Fostering Healthy Prenatal Development

Outline

Preconception
Stages of development from conception to birth
What can interfere with healthy development
Teratogens
Alcohol
Low Birth weight
Prevention
Cool Tool: http://www.zerotothree.org/baby-brain-
map.html
 Timelines of
Human Prenatal Development
Tri- 1st trimester 2nd trimester 3rd trimester
mester
Video Prenatal
week

Brain Growth Spurt (Dobbing) --> 2 yrs

birth
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39

Proliferation Migration Differentiation

Continued
wk 0 - 7 wk 8 - 15 wk 16 - 25
Differentiation
wk 26 - 39

Specialization

stages 5, 6, 7, 8
Connections
Aggregation
Proliferation
Brain Dvlp

Elimination of
Connections
Cell Death
Induction

Migration

postnatally
continue
Cowan

Neural

5
1

7
4

6
3
2

8
FETUS
Embryo

EMBRYO
OVUM
Ovum

Fetus

wks 3 - 7 to birth

birth
"quickening" viability

Tri- 1st trimester 2nd trimester 3rd trimester

mester wks 1 - 13 wks 14 - 26 wks 27 - 39
 Stages of prenatal development

1st trimester : Organ development; Nervous system

Cells multiply
Cells specialize and migrate to where they should be to be part
of certain organs
2nd trimester
Nerve cells proliferate and form connections
External organs continue to be laid down
3rd trimester
Brain growth spurt
Can hear sounds
Getting ready to come out: lungs very immature
 Cowan's Eight Stages in Brain
Development
1. Neural Induction (~ days 16-23)
2. Cell proliferation
Begins once neural tube has closed off.

3. Migration
4. Aggregation
 Cowan's Eight Stages in Brain
Development (cont.)
5. Specialization of immature neurons
(16-25 wks)
a. elaboration of processes
b. adoption of mode of transmission
6. Formation of Connections
7. Selective Cell Death
8. Selective Elimination of Connections
 Fig.5
OVUM EMBRYO (wks) FETUS (wks)
1-2 3 4 5 6 7 8 12 16 20-36 38
=Most
=Most Common
Common Site
Site of
of Birth
Birth Defect
Defect

Central Nervous System

Heart
Arms
Eyes
Legs
Teeth
Palate
External genitalia
Ears

7
 What can interfere with healthy development

Teratogens: literally means creates monsters

Now used to mean anything that mother exposed to
that interferes with prenatal development in ways that
cause:
Birth defects (visible at birth)
Behavioral Difficulties (behavioral teratogens)
Low birth weight
Prematurity
Low weight for gestational age
 1. Teratogens

How effect fetus/embryo

directly as in radiation
Cross from mothers body through placenta
Alcohol, infections
Affect genes environment
Examples
Thalidomide (drug)
Infections -- Rubella (measles)
Radiation
Alcohol
Thalidomide
Warning
Label

10
 Thalidomide Deformities
Normaldevelopment

Hands

Feet

Effectsoftimeofexposure(3.57wks
gestationalage)onlimbdeformities
Thalidomide Deformities
 Effects of teratogens

Critical periods of exposure

Embryo or fetus vulnerable to specific problems during
specific times when undergoing a particular
developmental process. (e.g., female fetus may have
genital malformations if exposed to androgens <male
sex hormone> during 10th week of gestation).
1st trimester (especially 1st two months): organs, limbs,
shape)
2nd & 3rd trimester: brain size (less visible effects); size
of fetus
Vulnerability of fetus (some tougher than others)
General health of mother
 Fig.5
OVUM EMBRYO (wks) FETUS (wks)
1-2 3 4 5 6 7 8 12 16 20-36 38
=Most
=Most Common
Common Site
Site of
of Birth
Birth Defect
Defect

Central Nervous System

Heart
Arms
Eyes
Legs
Teeth
Palate
External genitalia
Ears

14
 3rd Week of Development
NeuralInduction
15 16 17 18 19 20 21

primitive embryonic neural neural fold brain neural groove

first knot mesoderm plate neural
missed groove
menstrual
primitive
period streak somite
notochord somite
trilaminar embryo 2-3 mm
prim.streak thyroid developing heart tubes
 4th Week of Development
Proliferation&Migration
22 23 24 25 26 27 28
heart ant. heart otic depression arm bud
4 pairs
begins
neuropores

bulge branchial
to beat arches
neural arm & leg buds
folds 2 prs 3 prs
fusing post. branch. arches branch. arches CR 4 - 5 mm
 4th Week of Development
Proliferation&Migration
22 23 24 25 26 27 28
heart ant. heart otic depression arm bud
4 pairs
begins
neuropores

bulge branchial
to beat arches
neural arm & leg buds
folds 2 prs 3 prs
fusing post. branch. arches branch. arches CR 4 - 5 mm

hydrocephaly
anencephaly
hydroanencephaly

spinabifida
 Neural Tube Defects
Day22 SpinaBifida
Radiation: Interferes with cell
migration and aggregation --
stop too soon
 Rat Brain: Normal Development

Proliferation -- Migration -- Aggregation

Days Later
16-17 DAY
13-14 DAY

Mature
nice, neat, cortical layers
20
 Radiation on Days 13-14
Proliferation -- Migration -- Aggregation

Days Later
Hours after
Irradiation
13-14 DAY

Mature
subcortical ectopia
21
 Radiation on Days 16-17
Proliferation -- Migration -- Aggregation

Hours after
Days Later
Irradiation
16-17 DAY

Mature
scrambled cortex
22
Alcohol: Interferes with migration.
Cell dont stop

23
 Alcohol as a Teratogen
Negative effects throughout gestation
Neurological Damage
Retarded Physical Growth
Face and organ malformations
Unknown whats a safe dose
Leading known environmental cause of mental
retardation
5-10% of women of child-bearing age have alcohol
problem
 Alcohol-related birth defects

Facialfeatures:underdevelopedmidface

KathySulik
 Alcohol-related birth defects

Underdevelopedbrain
 Fetal Alcohol Syndrome (12,000 a year in
U.S.)

Mild retardation -- IQ 65-80

Difficulty with reasoning and planning
Distractable
Dont learn from mistakes
Indiscriminate affection
Verbal > Reasoning
(Anne Streissguth, U of Washington c.1970)
 Fetal Alcohol Spectrum Disorder
(36,000 a year in U.S.)

More common but less severe form of the

syndrome
Effects evident in behavior only
Problems with attention
Inhibition difficulties (start cant stop)
 FAS 8:43
 Learning about the effects of alcohol

Correlational studies in humans

Correlations show whether two things
tend to be found together
Dont prove cause
Experimental studies with animals
 Correlational studies in humans:
Limitations
Difficult to accurately estimate level of
alcohol exposure.
Amount mother ingests
- Amount fetus/embryo exposed to

Cant rule out alternative causes of problems

child might be showing: Correlated risks

Difficult to study effects of exposure during

specific periods
 Experimental studies with animals

Advantages:
Control when and how much exposed.
Compare to control group similar except for
exposure to alcohol
Infer that alcohol causes differences in offspring.
Look in a fine grained way at how alcohol exposure
disrupts brain development.
Disadvantages:
Unclear how findings apply to humans especially for
things that only humans do.
 Findings from animal studies

Ist trimester:
Facial malformations, worse for growth and
behavior than later exposure.
Effects on behavior even in the absence of
obvious physical defects.

Effects to nervous system due to exposure

in only 2nd and 3rd trimester.
 2nd semester
When nerve cells are generated and go to
appropriate regions of the brain
Effects
Nerve cell generation delayed
Fewer produced.
Nerve cells dont go where they are supposed to
go.
Unusual cell formations in
hippocampus learning,memory & emotion
cerebellum motor ability
 3rd trimester
Interferes with brain growth spurt
Brain weight & head circumference reduced
Fewer cells in cerebellum & hippocampus

These anatomical changes are related to

animal equivalent of hyperactivity and
learning deficits.
Humans: What can we tell about effect
of alcohol on behavior

Early, heavy drinking leads to most severe

problems:
mental retardation
sensory deficits (vision, hearing)
motor problems
Facial abnormalities: 1st 8 weeks (comparison of
women who stopped or continued: M = 24
drinks per week)
 Human Behavior cont.
Even in the absence of physical effects:
learning and attention problems.
Moderate early drinkin leads to more subtle
learning difficulties and attention problems.
Hyperactivity, language difficulties, motor
deficits greater when Mom drank through
pregnancy than stopped after 1st trimester
Weight, length, head circumference affected by
drinking later in pregnancy
Being alcohol free during 3rd trimester allows
growth catch up.
 FASD Adults
The following secondary effects were ascertained
from life history interviews of 415 FASD affected
individuals using 450 questions

Dr Anne Streissguth, et al, University of

Washington

www.faseout.ca 2008
 Secondary Disabilities
Mental health problems 94%
Disrupted school experiences 43%
Easily victimized 72%
Trouble with the law 60%
Inappropriate sexual behavior 45%
Alcohol and drug problems 50%
Problems parenting
Problems living independently

www.faseout.ca 2008
 FASD and Activities of Daily Living
Streissguth et al. Longitudinal Study (1996)
Sample of adults age 21+ were unable to:
Manage money 82%
Make daily living decisions 78%
Obtain social services 70%
Get medical care 68%
Handle interpersonal relationships 57%
Grocery shop 52%
Cook meals 49%
Structure leisure activities 48%
Stay out of trouble 48%
Maintain hygiene 37%
Use public transportation 24%

www.faseout.ca 2008
 Implications for intervention

FAS and FAE are common preventable

problems.
How can we develop interventions that work?
Type of intervention
Primary, secondary, tertiary
How should be target?
Getting knowledge to people
Motivation to change
Learning from people who have changed
 2. Preventing low birth weight babies

Who has low birthweight babies:

Poverty nexus of risk
Multiple births through infertility treatment
 Why? At risk for

medical problems
developmental problems such as
cerebral palsy
higher risk of mortality
Role of life style factors in preventing low
birth weight
 Nutritional and weight gain

Risk factors:
Low income/limited food budgets
Stress and distress
Lack of knowledge about proper nutrition
Smoking, alcohol
Life style choices: Cigarette smoking, alcohol,
caffeine, and illegal drugs

Risk factors:
Stress and distress
Lack of knowledge about their effects
Lack of support for stopping addictive behavior

Quitting smoking at any point has positive

effect on birth weight.
Smoking after birth increases childs risk of
respiratory problems (most women who quit
during pregnancy start again after the childs
birth).
 Stress

neuroendocrine functioning
depresses immune system
Affects health behaviors
decreases likelihood of prenatal care
increases likelihood of smoking, drinking
Anxiety may increase metabolism
Depression affects appetite, sleep
 Employment

Benefit: health insurance, income

Possible problems:
exposure to toxins
work related stress and fatigue
work overload may interfere with eating
regularly
 Domestic violence

Physical abuse can lead to

early onset of labor
neglect of prenatal care, chronic medical
conditions
 Sexually transmitted diseases

various infections linked with low birth

weight and preterm babies.
 Directions for prevention and intervention

Learn from women who despite living in

economically depressed or stressful situations,
dont engage in high-risk behaviors that may have a
detrimental effect on their child during pregnancy
who have been able to change.
Apply the lessons learned to intervention
programs.

 Change
Pregnancy is an opportunity for change.
Women want healthy babies
More likely to
seek information about healthy behavior
make changes in their own lives during or before pregnancy.
Benefits:
OWN HEALTH SHORT TERM AND LONGTERM
INCREASES LIKELIHOOD OF HEALTHY BABY
POSTNATAL HEALTH OF BABY
IMPROVES HEALTH OF ENTIRE FAMILY (CHANGES IN DIET)
 Barriers to change

Life circumstances that require focus on day-to-

day survival.
Unavailability of health care.
Development of addictive behaviors long before
pregnancy makes it hard to stop during pregnancy
Case of smoking
ads targeting young women
societal concern about weight