Maternal Factors

Maternal Factors

Teratogens from Pets and Other Animals

The tiny parasite, toxoplasma gondii, causes an infection called toxoplasmosis. 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 health-care provider about being tested. 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 Infections

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 (Fontenot & George, 2014). Sexually transmitted infections (STIs) can cause premature birth and low birth weight (Govender et al., 2024). Most babies become infected with STIs while passing through the birth canal during delivery, but some STIs can cross the placenta and infect the developing fetus.

Human Immunodeficiency Virus (HIV)

One of the most potentially devastating teratogens is HIV. One of the main ways children under age 13 become infected with HIV is via mother-to-child transmission of the virus prenatally, during labor, or by breastfeeding (Languluri, 2017). There are some measures, such as antiretroviral medications (Cerveny et al., 2021), that can be taken to lower the chance the child will contract the disease. However, the long-term risks of prenatal exposure to the medication are not known. It is recommended that women with HIV deliver the child by c-section, and that after birth they avoid breast feeding.

German measles (or rubella)

Rubella, also called German measles, is an infection that causes mild flu-like symptoms and a rash on the skin. 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 11th 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.

Maternal Infections

Table 5.1 Maternal infections and potential effects.

Mothers over 40

Most women over 40 who become pregnant are in good health and have healthy pregnancies. However, women over age 40 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 (Frederiksen et al., 2018).

Because a woman is born with all her eggs, environmental teratogens can affect the quality of her eggs as a woman gets older. Also, a woman’s reproductive system ages which can adversely affect the pregnancy. Some women over 40 choose special prenatal screening tests, such as a maternal blood screening, to determine if there are any health risks for the baby.

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. For example, older parents are more confident, less stressed, and typically married, providing family stability. Their children perform better in school and have fewer behavior problems (Duncan et al., 2018). Lastly, women who delay having children live longer (Grundy & Tomassini, 2005).

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 birthweight or other serious health problems. Premature and low birthweight 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. 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 2 years after the first baby’s birth.

Gestational Diabetes

Some pregnant women develop gestational diabetes. 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 9 pounds) making the labor and birth process more difficult. For expectant mothers, untreated gestational diabetes can cause preeclampsia, a complication that results in high blood pressure and signs of damage to other organs, most commonly the liver and kidneys. Risk factors for gestational diabetes include age (being over age 25), being overweight or gaining too much weight during pregnancy, family history of diabetes, having had gestational diabetes with a prior pregnancy, and race and ethnicity (African-American, 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 make sure to attend all their prenatal care visits, and follow the same advice as those for women with gestational diabetes as the risk of preeclampsia, 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 that can result 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. High blood pressure during pregnancy can cause premature birth and low birth weight (under five and a half pounds), placental abruption, and preeclampsia.

Rh Disease

Rh is a protein found in the blood. Most people are Rh positive, meaning they have this protein. Some people are Rh negative, meaning this protein is absent. Mothers who are Rh negative are at risk of having a baby with a form of anemia. A father who is Rh-positive and mother who is Rh-negative can conceive a baby who is Rh-positive. In this case, some of the fetus’s blood cells may get into the mother’s bloodstream and her immune system is unable to recognize the Rh 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 Rh positive baby is not harmed, but as the mother’s body will continue to produce antibodies to the Rh factor across her lifetime, subsequent pregnancies can pose greater risk for an Rh positive baby. In the newborn, Rh disease can lead to jaundice, anemia, heart failure, brain damage and death.

Weight Gain during Pregnancy

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 weight may have a baby who is low-birth 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 preeclampsia and diabetes, which can cause further problems during the pregnancy, so putting on the weight slowly is best. Mothers who are concerned about their weight gain should talk to their health care provider.

Stress and Depression

Feeling stressed is common during pregnancy, but high levels of stress can cause complications including having a premature baby or a low-birthweight baby. Babies born early or too small are at an increased risk for health problems. Stress-related hormones may cause these complications by affecting a woman’s 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 correlated with problems in the baby’s brain development and immune system functioning, as well as childhood problems such as trouble paying attention and being afraid.

Depression is a significant medical condition in which feelings of sadness, worthlessness, guilt, and fatigue interfere with one’s daily functioning. Depression can occur before, during, or after pregnancy, and 1 in 7 women is treated for depression sometime between the year before pregnancy and year after pregnancy. Women who have experienced depression previously are more likely to have depression during pregnancy. Consequences of depression include the baby being born premature, being low birthweight, 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 2 to 3 times more often in women who are prescribed certain Selective Serotonin Reuptake Inhibitors (SSRIs) for their depression.