Transcript Cognitive and Motor Development

McGraw-Hill/Irwin
© 2012 McGraw-Hill Companies. All Rights Reserved.
Negative factors influencing
prenatal life are believed to
be a result of genetic or
environmental misfortune
5-2
Prenatal Development
First Two Weeks ~ Germinal Period
Release of oocyte from ovary into uterine tube
Fertilization
Zygote divides and moves toward the uterus - morula
Morula enters uterus and is transformed into a blastocyst
Blastocyst attaches to endometrium and sinks below
5-3
Germinal Period
5-4
Prenatal Development
WEEKS 3 TO 8 ~ Embryonic Period
Zygote forms endoderm, ectoderm, and mesoderm – now called an
embryo
Endoderm – digestive and respiratory systems
Ectoderm – nervous system, sensory receptors, skin
Mesoderm – circulatory, muscular, skeletal, excretory, and
reproductive systems
Placenta, umbilical cord, and amnion develop
5-5
Prenatal Period
Negative factors influencing prenatal life are
believed to be a result of genetic or environmental
causes
Teratogen
Environmental agent that causes harm to the
embryo or fetus
Teratogens are most dangerous between 3 and 8
weeks of gestation
5-6
Prenatal Period
Myth ~ maternal environment is a protective
shelter for the developing embryo
Thalidomide - teratogen
A tranquilizing drug
Responsible for causing over 500 malformed births
Malformed arms, lack of outer ear, missing bones,
some with no effects
5-7
Prenatal Period
Weeks 9 to Birth ~ Fetal Period
Rapid body growth and organ system
differentiation
At 9 weeks, fetus is 3 inches long and
weighs 1 ounce
At birth, the baby will be 20 inches long
and weigh 7 pounds
5-8
Critical Periods in Human Development
5-9
Drugs and Medications
Recreational drugs
Alcohol
Cocaine
Tobacco
Marijuana (cannabis)
5-10
Alcohol
CDC estimates that more than 130,000 women in
the US consume alcohol during pregnancy at
levels known to increase birth defects
Prevalence
Use among pregnant women - 12.2%
5-11
Fetal Alcohol Spectrum Disorders
Fetal alcohol syndrome (FAS)
Cluster of birth defects resulting from prenatal
alcohol exposure
Alcohol-related neurodevelopmental disorders
(ARND)
Less severe symptoms
Alcohol-related birth defects (ARBD)
Neonatal abstinence syndrome (NAS)
Withdrawal symptoms during neonatal period
5-12
Fetal Alcohol Syndrome / Alcohol-Related
Neurodevelopmental Disorder
5-13
Cocaine
Effects of use during pregnancy
25% higher incidence of preterm birth
Fetal brain damage
Increased occurrence of miscarriage
Extreme fluctuations in heart rate and blood
pressure of mother and fetus
Constricted blood vessels in uterus
When born, baby is at risk for SIDS
5-14
Cocaine
“cocaine babies” exhibit mental retardation 5
times greater than that of the general population
Fine and gross motor deficiencies detectable
beyond 2 years of age
5-15
Tobacco
5-16
Tobacco
5-17
Tobacco
5-18
Tobacco
Carbon monoxide
Interferes with hemoglobin’s oxygen carrying
capacity
Fetal hypoxia
Nicotine
Affects placental blood vessels to induce fetal
hypoxia
13.8% of women smoke during pregnancy
5-19
Cannabis (Marijuana)
Little conclusive research on the effects of
marijuana and its effect on the human embryo or
fetus
Cannabis is associated with no known obstetric
complications
Drug does not alter fetal growth
5-20
Drugs and Medications
Prescriptive drugs
Some drugs may damage a body part that is growing
and developing during the drug use
Some drugs may adversely affect in the fetus that
which was intended to be positively affected in the
mother
Thyroid medication
5-21
Prescriptive Medications
5-22
Drugs and Medications
Nonprescriptive drugs
“over-the-counter” drugs (OTC)
Generally considered “safe”
OTC medications contain a variety of chemicals and
for that reason, caution is warranted during
pregnancy
5-23
OTC Medications
Considered
Safe
Potentially Dangerous
Acetaminophen
(Tylenol)
Aspirin: postterm pregnancy and prolonged
labor; bleeding in skull of baby; maternal
bleeding during delivery
Ibuprofen (Advil,
Motrin)
Cold medications containing alcohol: FAS
and ARND
Naproxen Sodium
(Aleve)
OTC drugs designed to treat a variety of
problems
5-24
Drugs and Medications
Obstetrical medications
There is controversy over the use of obstetrical
medications
These agents are known to enter fetal circulation,
exerting their effects on the child, within minutes
after administration to the mother
May impair fetal development
5-25
Maternal Diseases
Viral diseases
Rubella and congenital rubella syndrome
HIV
Parasitic diseases
Toxoplasmosis
Hematologic diseases
Rh incompatibility & erythroblastosis fetalis
Endocrine diseases
Diabetes mellitus
5-26
Rubella & Congenital Rubella Syndrome (CRS)
German measles
Damage to fetus is
tied to time of
maternal infection
20%-50% of infected
may not notice
symptoms
2003: 20,000
newborns had CRS
Associated defects
Growth retardation
Mental retardation
Congenital glaucoma
Cataracts
Bony lesions
Pneumonia
Hepatitis
Cardiac anomalies
Deafness (80%)
5-27
Incidence of Rubella & Congenital Rubella Syndrome
5-28
HIV
Human immunodeficiency virus
Easily passed on to offspring
In utero from the mother to the fetus
During delivery when the fetus comes in contact
with infected blood or infected vaginal secretions
Through breast milk
5-29
5-30
Toxoplasmosis
Protozoan parasites
Toxoplasma gondii
Pregnant women come into contact with this
parasite when cleaning a cat litter box
Infectious oocysts are in soil contaminated by cat
feces
5-31
Toxoplasmosis
Consequences
Mental retardation, convulsions
Motor abnormalities
Deafness or visual impairments
Silent infection
10% of newborns show any evidence of disease
5-32
Rh Incompatibility
Rh factor on red blood cells
85% of population is Rh+
Potential problem when an Rh+ man and Rhwoman conceive an Rh+ child
Rh+ blood cells escape fetal circulation
Rh+ blood cells in maternal circulation are treated as
foreign bodies
Antibodies are formed to fight fetal blood cells
5-33
Rh Incompatibility
1st offspring unaffected
Subsequent offspring will illicit antibody reaction
Mother given anti-D IgG immunoglobulin
immediately after first delivery
5-34
Rh Incompatibility
Erythroblastosis fetalis
Hemolytic disease of the newborn (HDN)
Rh+ offspring exposed to maternal antibodies
Characteristics
Anemia
Immature red blood cells
Edema
Jaundice
5-35
5-36
Neurological Deterioration in HIV-Infected Children
5-37
Diabetes Mellitus
The metabolic environment for the fetus
constantly changes in utero
Normoglycemia to hypoglycemia (low blood sugar)
to hyperglycemia (high blood sugar)
Hyperinsulinemia
Maternal hyperglycemia in 3rd trimester leads to
increases in fetal glucose
Fetal insulin secretion increases
5-38
Diabetes Mellitus
Hyperinsulinemia
Macrosomia
Increased insulin production increases glycogen in liver
which results in triglyceride production (birth weight
above 90th tile)
May be responsible for adult obesity
Inhibition of maturation of lung surfactant
Muscle weakness/cardiac arrhythmias
Permanent neurological damage due to neonatal
hypoglycemia
5-39
Diabetes Mellitus
Abnormalities of Infants Born to Diabetic Mothers
Spina bifida
Hydrocephalus
Heart defects
Skeletal and CNS
defects
Macrosomia
Musculoskeletal deformities
Asphyxia
Facial nerve injury
Brachial plexus injury
Cesarean section (cephalopelvic
disproportion)
5-40
Genetic-based Disorders
Down syndrome
Phenylketonuria
Cystic fibrosis
Sickle cell trait
Sickle cell disease
Fragile X syndrome
5-41
Down Syndrome
Chromosome-based disorders
Meiotic nondisjunction
One sperm or egg cell contains two members of a
particular numbered chromosome while the other
member contains none
Could result in 47 chromosomes
Down Syndrome
5-42
Down Syndrome
Symptoms and Signs of Trisomy 21
(Down Syndrome)
Walking delayed 1 or more
years
Slow speech development
Slow development of fine
motor control
Toilet training delayed
Lower than normal birth
weight
Hypotonia
Short stature
Delayed puberty
Prone to respiratory
infections
Heart disease
Prominent anatomical
features
5-43
Down Syndrome
Mental retardation
Walking delayed
Treadmill walking can help the child develop walking
pattern
Emphasizes neural connections
Train multiple subsystems
5-44
Phenylketonuria (PKU)
Caused by a disturbance in amino acid
metabolism by a gene that suppresses activity of
the liver enzyme phenylalanine hydroxylase
This enzyme converts L-phenylalanine to tyrosine
If L-phenylalanine not converted, the CNS is affected
5-45
Cystic Fibrosis (CF)
Causes a thick, sticky mucus to be secreted in the
lungs
Mucus can clog pancreas disrupting digestion
Person with CF has repeated respiratory infections
Scar tissue develops on the lungs
CF drug contains enzyme to thin mucus
There is no cure
5-46
Sickle Cell Trait (SCT)
Individual inherits normal gene for hemoglobin
(Hb-A) and one abnormal gene (Hb-S)
Asymptomatic
Live normal lives
Can pass the SCT gene to offspring
No problems with physical activity
5-47
Sickle Cell Disease (SCD)
Child inherits two abnormal Hb genes (SS)
Red blood cells are sickle-shaped and can get
caught in small blood vessels blocking blood flow
Red blood cells are also easily destroyed or
concentrate in high levels in the spleen
Affects predominantly people in Africa and those
of African descent
5-48
1 of 2
5-49
SCT
2 of 2
5-50
Fragile X Syndrome
Extra chromosome on chromosome #21
Leading cause of autism
Delay in motor skills
Sitting, crawling, walking
Low muscle tone, poor balance, flat feet,
hyperextensibility of joints
Game playing is difficult
5-51
Prenatal Diagnostic Procedures
One at high risk for giving birth
Will be over 35 years at time of delivery
Has already given birth (or whose partner has) to
child with genetic disease or birth defect
Has a family history of genetic disease or birth
defects
Has a medical history of genetic traits
5-52
Prenatal Diagnostic Procedures
Common procedures
Ultrasound
Amniocentesis
Chorionic villus sampling
Alpha-fetoprotein test
Triple marker screening blood test
5-53
Ultrasound
Sonogram
Can be used to measure head size of baby
Helps to determine exact length of gestation
Used to examine placement and structure of
placenta
Can detect baby’s gender; multiple pregnancies
5-54
Amniocentesis
Needle inserted through abdominal wall
Sample of fluid from amniotic sac removed
Fetal cells can be tested to determine
abnormalities
Ultrasound is used to guide needle placement
Employed when mother is at high risk
5-55
Chorionic Villus Sampling (CVS)
Can detect abnormalities earlier than
amniocentesis
Between 10-12 weeks of gestation
Instead of amniotic fluid, a sample of the villi of
the chorion are collected and tested
Carries a greater risk than amniocentesis
5-56
Chorionic Villus Sampling (CVS)
Chorionic Villus Sampling A plastic catheter
is inserted through
the cervix and
guided by ultrasound
5-57
Chorionic Villus Sampling (CVS)
Chorionic Villus Sampling
A biopsy needle is
inserted through
the abdominal wall
and guided by
ultrasound
5-58
Alpha-fetoprotein (AFP) Test
Blood test performed at 15-20 weeks into
pregnancy
Measures the amount of AFP to detect neuraltube defects (high levels) or Down Syndrome (low
levels)
Because of the number of false positives, it is used
mainly as a screening test
5-59
Triple Marker Screening
Test for detecting Down Syndrome in pregnant
women younger than 35 yr
Not acceptable for women older than 35 yr
The amount of human chorionic gonadotropin,
unconjugated estriol, and alpha-fetoprotein (triple
marker) is determined from blood
Safe with a 40%-60% accuracy rate
5-60
Maternal Nutrition
Sedentary women need to increase caloric intake
by 300 kcal/day
Active women must make additional adjustments
based upon caloric expenditure
Weight gain is based upon preconception BMI
5-61
5-62
Maternal Nutrition
Lack of protein in maternal can lead to impaired
prenatal brain growth
The developing fetal brain should achieve 25% of
its mature weight prior to birth
Perinatal mortality common in underweight
mothers
5-63
Maternal Nutrition
Grandmother effect
The second – as well as the first-generation show
the elicit the effects of poor nutrition
Even if a woman attains adequate nutrition
throughout life, she has an increased change of
giving birth to an abnormal offspring if her mother
was undernourished
5-64
Birth Weight Categories
Low birth weight
Very low birth weight
Extremely low birth weight
Small for gestational age
Appropriate for gestational age
Large for gestational age
5-65
Low Birth Weight
Low birth weight: <2500 grams
Very low birth weight: <1500 grams
Extremely low birth weight: <500 grams
Low birth weight is not synonymous with
premature
Is the low birth weight due to a shortened
gestational period or growth retardation from
malnourishment
5-66
Small for Gestational Age
Can be born preterm (< 37 weeks) or full term (40
weeks)
Inadequate nutrition in utero
Growth retardation
Decreased brain development
Learning difficulties
May have low motor abilities
Parents are often concerned about SGA or LBW
children involved in vigorous activities
5-67
Appropriate for Gestational Age
Even if born weighing < 1500 grams, these babies
are at less risk compared to SGA
Exhibit some developmental delays in weight,
length, brain circumference
Catch-up by 2nd year
5-68
Large for Gestational Age
> 90th percentile for gestational age
Birth injuries are common
Brachial plexus injuries
Fracture of clavicle
Respiratory distress syndrome
Mental retardation
Diabetic mothers tend to have babies of LGA
5-69
5-70
5-71
Maternal Health & Exercise
Preeclampsia
Pregnancy induced hypertension
Developed in women exercising > 420 min/wk
Normally, exercise reduces risk of hypertension
Gestational diabetes
Exercise prevents gestational diabetes
5-72
Maternal Health & Exercise
Weight gain during pregnancy
Exercise reduces risk of weight gain
Fetal distress
Extended periods of fetal bradycardia (<60 bpm)
No problems associated with aerobic exercise
Preterm delivery
No association between exercise and preterm
delivery
Birth weight
No increased risk for LBW baby
5-73
Exercise During Pregnancy
Maternal responses
Blood volume increases by 35% to 45%
Blood shunted to muscles during exercise
Does this maternal response decrease fetal oxygen
supply?
Body temperature rises
Could be dangerous to the fetus
Fetus cannot reduce body temperature
5-74
Exercise During Pregnancy
Review the exercise guidelines for exercise during
pregnancy
5-75
5-76