as their growth was adversely affected . et al . 2003 ) found that date infants died at rates more than four times higher than other infants . Remember that many causes of low birth weight and preterm births are preventable with proper prenatal care . Postpartum Maternal Concerns After pregnancy many women experience emotional changes . The baby blues are often mentioned as a common occurrence in new mothers . The baby blues are feelings of sadness that occur to days after having a baby , and typically disappear usually within 10 days of the birth . New mothers may have trouble sleeping , be Chapter Heredity , Prenatal Development , Birth 329

moody , and feel from the birthing experience . However , postpartum depression is not the same as the baby blues . According to the Diagnostic and Statistical Manual of Mental edition ( American Psychiatric Association , 2013 ) onset of depression , also known as postpartum depression , is a type of depression that occurs during pregnancy or in the weeks following pregnancy . Approximately out of women experience postpartum depression and symptoms can include feelings of sadness , sleeplessness , and difficulty bonding with the newborn . Changing hormone levels are thought to be a factor in the occurrence of depression , however , risk factors include having depression previously , a family history of depression , being younger than 20 , experiencing stress , and substance use . mood disorders , both depression , and mania can present with or without psychotic features . Hallucinations and delusions are associated with postpartum psychotic episodes and have included command hallucinations to kill the infant or delusions that the infant is possessed . Psychotic features occur in approximately in 500 to in deliveries , and the risk is higher for women with prior postpartum mood episodes ( American Psychiatric Association , 2013 ) Postpartum anxiety is also a concern for many new mothers . According to ( 2017 ) because oxytocin , a bonding hormone , rises during pregnancy , brain areas related to empathy and anxiety are heightened . Consequently , the new mother is to respond to and fend for her baby , which can lead to toxic levels of stress and anxiety . These can manifest as heightened alertness , intrusive and horrifying thoughts of something terrible happening to the infant , and physiological arousal . Just as for depression and postpartum psychosis , a new mother experiencing postpartum anxiety should seek assistance from a health care provider . 330 Chapter Heredity , Prenatal Development , Birth

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