Module- 3

Prenatal Development
Stages of prenatal development:
Typical prenatal development begins with fertilization and ends with birth, lasting between
255 and 280 days (from 38 to 40 weeks). It can be divided into three periods: germinal,
embryonic, and fetal.

Conception
 Menstrual cycle: Every 28 days one among
the two of womenÕs ovary produces egg
cell/ ovum, travels through fallopian tube
to uterus.

 Corpus luteum: Releases hormones to

prepare uterus for fertilized ovum; if no
pregnancy, uterus lining discarded with
menstruation.

 Male sperm production: Approximately

300 million daily, with tail development for
swimming.

 Sperm journey: Travels through female reproductive tract to reach fallopian tube for
fertilization.

 Sperm lifespan: Live up to 6 days, while the ovum survives only 1 day after release.

 Conception timing: Most likely during a 3-day period around ovulation.

 Prenatal development: Divided into three stages during the pregnancy are : Germinal
Stage, Embryonic Stage and Fetal Stage.
Germinal period /Period of Zygote (First 2 weeks):
 It includes the creation of the zygote, continued cell
division, and the attachment of the zygote to the
uterine wall.

 Zygote development: Lasts about 2 weeks after

conception, with initial cell duplication taking around
30 hours.

 Blastocyst formation: By the fourth day, a

blastocyst (hollow fluid filled ball that has 60-70
cells) with embryonic disk (an inner mass of cells)
and trophoblast (an outer layer of cells) is formed.

 Implantation: Occurs between the seventh and

ninth days, as the blastocyst attaches to the
uterine lining. This mass cell is now termed as
Embryo.

 Trophoblast development: Rapid multiplication

forms the amnion (encloses developing
organism into amniotic fluid.), providing
nourishment and helps to keep the
temperature of the prenatal world constant
and provides a cushion against any jolts
caused by the womenÕs movement.

 A yolk sac produces blood cells until the developing liver, spleen and bone marrow are
mature enough to take over this function.

 Uncertain events: Delicate period, with up to 30% of zygotes not surviving; some due
to improper joining or lack of cell duplication preventing implantation.

Placenta and Umbilical Cord:

Chorion formation: By the end of the second week, trophoblast cells form the chorion
(another protective membrane which surrounds the amnion).

Placenta development: Villi from the chorion create the

placenta, facilitating nutrient exchange between mother
and embryo.

Umbilical cord: Connects placenta to the developing

organism; contains one vein for nutrients and two
arteries for waste removal.

Umbilical cord growth: Grows to 1 to 3 feet during

pregnancy, providing essential blood flow.
Blood exchange: Membrane in the placenta allows nutrient and oxygen exchange while
preventing direct mixing of maternal and embryonic blood.

Force in the umbilical cord: Blood flow keeps the cord firm, preventing tangles.

Complex development:
By the end of the period of the zygote, the organism is already complex, finding nourishment
and shelter in the uterus.

These developments occur before most mothers are aware of their pregnancy.

Embryonic Stage/ Period of Embryo (Implantation to 8th week):

Rapid prenatal changes: Takes place from implantation through the eighth week, laying the
groundwork for all body structures and organs.

Last Half of the First Month:

Embryonic disk forms three layers of cells:
1. Ectoderm - nervous system and brain, sensory receptor
and skin parts

2. Mesoderm - circulatory system, bones, muscles,

excretory system, and reproductive system

3. Endoderm - digestive system, respiratory system,

urinary tract and glands

Nervous system development: the nervous system develops fastest,

 Ectoderm folds to form a neural tube or primitive spinal cord, with rapid production
of neurons (250,000 per minute).

 At 3½ weeks, the top of the neural tube

swells to form a brain.

 While the nervous system is developing,

the heart begins to pump blood, and
muscles, backbone, ribs and digestive
tract appear.

 At the end of first month, the curled

embryo consists of millions of organized group of cells with specific functions.

The Second Month:

Rapid growth: Eyes, ears, nose, jaw, neck, arms, legs, fingers, and toes form.

Organ development: Intestines grow, heart develops separate chambers, liver and spleen
take over blood cell production.

Body proportions change: Embryo becomes more upright. At 1 inch long and 1/7 of an ounce,
it can sense its world, respond to touch, and make subtle movements.
Sensory responsiveness: Responds to touch, particularly in the mouth and on the soles of the
feet. Can move, although movements are too light to be felt by the mother.

Fetal Stage/ Period of Fetus

 Longest prenatal period, characterized by rapid growth and finishing.

 Significant size increase, especially from the ninth to the twentieth week.

The Third Month:

 The organs, muscles and nervous system start to become organized and connected.

 Fetus exhibits coordinated movements to brain signals, and in response, the fetus kicks,
arm bending, fist formation, toe curling, mouth opening, and thumb-sucking.

 The tiny lungs begin to expand and contracts in an early rehearsal of breathing
movements.

 By the 12th week, the external genitals are well formed, and the sex of the fetus can be
detected using ultrasound.

 Development of finishing touches: Fingernails, toenails, tooth buds, and eyelids that open
and close.

 Stronger heartbeat audible through a stethoscope.

 Completion of the first trimester.

The Second Trimester (17 to 20 weeks):

 Movements felt by the mother.

 A white cheese like substance called vernix cover the skin

protecting it from chapping during the long months spent in
amniotic fluid.

 White downy hair called lanugo also covers the entire body,
helping the vernix stick to the skin.

 Major organ development; brain growth continues with glial cells

supporting neurons.

 Brain milestones: Neurons in mature brain nearly all in place; brain weight increases
tenfold from the 20th week until birth.

 However, the glial cells, which support and feed the neurons, continue to increase at a
rapid rate throughout the remaining months of pregnancy as well as after the birth.

A fetus born at this time cannot survive. The lungs are too immature, and the brain cannot
yet control breathing and body temperature.

The Third Trimester:

 Age of viability (22-26 weeks) marks the point at which the baby can first survive
outside the womb.
 Respiratory system matures, but premature babies may still need oxygen assistance.

 Continued brain development in the cerebral cortex, with increased surface area.

 Fetal awareness increases, spending more time awake.

Personality development: Fetal activity in the last weeks predicts infant temperament and
early childhood traits.

Weight and size gain: Fetus gains more than 5 pounds and grows 7 inches during the final 3
months.

Physical changes: Layer of fat added for temperature regulation, antibodies received from
the mother for immune protection.

 Upside-down position assumed, growth slows, and birth is imminent.

Prenatal Diagnostic Tests

Birth defects can be diagnosed during pregnancy or after the baby is born, depending on the
specific type of birth defect.

A number of tests can indicate whether a fetus is developing normally, including ultrasound
sonography, fetal MRI, chorionic villus sampling, amniocentesis, maternal blood screening, and
non-invasive prenatal diagnosis.

Ultrasound Sonography
Ultrasound sonography, also known as ultrasound imaging or ultrasonography, is a medical
imaging technique that uses high-frequency sound waves to create visual images of the inside
of the body. The echo from the sounds is transformed into a visual representation of the
fetusÕs inner structures. In the context of pregnancy, it is commonly used for prenatal care
to monitor the development of the fetus.

Purpose:
 Early Pregnancy Confirmation: Ultrasound is typically performed seven weeks into a
pregnancy to confirm the presence of a gestational sac, heartbeat, and embryo's
viability.

 Monitoring Fetal Development: Ultrasounds are utilized during pregnancy to monitor

fetal growth and development, aiding healthcare providers in assessing fetus health
and identifying potential issues.

 This technique can detect many

structural abnormalities in the fetus,
including microencephaly, a form of
mental retardation involving an
abnormally small brain; it can also
determine the number of fetuses and
give clues to the babyÕs sex.
  There is virtually no risk to the woman or fetus in this test.

Fetal MRI
Fetal MRI, or fetal magnetic resonance imaging, is a medical imaging technique that uses a
powerful magnetic field and radio waves to create detailed images of the developing fetus in
the womb.

 Ultrasound is commonly the initial choice for fetal screening due to its safety and
real-time imaging capabilities.

 However, in cases where ultrasound suggests a possible abnormality, fetal MRI may be
used to obtain more detailed and clearer images.

Chorionic villus sampling (CVS)

Chorionic Villus Sampling (CVS) is a prenatal diagnostic procedure performed between the
10th and 12th weeks of pregnancy to detect genetic defects and chromosomal abnormalities
in the developing fetus.

Procedure: During CVS, a small sample of the chorionic villi, which are finger-like
projections on the placenta, is collected. The placenta is the organ that provides
nutrients and oxygen to the developing fetus.

Diagnostic Timeframe: The diagnostic

results from CVS are usually available
within about 10 days after the procedure.
This relatively quick turnaround allows for
timely decision-making regarding the
pregnancy.

There is a small risk of limb deformity when

CVS is used.

Amniocentesis
Amniocentesis is a prenatal medical procedure performed between the 15th and 18th weeks
of pregnancy to obtain a sample of amniotic fluid for testing.

Purpose of Amniocentesis: Amniocentesis is primarily used to diagnose chromosomal

abnormalities, such as Down syndrome, and metabolic disorders, including
phenylketonuria (PKU).

Procedure: During amniocentesis, a thin needle is inserted through the abdominal wall
and into the amniotic sac that surrounds the developing fetus. A small amount of
amniotic fluid is withdrawn using a syringe.

 The later amniocentesis is performed, the better its diagnostic potential.

 The earlier it is performed, the more useful it is in deciding how to handle a

pregnancy.
 It may take two weeks for enough cells to grow and amniocentesis test results to be
obtained. Amniocentesis brings a small risk of miscarriage.

Maternal Blood Screening

 During the 16th to 18th weeks of pregnancy, maternal blood screening may be
performed.

 Maternal blood screening identifies pregnancies that have an elevated risk for birth
defects such as spina bifida (a defect in the spinal cord) and Down syndrome
(Bustamante-Aragones & others, 2010).

 The current blood test is called the triple screen because it measures three substances
(alpha-fetoprotein, human chorionic gonadotropin and estriol) in the motherÕs blood.

 An elevated level of alpha-fetoprotein indicate kidney disease, abnormal closure of

esophagus, neural tube defects such as anencephaly (absence of most of the brain) and
spina bifida (bulging of spinal cord from spinal column).

 After an abnormal triple screen result, the next step is usually an ultrasound examination.
If an ultrasound does not explain the abnormal triple screen results, amniocentesis is
typically used.

Noninvasive prenatal diagnosis (NIPD)

 Noninvasive prenatal diagnosis (NIPD) is increasingly being explored as an alternative to
such procedures as chorionic villus sampling and amniocentesis (Susman & others,
2010).

 At this point, NIPD has mainly focused on the isolation and examination of fetal cells
circulating in the motherÕs blood and analysis of cell-free fetal DNA in maternal
plasma (Prakash, Powell, & Geva, 2010).

 They are exploring the potential for using NIPD to diagnose a babyÕs sex, as early as
five weeks after conception, and Down syndrome (Avent & others, 2008).

 Being able to detect an offspringÕs sex and various diseases and defects so early raises
ethical concerns about couplesÕ motivation to terminate a pregnancy (Benn & Chapman,
2010).

Health and responsiveness

Apgar Scale
The Apgar Scale is a quick and standardized assessment tool used to evaluate the health and
responsiveness of newborns at 1 and 5 minutes after birth.

 It was developed by Dr. Virginia Apgar in 1952 and has since become a widely used
method in the field of neonatal care.

 The Apgar Scale evaluates an infantÕs heart rate, respiratory effort, muscle tone,
body color, and reflex irritability.
  An obstetrician or a nurse does the evaluation and gives the newborn a score, or
reading, of 0, 1, or 2 on each of these five health signs.

 A total score of 7 to 10 indicates that the newbornÕs condition is good.

 A score of 5 indicates there may be developmental difficulties.

 A score of 3 or below signals an emergency and indicates that the baby might not
survive.

APGAR Scale
A - Appearance

P - Pulse

G - Grimace (Baby's reaction to stimulation. It's also called reflex irritability.

A- Activity

R- Respiratory

Brazelton Neonatal Behavioral Assessment Scale (NBAS)

A measure that is used in the first month of life to assess the newbornÕs neurological
development, reflexes, and reactions to people and objects. 16 reflexes, such as sneezing,
blinking, and rooting, are assessed, along with reactions to animate (such as a face and voice)
and inanimate stimuli (such as a rattle).

 The Brazelton Neonatal Behavioral Assessment Scale (NBAS) is a comprehensive tool

used to assess the behavioral and neurological functioning of newborns within the first
month of life.

 It was developed by Dr. T. Berry Brazelton and his colleagues and has been widely used to
evaluate the newborn's responses to various stimuli.

 16 reflexes, such as sneezing, blinking, and rooting, are assessed, along with reactions to
animate (such as a face and voice) and inanimate stimuli (such as a rattle).

 The NBAS provides a more detailed and nuanced understanding of a newborn's behavior,
reflexes, and interactions compared to the Apgar Scale.

Neonatal Intensive Care Unit Network Neurobehavioral Scale

(NNNS)
The Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) is an assessment
tool developed as an extension or "offspring" of the Brazelton Neonatal Behavioral
Assessment Scale (NBAS).

 While the NBAS is designed to assess the behavior and neurological development of
normal, healthy, term infants, the NNNS focuses on evaluating the neurobehavioral
responses of "at-risk" newborns, particularly those who are admitted to neonatal
intensive care units (NICUs).
Teratogens:
Environmental agents causing damage during the prenatal period.

The field of study that investigates the causes of birth defects is called Teratology.

Origin: From the Greek word "teras," meaning "malformation" or "monstrosity."

Factors influencing teratogenic effects:

The dose, genetic susceptibility, and the time of exposure to a particular teratogen
influence both the severity of the damage to an embryo or fetus and the type of defect.

Dose: Larger doses over longer periods generally have more negative effects.
Genetic Susceptibility: abnormalities caused by a teratogen is linked to the genotype
of the pregnant woman and the genotype of the embryo or fetus. Also male fetuses
are far more likely to be affected by teratogens than female fetuses.

Other negative influences: Combined effects of poor nutrition, lack of medical care,
and additional teratogens worsen impact.

Time of exposure: Teratogens do more damage when they occur at some points in
development than at others.

Prenatal Sensitive Periods:

Some body parts, like the brain and eyes, have long sensitive periods, while others, such as
limbs and palate, have shorter ones.

General timing of harmful influences:

 Zygotic period: The effects of teratogens are rarely felt prior to implantation. It
dies even if they succeed.

 Embryonic period: Most likely for serious defects as foundations for body parts are
laid down.

 Fetal period: Minor teratogenic damage, but organs like the brain, eyes, and genitals
can still be affected.

Long-term and indirect effects:

 Teratogens can have subtle and delayed health outcomes, sometimes not apparent for
decades.
 Psychological consequences may occur indirectly, affecting cognitive, emotional, and social
development.
 Bidirectional influences between child and environment play a role in shaping
developmental outcomes.

Prescription and Nonprescription Drugs

Prescription Drugs as Teratogens: Certain prescription drugs can function as
teratogens, substances that cause abnormalities in fetal development. Examples include
antibiotics like streptomycin and tetracycline, some antidepressants, certain hormones such
as progestin and synthetic estrogen, and the potent teratogen Accutane (isotretinoin).

Thalidomide's Impact on Prenatal Development: Thalidomide, a sedative and anti-

nausea drug, caused severe prenatal development in the early 1960s. When taken by
mothers, it caused deformities in embryos' arms, legs, ears, heart, kidneys, genitals, and
potentially damaged the central nervous system.

Diethylstilbestrol (DES) and Reproductive System Damage: DES, a synthetic

hormone used to prevent miscarriages, led to long-term health issues in offspring, with
daughters experiencing vaginal cancer, uterine malformations, and infertility, and sons
experiencing genital abnormalities and testicular cancer.

Accutane as a Potent Teratogen: Accutane, a potent teratogen used to treat acne,

can cause severe damage to the developing organism during pregnancy. The packaging
advises women to use two birth control methods, but compliance is not universal.

Nonprescription drugs, like diet pills and high aspirin can be harmful during pregnancy,
with regular use linked to low birth weight, infant death, poor motor development, and lower
intelligence test scores, but conflicting research makes it difficult to definitively attribute
these risks.

Psychoactive Drugs
Psychoactive drugs can have significant impacts on prenatal development and postnatal
outcomes when used during pregnancy. Drugs that act on the nervous system to alter states
of consciousness, modify perceptions, and change moods.

Examples include caffeine, alcohol, and nicotine, as well as illicit drugs such as cocaine,
methamphetamine, marijuana, and heroin.

Caffeine:
Effects on Pregnancy: Pregnant women consuming 200 or more milligrams of caffeine a day
may have an increased risk of miscarriage, low birth weight, and newborn withdrawal
symptoms like irritability and vomiting.

Sources: Common sources of caffeine include coffee, colas, tea, and energy drinks.
Alcohol:
Fetal Alcohol Spectrum Disorders (FASD): Heavy drinking during pregnancy can result in
FASD, characterized by facial deformities, defective limbs, heart issues, learning problems,
and below-average intelligence.

Memory Impairment: Recent studies have shown impaired memory development in children
and adults with FASD, as well as impaired math ability linked to multiple brain regions.
 Nicotine (from Cigarette Smoking):
Adverse Outcomes: Maternal smoking during pregnancy is associated with preterm births,
low birth weights, fetal and neonatal deaths, respiratory problems, sudden infant death
syndrome (SIDS), and cardiovascular issues in offspring.

ADHD Risk: Maternal smoking is identified as a risk factor for the development of attention
deficit hyperactivity disorder (ADHD) in offspring.

Cocaine:
Reduced Birth Parameters: Cocaine exposure during prenatal development is associated
with reduced birth weight, length, and head circumference.

Behavioral and Cognitive Impacts: Studies link prenatal cocaine exposure to lower arousal,
less effective self-regulation, impaired motor development, deficits in behavioral self-
regulation, impaired language development, attention deficits, and an increased likelihood of
special education needs.

Methamphetamine:
Stimulant Effects: Methamphetamine, a stimulant, can lead to high infant mortality, low birth
weight, and developmental and behavioral problems in babies born to mothers who use it
during pregnancy.

Memory Deficits: Recent studies have found memory deficits in children whose mothers
used methamphetamine during pregnancy.

Marijuana:
Lower Intelligence: Prenatal marijuana exposure is related to lower intelligence in children.
Long-Term Use: Prenatal exposure to marijuana has been linked to continued marijuana use
at 14 years of age.

Heroin:
Withdrawal Symptoms: Infants born to mothers addicted to heroin may experience
withdrawal symptoms, such as tremors, irritability, abnormal crying, disturbed sleep, and
impaired motor control.

Incompatible Blood Types

Incompatibility between the motherÕs and fatherÕs blood types poses another risk to prenatal
development. If a pregnant woman is Rh-negative and her partner is Rh-positive, the
fetus may be Rh-positive. If the fetusÕ blood is Rh-positive and the motherÕs is Rh-negative,
the motherÕs immune system may produce antibodies that will attack the fetus. This can
result in any number of problems, including miscarriage or stillbirth, anemia, jaundice,
heart defects, brain damage, or death soon after birth. Generally, the first Rh-positive
baby of an Rh-negative mother is not at risk, but with each subsequent pregnancy the risk
increases.
Environmental Hazards
Some specific hazards to the embryo or fetus include radiation, toxic wastes, and other
chemical pollutants. X-ray radiation can affect the developing embryo or fetus, especially
in the first several weeks after conception. Women and their physicians should weigh the
risk of an X-ray when an actual or potential pregnancy is involved.

Environmental pollutants and toxic wastes are also sources of danger to unborn children.
Among the dangerous pollutants are carbon monoxide, mercury, and lead, as well as
certain fertilizers and pesticides.

Maternal Diseases
Maternal diseases can have significant implications for prenatal development and the health
of the developing fetus.

Rubella (German Measles):

Prenatal Defects: Rubella infection during pregnancy can cause a range of prenatal defects,
including deafness, eye abnormalities, heart defects, and intellectual disabilities.

Prevention: Women planning to have children are often advised to undergo a blood test
before pregnancy to determine if they are immune to rubella. Vaccination prior to pregnancy
is crucial for preventing rubella-related complications.

Syphilis:
Effects on Prenatal Development: Syphilis, a sexually transmitted infection, can be more
damaging to the developing fetus if the infection occurs later in prenatal development,
approximately four months or more after conception.

Complications: Syphilis can lead to serious complications in the newborn, including eye
lesions that may cause blindness and skin lesions.

Genital Herpes:
Transmission during Birth: Newborns can contract the herpes simplex virus when delivered
through the birth canal of a mother with genital herpes.

Complications: Neonatal herpes infections can result in severe health issues, including brain
damage, developmental delays, and in some cases, death.

AIDS (HIV/AIDS):
Modes of Transmission:
During Gestation: HIV can be transmitted to the fetus across the placenta during
gestation.

During Delivery: Contact with maternal blood or fluids during delivery can lead to
transmission.

Postpartum (Breastfeeding): HIV can be transmitted through breast milk after birth.

Prevention: Antiretroviral therapy (ART) during pregnancy and avoiding breastfeeding are
key preventive measures to reduce the risk of mother-to-child transmission of HIV.
 Diabetes:
High Blood Sugar Levels: Diabetes, characterized by high levels of sugar in the blood, can
affect prenatal development and the health of the offspring.

Complications: Uncontrolled diabetes during pregnancy may lead to complications such as

macrosomia (large birth weight), birth injuries, and an increased risk of congenital anomalies.

Gestational Diabetes: In some cases, diabetes may develop during pregnancy (gestational
diabetes), and proper management is crucial to minimize risks.

Maternal Age
Harmful effects on the fetus and infant are considered, two maternal ages are of special
interest:

(1) adolescence,
(2) 35 years and older.

The mortality rate of infants born to adolescent mothers is double that of infants born
to mothers in their twenties. Adequate prenatal care decreases the probability that a child
born to an adolescent girl will have physical problems.

Maternal age is also linked to the risk that a child will have Down syndrome. When the
mother reaches 40 years of age, the probability is slightly over 1 in 100 that a baby born to
her will have Down syndrome, and by age 50 it is almost 1 in 10.

When mothers are 35 years and older, risks also increase for low birth weight, for preterm
delivery, and for fetal death.

Maternal Diet and Nutrition

A developing embryo or fetus depends completely on its mother for nutrition, which comes
from the motherÕs blood (Shapira, 2008). The nutritional status of the embryo or fetus is
determined by the motherÕs total caloric intake, and her intake of proteins, vitamins,
and minerals. Children born to malnourished mothers are more likely than other children to
be malformed.

Being overweight before and during pregnancy can also put the embryo or fetus at risk.
One aspect of maternal nutrition that is important for normal prenatal development is folic
acid, a B-complex vitamin. Pregnant women can consume a minimum of 400 micrograms of
folic acid per day. Orange juice and spinach are examples of foods rich in folic acid.

Eating fish is often recommended as part of a healthy diet, but pollution has made many fish
a risky choice for pregnant women. Some fish contain high levels of mercury, which is
released into the air both naturally and by industrial pollution (Genuis, 2009).

When mercury falls into the water it can become toxic and accumulate in large fish, such as
shark, swordfish, king mackerel, and some species of large tuna (Mayo Clinic, 2009; Ramon &
others, 2009). Mercury is easily transferred across the placenta, and the embryoÕs
developing brain and nervous system are highly sensitive to the metal (Gliori & others,
2006). Researchers have found that prenatal mercury exposure is linked to adverse
outcomes, including miscarriage, preterm birth, and lower intelligence.

Emotional States and Stress

When a pregnant woman experiences intense fears, anxieties, and other emotions or negative
mood states, physiological changes occur that may affect her fetus (Entringer & others,
2009; Leung & others, 2010).

A motherÕs stress may also influence the fetus indirectly by increasing the likelihood that
the mother will engage in unhealthy behaviors, such as taking drugs and engaging in poor
prenatal care. High maternal anxiety and stress during pregnancy can have long-term
consequences for the offspring. A recent research review indicated that pregnant women
with high levels of stress are at increased risk for having a child with emotional or cognitive
problems, attention deficit hyperactivity disorder (ADHD), and language delay (Taige &
others, 2007). A recent study revealed maternal depression was linked to preterm birth and
slower prenatal growth rates (Diego & others, 2009). In this study, mothers who were
depressed had elevated cortisol levels.

Paternal Factors
MenÕs exposure to lead, radiation, certain pesticides, and petrochemicals may cause
abnormalities in sperm that lead to miscarriage or diseases, such as childhood cancer.

The fatherÕs smoking during the motherÕs pregnancy also can cause problems for the
offspring. In one study, heavy paternal smoking was associated with the risk of early
pregnancy loss (Venners & others, 2003). This negative outcome may be related to
secondhand smoke.

Pre term and low birth weight infants.

Low birth weight infants weigh less than 5½ pounds at birth. Very low birth weight
newborns weigh under 3½ pounds, and extremely low birth weight newborns weigh
under 2 pounds.

Preterm infants are those born three weeks or more before the pregnancy has
reached its full term—in other words, before the completion of 37 weeks of gestation.

Small for date infants (also called small for gestational age infants) are those
whose birth weight is below normal when the length of the pregnancy is considered.
They weigh less than 90% of all babies of the same gestational age. Small for date
infants may be preterm or full term. One study found that small for date infants had
more than a fourfold risk of death.

Contributing Factors to Increased Preterm Birth Rates:

Maternal Age: The increasing number of births to women aged 35 and older is
associated with higher rates of preterm birth.

Multiple Births: The rise in rates of multiple births, often associated with assisted
reproductive technologies, contributes to increased preterm births.
 Medical Interventions: Increased management of maternal and fetal conditions,
including the induction of labor preterm if medically indicated for better survival
chances, can influence preterm birth rates.
Substance Abuse: Higher rates of substance abuse, such as tobacco and alcohol
consumption, are linked to preterm births.
Stress: Increased stress levels among pregnant women are identified as a factor
influencing preterm birth rates.

Role of Progestin in Reducing Preterm Births:

Effectiveness: Progestin has been investigated for its potential in reducing preterm
births.

Target Population: Research suggests that progestin is most effective when

administered to women with a history of previous spontaneous preterm births, those
with a short cervical length, and those with a singleton pregnancy rather than twins.

Physical Activity and Yoga:

Reduced Likelihood of Preterm Delivery: Engaging in light leisure time physical
activity is associated with a 24 percent reduced likelihood of preterm delivery.
Moderate to heavy leisure time physical activity further reduces the risk by 66
percent.

Positive Link with Yoga: Yoga has been positively linked to favorable pregnancy
outcomes.

Global Variation in Low Birth Weight:

Regional Disparities: The incidence of low birth weight varies significantly from
country to country.

Poverty and Maternal Health: Countries with high poverty rates and poor maternal
health and nutrition, such as India and Sudan, may experience a higher percentage of
low birth weight babies (up to 31 percent).

Consequences of Preterm Birth and Low Birth Weight

The consequences of preterm birth and low birth weight can have significant and long-lasting
impacts on the health and development of infants.

Extremely preterm infants are those born less than 28 weeks preterm, and very
preterm infants are those born less than 33 weeks of gestational age.

A recent Norwegian study indicating that the earlier preterm infants are born the more
likely they will drop out of school (Swamy, Ostbye, & Skjaerven, 2008).

Survival rates for infants who are born very early and very small have risen, but with
this improved survival rate have come increases in rates of severe brain damage (Casey,
2008).
Children born low in birth weight are more likely than their normal birth weight
counterparts to develop a learning disability, attention deficit hyperactivity disorder, or
breathing problems such as asthma (Santo, Portuguez, & Nunes, 2009).

Nurturing Low Birth Weight and Preterm Infants

Two increasingly used interventions in the neonatal intensive care unit (NICU) are kangaroo
care and massage therapy.

Kangaroo care
Kangaroo care involves skin-to-skin contact in which the baby, wearing only a diaper, is
held upright against the parentÕs bare chest, much as a baby kangaroo is carried by its
mother (Ludington-Hoc & others, 2006). Kangaroo care is typically practiced for two to
three hours per day, skin-to-skin over an extended time in early infancy.

Preterm infants often have difficulty coordinating their breathing and heart rate, and
the close physical contact with the parent provided by kangaroo care can help to
stabilize the preterm infantÕs heartbeat, temperature, and breathing (Nyqvist & others,
2010). Preterm infants who experience kangaroo care also gain more weight than their
counterparts who are not given this care (Gathwala, Singh, & Balhara, 2008). A recent study
also revealed that kangaroo care decreased pain responses in preterm infants (Johnston &
others, 2009).

Massage Therapy
In a recent study, preterm infants in a neonatal intensive care unit (NICU) were randomly
assigned to a massage therapy group or a control group (Hernandez-Reif, Diego, & Field,
2007). For five consecutive days, the preterm infants in the massage group were given
three 15-minute moderate pressure massages. Behavioral observations of the following
stress behaviors were made on the first and last days of the study: crying, grimacing,
yawning, sneezing, jerky arm and leg movements, startles, and finger flaring. Massage had a
stress-reducing effect on the preterm infants, which is especially important because they
encounter numerous stressors while they are hospitalized.

Field has demonstrated the benefits of massage therapy for infants who face a variety of
problems. For example, preterm infants exposed to cocaine in utero who received massage
therapy gained weight and improved their scores on developmental tests (Wheeden &
others, 1993). Another study investigated 1- to 3-month-old infants born to depressed
adolescent mothers (Field & others, 1996). The infants of depressed mothers who received
massage therapy had lower stress— as well as improved emotionality, sociability, and
soothability—compared with the non-massaged infants of depressed mothers.

The most consistent findings related to massage therapy involve two positive results: (1)
increased weight gain and (2) discharge from the hospital from three to six days
earlier.