Prenatal Developmental Concerns

Question 1

What are determinants of intra-uterine growth and birth weight?

Answer 1

Infant sex
Ethnicity/race
Maternal height
Pregnancy weight
Alcohol consumption
Pregnancy height and weight
Maternal birth weight
Parity (the more pregnancies you have the better the following pregnancies are)
Gestational weight gain
Prior low birth weight infant
Caloric intake
Cigarette smoking
Pregnancy height and weight
Tobacco chewing
Maternal age (indirect)
SES (indirect)

Question 2

What are characteristics of Low birth weight babies?

Answer 2

Full term infants @10th percentile birth weight = 2.5x risk of mortality
Birth weight <2500 gm (5lbs 8oz) is classified as low birth weight
Two distinct groups:
-pre-term
- small-for-date, small for gestational age (SGA)

Pre-term= physiological immaturity
SGA display intrauterine growth retardation or fetal growth restriction

Question 3

What effect does low birth weight have on growth?

Answer 3

low birth weight has significance for postnatal growth:

• shorter status during childhood and at maturity and
• Possible deficiencies in neuromuscular coordination and power

Question 4

What are the most common causes of spontaneous abortions?

Answer 4

Faulty or incompatible gametes

Question 5

What is the percentage of clinically recognized pregnancies that end in a miscarriage (loss prior to week 20)?

Answer 5

10-25%

Question 6

What are causes of miscarriage?

Answer 6

Maternal age
Illness
Lifestyle
Trauma

Question 7

What are congenital malformations?

Answer 7

Indicates an abnormal condition present at birth
It does not specify the what or why
Causal factors can be both genetic and environmental

Question 8

Which period is most critical with respect to genetic malformations?

Answer 8

Period of the embryo

Question 9

What is crucial in congenital malformations? What are causal agents of congenital malformation?

Answer 9

Timing is crucial

Trauma, chemicals or therapeutic drugs
Radiation, infections, hypoxia
Maternal metabolic imbalances
Maternal substance abuse

Question 10

What factors is prenatal nutrition related to?

Answer 10

Placental
Fetal and
Maternal factors

Question 11

The effects of prenatal nutrition are determined by what?

Answer 11

The timing, persistence and degree of nutritional inadequacy

Question 12

What do placental nutrition factors relate to?

Answer 12

Circulation and the transport of nutrients from placenta to fetus

Question 13

What do fetal nutritional factors relate to?

Answer 13

The utilization of available nutrients

Question 14

What do the maternal nutritional factors relate to?

Answer 14

Mother’s overall nutritional status
Especially the adequacy of energy and nutrient intake and weight gain during pregnancy

Question 15

What are teratogens?

Answer 15

Defined as an environmental agent that causes harm to the embryo or fetus

Question 16

The amount of harm a teratogen can cause is a function of what?

Answer 16

Baby’s genetic makeup
Amount of exposure
Time/duration of exposure

Question 17

What is the effect of maternal smoking?

Answer 17

Effects on prenatal growth determined by number of cigarettes smoked daily
Dose response, deficits in weight and length range from:
70g, 0.7 cm ==> 9 cigarettes daily
210g, 1.0cm ==> 20 cigarettes daily
Effects on physical development continue postnatally

Question 18

What is maternal alcohol consumption associated with?

Answer 18

fetal growth restriction
abnormal facial development
impairment of the CNS

Dose - response effect:
=<2 drinks per day = 65g weight loss
>= 2 drinks per day= 150g weight loss

Question 19

What are the characteristics of maternal exercise?

Answer 19

Moderate PA:
Has no negative effect on fetal development
Benefits from the mother are well documented
Guidelines are well established

Question 20

What are the guidelines for exercise during pregnancy?

Answer 20

Same as before
Avoid HIIT
Stay in a thermoregulated environment
Stay under 60-80% of MaxHR
If person was not active before the pregnancy, it is not the time to start

Question 21

What is the fetal origins of adult disease hypothesis?

Answer 21

Originated by Dr. David Barker
“events that happen very early in fetal development can have a profound impact on the risk for incurring disease as an adult

Implications of FOAD extend beyond LBW babies to include nutritional and non nutritional stress during different periods of development

Question 22

What are some gene based disorders?

Answer 22

Phenylketonuria (intellectual disability, seizures, behavioral problems, mental disorders, musty odor)
Cystic fibrosis
Sickle-cell disease and trait

Question 23

When can genetic testing be done and what does it include?

Answer 23

Can be done at multiple points throughout pregnancy
Includes: fetal ultrasound and maternal blood testing

Question 24

What can genetic testing screen for?

Answer 24

Cystic fibrosis
Duchenne muscular dystrophy
Polycystic kidney disease
Sickle cell disease
Tay-sachs disease
Thalassemia
Down syndrome

Question 25

What are lifespan reflexes versus infant reflexes?

Answer 25

Most Infant reflexes will disappear by the end of the first year (i.e. sucking reflex, labyrinthine reflex, etc..)

Lifespan reflexes: knee jerk reflex, flexor withdrawal

Question 26

What are primitive reflexes?

Answer 26

Reflexes that dominate the first 6 months
Role is to ensure survival

Question 27

What are the characteristics of primitive reflexes?

Answer 27

Produced subcortically
Occur in all normal developing newborns
Appear during gestation and at birth to 6 months
Used predominantly for protection, nutrition or survival

Question 28

Where are postural reflexes produced?

Answer 28

Cortically, higher brain centers
some are considered direct precursors to complex movement

Question 29

Which reflexes are commonly used for diagnosis of neurological conditions?

Answer 29

Moro reflex
Asymmetrical tonic neck reflex

Monitoring motor function:
- milani Comparetti Neuromotor Development
- Primitive Reflex Profile

Question 30

What are stereotypies?

Answer 30

rhythmic, patterned, centrally controlled movement behavior of infancy apparently not learned through imitation or a consequence of external stimuli

Can be exhibited in lower or upper extremities, head and neck, torso
Number of stereotypies and frequency of occurrence is greatest from 2-42 weeks and then diminishes.

Question 31

What is the purpose of stereotypies?

Answer 31

Uncertain
could be calming, practice?