{"id":1215,"date":"2018-12-17T04:02:08","date_gmt":"2018-12-17T04:02:08","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/?post_type=chapter&#038;p=1215"},"modified":"2019-09-11T18:55:20","modified_gmt":"2019-09-11T18:55:20","slug":"prenatal-development","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/suny-hvcc-lifespandevelopment5\/chapter\/prenatal-development\/","title":{"raw":"Prenatal Development","rendered":"Prenatal Development"},"content":{"raw":"<h2>What you'll learn to do: explain the main stages of prenatal development<\/h2>\r\n<a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2018\/12\/19212406\/pregnancy.png\"><img class=\"aligncenter wp-image-3600\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2018\/12\/19212406\/pregnancy-300x300.png\" alt=\"Graphic of stages of pregnancy from conception to birth \" width=\"321\" height=\"321\" \/><\/a>\r\n\r\nHow did you come to be who you are? From beginning as a one-cell structure to your birth, your\u00a0prenatal development\u00a0occurred in an orderly and delicate sequence. There are three stages of prenatal development: germinal, embryonic, and fetal. Keep in mind that this is different than the three trimesters of pregnancy. Let\u2019s take a look at what happens to the developing baby in each of these stages.\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Learning outcomes<\/h3>\r\n<ul>\r\n \t<li>Differentiate between development during the germinal, embryonic, and fetal periods<\/li>\r\n \t<li>Examine risks to prenatal development\u00a0posed by exposure to teratogens<\/li>\r\n \t<li>Explain potential complications of pregnancy and delivery<\/li>\r\n<\/ul>\r\n<\/div>\r\n<h2>Prenatal Development<\/h2>\r\n<blockquote><span style=\"color: #333333;\">\"The body of the unborn baby is more complex than ours. The preborn baby has several extra parts to his body which he needs only so long as he lives inside his mother. He has his own space capsule, the amniotic sac. He has his own lifeline, the umbilical cord, and he has his own root system, the placenta. These all belong to the baby himself, not to his mother. They are all developed from his original cell.\"[footnote]Day &amp; Liley, The Secret World of a Baby, Random House, 1968, p. 13[\/footnote]\u00a0<\/span><\/blockquote>\r\n<h3>Periods of Prenatal Development<\/h3>\r\nLet's take a look at some of the changes that take place during each of the three periods of prenatal development: the germinal period, the embryonic period, and the fetal period.\r\n<h4>The Germinal Period (Weeks 1-2)<\/h4>\r\n[caption id=\"attachment_580\" align=\"alignleft\" width=\"300\"]<img class=\"wp-image-580 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/1496\/2014\/09\/18153941\/Germinal-300x205.jpeg\" alt=\"magnified photo of sperm approaching ovum.\" width=\"300\" height=\"205\" \/> <strong>Figure 1<\/strong>. Sperm and Ovum at Conception[\/caption]\r\n\r\nConception occurs when a sperm fertilizes an egg and forms a\u00a0<strong>zygote,<\/strong>\u00a0which begins as a one-cell structure. The\u00a0mother and father\u2019s DNA is passed on to the child at the moment of conception. The genetic makeup and sex of the baby are set at this point. The germinal period (about 14 days in length) lasts from conception to implantation of the zygote (fertilized egg) in the lining of the uterus.\r\n\r\nDuring the first week after conception, the zygote divides and multiplies, going from a one-cell structure to two cells, then four cells, then eight cells, and so on. The process of cell division is called <strong>mitosis<\/strong>.\u00a0After the fourth division, differentiation of the cells begins to occur as well. Differentiated cells become more specialized, forming different organs and body parts.\u00a0\u00a0After 5 days of mitosis, there are 100 cells, and after 9 months there are billions of cells.\u00a0Mitosis\u00a0is a fragile process, and fewer than one-half of all zygotes survive beyond the first two weeks (Hall, 2004).\r\n\r\n<span style=\"color: #333333;\">After the zygote divides for about 7\u201310 days and has 150 cells, it travels down the fallopian tubes and implants itself in the lining of the uterus.<\/span>\u00a0It\u2019s estimated that about 60 percent of natural conceptions fail to implant in the uterus. The rate is higher for in vitro conceptions.\u00a0Once the zygote attaches to the uterus, the next stage begins.\r\n<h3>The Embryonic Period (Weeks 3-8)<\/h3>\r\n[caption id=\"attachment_1996\" align=\"alignright\" width=\"200\"]<a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/25050356\/548063929_d087ee4a1f_z.jpg\"><img class=\"size-medium wp-image-1996\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/25050356\/548063929_d087ee4a1f_z-200x300.jpg\" alt=\"Photograph of -Week Human Embryo from Ectopic Pregnancy\" width=\"200\" height=\"300\" \/><\/a> <strong>Figure 2<\/strong>. Human Embryo[\/caption]\r\n\r\nThe embryonic period begins once the zygote is implanted in the uterine wall. It lasts from the third through the eighth week after conception. <span style=\"color: #333333;\">Upon implantation, this multi-cellular organism is called an\u00a0<strong>embryo<\/strong>. Now blood vessels grow, forming the placenta. The\u00a0<strong>placenta<\/strong>\u00a0is a structure connected to the uterus that provides nourishment and oxygen from the mother to the developing embryo via the umbilical cord. <\/span>\r\n\r\n<span style=\"color: #333333;\">During this period, cells continue to differentiate. Basic structures of the embryo start to develop into areas that will become the head, chest, and abdomen. During the embryonic stage, the heart begins to beat and organs form and begin to function. At 22 days after conception, the neural tube forms along the back of the embryo, developing into the spinal cord and brain.\u00a0<\/span>\r\n\r\nGrowth during prenatal development occurs in two major directions: from head to tail (cephalocaudal\u00a0development) and from the midline outward (proximodistal\u00a0development).\u00a0This means that those structures nearest the head develop before those nearest the feet and those structures nearest the torso develop before those away from the center of the body (such as hands and fingers).\r\n\r\nThe head develops in the fourth week and the precursor to the heart begins to pulse. In the early stages of the embryonic period, gills and a tail are apparent. But by the end of this stage, they disappear and the organism takes on a more human appearance.\u00a0The embryo is approximately 1 inch in length and weighs about 4 grams at the end of this period.\u00a0The embryo can move and respond to touch at this time.\r\n\r\nAbout 20 percent of organisms fail during the embryonic period, usually due to gross chromosomal abnormalities.\u00a0As in the case of the germinal period, often the mother does not yet know that she is pregnant.\u00a0It is during this stage that the major structures of the body are taking form making the embryonic period the time when the organism is most vulnerable to the greatest amount of damage if exposed to harmful substances. Potential mothers are not often aware of the risks they introduce to the developing child during this time.\r\n<h3>The Fetal Period (Weeks 9-40)<\/h3>\r\n[caption id=\"attachment_3498\" align=\"alignleft\" width=\"300\"]<a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/17012732\/797px-Human_fetus_10_weeks_with_amniotic_sac_-_therapeutic_abortion.jpg\"><img class=\"wp-image-3498 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/17012732\/797px-Human_fetus_10_weeks_with_amniotic_sac_-_therapeutic_abortion-300x226.jpg\" alt=\"44-year-old pregnant person with 6 previous children was diagnosed with carcinoma in situ of cervix (early-stage cancer of the uterus). The uterus (womb) was completely removed, including the fetus, to protect the health of the patient.\" width=\"300\" height=\"226\" \/><\/a> <strong>Figure 3<\/strong>. A fetus at 10 weeks of development.[\/caption]\r\n\r\n<span style=\"color: #333333;\">When the organism is about nine weeks old, the embryo is called a <strong>fetus<\/strong>. At this stage, the fetus is about the size of a kidney bean and begins to take on the recognizable form of a human being as the \u201ctail\u201d begins to disappear.<\/span>\r\n\r\n<span style=\"color: #333333;\">From 9\u201312 weeks, the sex organs begin to differentiate. By the 12th week, the fetus has all its body parts including external genitalia. In the following weeks, the fetus will develop hair, nails, teeth and the excretory and digestive systems will continue to develop. At the end of the 12th\u00a0week, the fetus is about 3 inches long and weighs about 28 grams.<\/span>\r\n\r\n<span style=\"color: #333333;\">At about 16 weeks, the fetus is approximately 4.5 inches long. Fingers and toes are fully developed, and fingerprints are visible. During the 4-6th months, the eyes become more sensitive to light and hearing develops. The respiratory system continues to develop. Reflexes such as sucking, swallowing and hiccuping develop during the 5th month. Cycles of sleep and wakefulness are present at that time as well. Throughout the fetal stage, the brain continues to grow and develop, nearly doubling in size from weeks 16 to 28. The majority of the neurons in the brain have developed by 24 weeks although they are still rudimentary and the glial or nurse cells that support neurons continue to grow.\u00a0At 24 weeks the fetus can feel pain (Royal College of Obstetricians and Gynecologists, 1997).<\/span>\r\n\r\n<span style=\"color: #333333;\">The first chance of survival outside the womb, known as the\u00a0age of viability\u00a0is reached at about 22 to 26 weeks (Moore &amp;\u00a0Persaud, 1998). By the time the fetus reaches the sixth month of development (24 weeks), it weighs up to 1.4 pounds. The hearing has developed, so the fetus can respond to sounds. The internal organs, such as the lungs, heart, stomach, and intestines, have formed enough that a fetus born prematurely at this point has a chance to survive outside of the mother\u2019s womb. <\/span>\r\n\r\nBetween the 7th and 9th\u00a0months, the fetus is primarily preparing for birth. It is exercising its muscles, its lungs begin to expand and contract. It is developing fat layers under the skin.\u00a0The fetus gains about 5 pounds and 7 inches during this last trimester of pregnancy which includes a layer of fat gained during the 8th\u00a0month.\u00a0This layer of fat serves as insulation and helps the baby regulate body temperature after birth.\r\n\r\n<span style=\"color: #333333;\">Around 36 weeks, the fetus is almost ready for birth. It weighs about 6 pounds and is about 18.5 inches long, and by week 37 all of the fetus\u2019s organ systems are developed enough that it could survive outside the mother\u2019s uterus without many of the risks associated with premature birth. The fetus continues to gain weight and grow in length until approximately 40 weeks. By then, the fetus has very little room to move around and birth becomes imminent.\u00a0<\/span>\r\n\r\n[caption id=\"attachment_3499\" align=\"aligncenter\" width=\"731\"]<img class=\"wp-image-3499 size-full\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/17013105\/CNX_Psych_09_02_Stages.jpg\" alt=\"Images of fetal development from 9 weeks through 40 weeks.\" width=\"731\" height=\"763\" \/> <strong>Figure 4<\/strong>. During the fetal stage, the baby\u2019s brain develops and the body adds size and weight until the fetus reaches full-term development.[\/caption]\r\n\r\n<div class=\"textbox examples\">\r\n<h3>Watch It<\/h3>\r\nThis video explains many of the developmental milestones and changes that happen during each month of development for the embryo and fetus.\r\n\r\n[embed]https:\/\/www.youtube.com\/embed\/UA-Tk9qlG9A[\/embed]\r\n\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assessments.lumenlearning.com\/assessments\/16541\r\n\r\n<\/div>\r\n<h2>Environmental Risks<\/h2>\r\n<h3>Teratology<\/h3>\r\nGood prenatal care is essential. The developing child is most at risk for some of the most severe problems during the first three months of development. Unfortunately, this is a time at which most mothers are unaware that they are pregnant. It is estimated that 10% of all birth defects are caused by a prenatal exposure or <strong>teratogen<\/strong>.\u00a0Teratogens are factors that can contribute to birth defects which include some maternal diseases, drugs, alcohol, and stress. These exposures can also include environmental and occupational exposures. Today, we know many of the factors that can jeopardize the health of the developing child.\u00a0Teratogen-caused birth defects are potentially preventable.\r\n\r\nThe study of factors that contribute to birth defects is called teratology.\u00a0Teratogens are usually discovered after an increased prevalence of a particular birth defect. For example, in the early 1960\u2019s, a drug known as thalidomide was used to treat morning sickness. Exposure of the fetus during this early stage of development resulted in cases of phocomelia, a congenital malformation in which the hands and feet are attached to abbreviated arms and legs.\r\n<h3><strong>A Look at Some Teratogens<\/strong><\/h3>\r\n<h4><strong>Alcohol<\/strong><\/h4>\r\n[caption id=\"attachment_3501\" align=\"alignright\" width=\"265\"]<img class=\"wp-image-3501 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/17015318\/Photo_of_baby_with_FAS-265x300.jpg\" alt=\"Image of a baby boy with FAS facial characteristics of small eye openings, a smooth philtrum, and a thin upper lip.\" width=\"265\" height=\"300\" \/> <strong>Figure 5<\/strong>. Some distinguishing characteristics of fetal alcohol spectrum disorders include more narrow eye openings, A smooth philtrum, meaning a smooth area between the upper lip and the nose, and a thin upper lip.[\/caption]\r\n\r\nOne of the most commonly used teratogens is alcohol. Because half of all pregnancies in the United States are unplanned, it is recommended that women of child-bearing age take great caution against drinking alcohol when not using birth control and when pregnant (Surgeon General\u2019s Advisory on Alcohol Use During Pregnancy, 2005). Alcohol consumption, particularly during the second month of prenatal development, but at any point during pregnancy, may lead to neurocognitive and behavioral difficulties that can last a lifetime.\r\n\r\nThere is\u00a0no acceptable safe limit for alcohol use during pregnancy, but binge drinking (5 or more drinks on a single occasion) or having 7 or more drinks during a single week places a child at particularly high risk.\u00a0In extreme cases, alcohol consumption can lead to fetal death, but more frequently it can result in\u00a0<strong>fetal alcohol spectrum disorders\u00a0(FASD)<\/strong>. This terminology is now used when looking at the effects of exposure and replaces the term fetal alcohol syndrome. It is preferred because it recognizes that symptoms occur on a spectrum and that all individuals do not have the same characteristics. Children with FASD share certain physical features such as flattened noses, small eye openings, small heads, intellectual developmental delays, and behavioral problems.\u00a0Those with FASD are more at risk for lifelong problems such as criminal behavior, psychiatric problems, and unemployment (CDC, 2006).\r\n\r\nThe terms alcohol-related neurological disorder (ARND) and alcohol-related birth defects (ARBD) have replaced the term Fetal Alcohol Effects to refer to those with less extreme symptoms of FASD. ARBD include kidney, bone and heart problems.\r\n<div class=\"textbox examples\">\r\n<h3>watch it<\/h3>\r\nSeveral medical experts debunk common myths about the safety of drinking alcohol during pregnancy.\r\n\r\n<iframe src=\"\/\/plugin.3playmedia.com\/show?mf=3935252&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=pvFqjU43Odo&amp;video_target=tpm-plugin-z36ohj3l-pvFqjU43Odo\" width=\"800px\" height=\"520px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe>\r\n\r\n<\/div>\r\n<h4><b>Tobacco<\/b><\/h4>\r\nSmoking is also considered a teratogen because nicotine travels through the placenta to the fetus. When the mother smokes, the developing baby experiences a reduction in blood oxygen levels. Tobacco use during pregnancy has been associated with low birth weight, placenta\u00a0previa, birth defects, preterm delivery, fetal growth restriction, and sudden infant death syndrome.\u00a0Smoking in the month before getting pregnant and throughout pregnancy increases the chances of these risks. Quitting smoking\u00a0<em>before<\/em>\u00a0getting pregnant is best. However, for women who are already pregnant, quitting as early as possible can still help protect against some health problems for the mother and baby.[footnote]Birth Defects Research and Tracking. Centers for Disease Control and Prevention. Retrieved from https:\/\/www.cdc.gov\/ncbddd\/birthdefects\/research.html[\/footnote]\r\n<h4><strong>Drugs<\/strong><\/h4>\r\nPrescription, over-the-counter, or recreational drugs\u00a0can have serious\u00a0teratogenic\u00a0effects. In general, if medication is required, the lowest dose possible should be used. Combination drug therapies and first trimester exposures should be avoided. Almost three percent of pregnant women use illicit drugs such as marijuana, cocaine, Ecstasy and other amphetamines, and heroin. These drugs can cause low birth-weight, withdrawal symptoms, birth defects, or learning or behavioral problems. Babies born with a heroin addiction need heroin just like an adult addict. The child will need to be gradually weaned from the heroin under medical supervision; otherwise, the child could have seizures and die.\r\n<h4>Environmental Chemicals<\/h4>\r\nEnvironmental chemicals can include an exposure to a wide array of agents including pollution, organic mercury compounds, herbicides, and industrial solvents. Some environmental pollutants of major concern include lead poisoning, which is connected with low birth weight and slowed neurological development. Children who live in older housing in which lead-based paints have been used have been known to eat peeling paint chips thus being exposed to lead. The chemicals in certain herbicides are also potentially damaging. Radiation is another environmental hazard that a pregnant woman must be aware of. If a mother is exposed to radiation, particularly during the first three months of pregnancy, the child may suffer some congenital deformities. There is also an increased risk of miscarriage and stillbirth.\u00a0Mercury leads to physical deformities and intellectual disabilities (Dietrich, 1999).\r\n<h4>Sexually Transmitted Infections<\/h4>\r\nSexually transmitted infections (STIs) can complicate pregnancy and may have serious effects on both the mother and the developing baby. Most prenatal care today includes testing for STIs, and early detection is important. STIs, such as chlamydia, gonorrhea, syphilis, trichomoniasis and bacterial vaginosis can all be treated and cured with antibiotics that are safe to take during pregnancy. STIs that are caused by viruses, like genital herpes, hepatitis B, or HIV cannot be cured. However, in some cases these infections can be treated with antiviral medications or other preventive measures can be taken to reduce the risk of passing the infection to the baby.[footnote]STDs during Pregnancy - CDC Fact Sheet. Centers for Disease Control and Prevention. Retrieved from https:\/\/www.cdc.gov\/std\/pregnancy\/stdfact-pregnancy.htm[\/footnote]\r\n<h4>Maternal Diseases<\/h4>\r\nMaternal illnesses increase the chance that a baby will be born with a birth defect or have a chronic health problem. Some of the diseases that are known to potentially have an adverse effect on the fetus include: diabetes, cytomegalovirus, toxoplasmosis, Rubella, varicella, hypothyroidism, and Strep B. If the mother contracts Rubella during the first three months of pregnancy, damage can occur in the eyes, ears, heart, or brain of the unborn child. On a positive note, Rubella has been nearly eliminated in the industrial world due to the vaccine created in 1969. Diagnosing these diseases early and receiving appropriate medical care can help improve the outcomes. Routine prenatal care now includes screening for gestational diabetes and Strep B.[footnote]Maternal Illness \u2013 Birth Defect Prevention for Expecting Parents.\u00a0Birth Defect Research for Children. Retrieved from https:\/\/www.birthdefects.org\/healthy-baby\/maternal-illness\/[\/footnote]\r\n<h4>Maternal Stress<\/h4>\r\nStress represents the effects of any factor able to threaten the homeostasis of an organism; these either real or perceived threats are referred to as the \u201cstressors\u201d and comprise a long list of potentially adverse factors, which can be emotional or physical. Because of a link in blood supply between a mother and fetus, it has been found that stress can leave lasting effects on a developing fetus, even before a child is born.\u00a0The best-studied outcomes of fetal exposure to maternal prenatal stress are preterm birth and low birth weight.\u00a0Maternal prenatal stress is also considered responsible for a variety of changes of the child's brain, and a risk factor for conditions such as behavioral problems, learning disorders, high levels of anxiety, attention deficit hyperactivity disorder, autism, and schizophrenia. Furthermore, maternal prenatal stress has been associated with a higher risk for a variety of immune and metabolic changes in the child such as asthma, allergic disorders, cardiovascular diseases, hypertension, hyperlipidemia, diabetes, and obesity.[footnote]Douros Konstantinos, Moustaki Maria, Tsabouri Sophia, Papadopoulou Anna, Papadopoulos Marios, Priftis Kostas N. (2017). Prenatal Maternal Stress and the Risk of Asthma in Children.\u00a0Frontiers in Pediatrics. Retrieved from https:\/\/www.frontiersin.org\/article\/10.3389\/fped.2017.00202[\/footnote]\r\n<h3><strong>Factors influencing prenatal risks\u00a0<\/strong><\/h3>\r\nThere are several considerations in determining the type and amount of damage that might result from exposure to a particular teratogen (Berger, 2004). These include:\r\n<ul>\r\n \t<li><strong>The timing of the exposure<\/strong>: Structures in the body are vulnerable to the most severe damage when they are forming. If a substance is introduced during a particular structure's critical period (time of development), the damage to that structure may be greater. For example, the ears and arms reach their critical periods at about 6 weeks after conception. If a mother exposes the embryo to certain substances during this period, the arms and ears may be malformed.<\/li>\r\n \t<li><strong>The amount of exposure:\u00a0<\/strong>Some substances are not harmful unless the amounts reach a certain level. The critical level depends in part on the size and metabolism of the mother.<\/li>\r\n \t<li><strong>Genetics:\u00a0<\/strong>Genetic make-up also plays a role on the impact a particular teratogen might have on the child. This is suggested by fraternal twin studies\u00a0who\u00a0are exposed to the same prenatal environment, yet do not experience the same\u00a0teratogenic\u00a0effects.\u00a0The genetic make-up of the mother can also have an effect; some mothers may be more resistant to\u00a0teratogenic\u00a0effects than others.<\/li>\r\n \t<li><strong>Being male or female:<\/strong> Males are more likely to experience damage due to teratogens than are females. It is believed that the Y chromosome, which contains fewer genes than the X, may have an impact.<\/li>\r\n<\/ul>\r\n[caption id=\"attachment_586\" align=\"aligncenter\" width=\"629\"]<img class=\"wp-image-586 \" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/1496\/2014\/09\/18154211\/baby-dev.png\" alt=\"Chart showing stages of prenatal development, beginning with the dividing zygote and implantation within the first two weeks, then the CNS and heart formation in week 3, then eyes, the heart, limbs, and ears between weeks 3 and 8, then genitals and increase brain development after week 9.\" width=\"629\" height=\"399\" \/> <strong>Figure 6. Critical Periods of Prenatal Development.\u00a0<\/strong>This image summarizes the three developmental periods in prenatal development. The blue images indicate where major development is happening and the aqua indicate where refinement is happening. As shown, the majority of organs are particularly susceptible during the embryonic period. The central nervous system still continues to develop in major ways through the fetal period as well.[\/caption]\r\n\r\n<div class=\"textbox exercises\">\r\n<h3>Interactive: reducing the risk<\/h3>\r\nDid you know that pregnant women can improve outcomes for themselves and their babies through a balanced diet and adequate exercise? Click through this interactive to learn more about the importance of maternal health.\r\n\r\n<iframe src=\"https:\/\/h5p.org\/h5p\/embed\/545427\" width=\"1090\" height=\"638\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/h5p.org\/sites\/all\/modules\/h5p\/library\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script>\r\n\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assessments.lumenlearning.com\/assessments\/16542\r\n\r\n<\/div>\r\n<h2>Complications of Pregnancy and Delivery<\/h2>\r\n<h3>Complications of Pregnancy and Delivery<\/h3>\r\n[caption id=\"attachment_750\" align=\"alignright\" width=\"259\"]<img class=\"wp-image-750 \" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/1496\/2016\/03\/15195536\/PregnantWoman-195x300.jpg\" alt=\"Pregnant Woman\" width=\"259\" height=\"398\" \/> <strong>Figure 7<\/strong>. Pregnancy affects\u00a0 women in different ways; some notice few adverse side effects, while others feel high levels of discomfort, or develop more serious complications.[\/caption]\r\n\r\nThere are a number of common side effects of pregnancy. Not everyone experiences all of these nor do women experience them to the same degree. And although they are considered \"minor\" these problems are potentially very uncomfortable. These side effects include nausea (particularly during the first 3-4 months of pregnancy as a result of higher levels of estrogen in the system), heartburn, gas, hemorrhoids, backache, leg cramps, insomnia,\u00a0constipation, shortness of breath or varicose veins (as a result of carrying a heavy load on the abdomen). What is the cure? Delivery!\r\n<h4><strong>Major Complications\u00a0<\/strong><\/h4>\r\nThe following are some serious complications of pregnancy which can pose health risks to mother and child and that often require special care.\r\n<ul>\r\n \t<li><span id=\"Gestational_diabetes\" class=\"mw-headline\">Gestational diabetes\u00a0<\/span>is when a woman without\u00a0diabetes\u00a0develops\u00a0high blood sugar\u00a0levels during\u00a0pregnancy.<sup id=\"cite_ref-7\" class=\"reference\"><\/sup><\/li>\r\n \t<li>Hyperemesis gravidarum\u00a0is the presence of severe and persistent vomiting, causing dehydration and weight loss. It is more severe than the more common\u00a0morning sickness.<\/li>\r\n \t<li>Preeclampsia\u00a0is gestational hypertension. Severe preeclampsia involves blood pressure over 160\/110 with additional signs.\u00a0<sup id=\"cite_ref-11\" class=\"reference\"><\/sup>Eclampsia\u00a0is seizures in a pre-eclamptic patient.<sup id=\"cite_ref-12\" class=\"reference\"><\/sup><\/li>\r\n \t<li><span id=\"Deep_vein_thrombosis\" class=\"mw-headline\">Deep vein thrombosis is the formation of a\u00a0blood clot\u00a0in a\u00a0deep vein, most commonly in the legs.<\/span><\/li>\r\n \t<li><span id=\"Deep_vein_thrombosis\" class=\"mw-headline\"><\/span>A pregnant woman is more susceptible to\u00a0infections. This increased risk is caused by an increased\u00a0immune tolerance in pregnancy\u00a0to prevent an immune reaction against the fetus.<\/li>\r\n \t<li>Peripartum cardiomyopathy\u00a0is a decrease in heart function which occurs in the last month of pregnancy, or up to six months post-pregnancy.<\/li>\r\n<\/ul>\r\n<h4><strong>Maternal Mortality<\/strong><\/h4>\r\n<span style=\"color: #333333;\">Maternal mortality is unacceptably high. About 830 women die from pregnancy or childbirth-related complications around the world every day. It was estimated that in 2015, roughly 303,000 women died during and following pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. The high number of maternal deaths in some areas of the world reflects inequities in access to health services and highlights the gap between rich and poor. Almost all maternal deaths (99%) occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia.\u00a0<\/span>\r\n\r\n<span style=\"color: #333333;\">Almost all maternal deaths can be prevented, as evidenced by the huge disparities found between the richest and poorest countries. The lifetime risk of maternal death in high-income countries is 1 in 3,300, compared to 1 in 41 in low-income.\u00a0[footnote]<\/span>Maternal mortality (<span class=\"timestamp\">February 2018). World Health Organization. Retrieved from\u00a0<\/span><span style=\"color: #333333;\">https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/maternal-mortality[\/footnote]<\/span>\r\n\r\n[caption id=\"attachment_3503\" align=\"aligncenter\" width=\"687\"]<img class=\"wp-image-3503 size-full\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/17022628\/Screen-Shot-2019-06-16-at-10.24.59-PM.png\" alt=\"Maternal mortality fel by almost half between 1990 and 2015. Bar graphs showing declining rates in al the major world regions, and rates falling in least developed countries from 903 in 1990 to 436 in 2015.\" width=\"687\" height=\"579\" \/> <strong>Figure 8<\/strong>. This graph shows declining maternal mortality rates, as measured as the number of deaths per 100,000 live births. in 1990, 903 out of 100,000 live births resulted in death in the least developed countries, but that number has improved to 436 out of 100,000 births in 2015. Globally, there were 216 deaths for every 100,000 live births in 2015. Source: UNICEF, https:\/\/data.unicef.org\/topic\/maternal-health\/maternal-mortality\/.[\/caption]\r\n\r\nEven though maternal mortality in the United States is relatively rare today because of advanced in medical care, it is still an issue that needs to be addressed. The number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 18.0 deaths per 100,000 live births in 2014. The Centers for Disease Control and Prevention define a<strong>\u00a0pregnancy-related death<\/strong> as the death of a woman while pregnant or within 1 year of the end of a pregnancy\u2013regardless of the outcome, duration, or site of the pregnancy\u2013from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. The reasons for the overall increase in pregnancy-related mortality are unclear. What do you think are some reasons for this surprising increase in the United States? What can be done to change this statistic?\r\n<div class=\"textbox examples\">\r\n<h3>Watch It: Maternal Mortality in the united States<\/h3>\r\nIn the United States, black women are disproportionately more likely to die from complications related to pregnancy or childbirth than any other race; they are three or four times more likely than white women to die due to pregnancy-related death and are more likely to receive worse maternal care.[footnote] Black Women\u2019s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities (April 2018). National Partnership for Women and Families. Retrieved from\u00a0http:\/\/www.nationalpartnership.org\/our-work\/health\/reports\/black-womens-maternal-health.html.[\/footnote] Black women from higher income groups and with advanced education levels also have heightened risks\u2014even tennis superstar <a href=\"https:\/\/www.cnn.com\/2018\/01\/10\/health\/serena-williams-birth-c-section-olympia-bn\/index.html\">Serena Williams had near-deadly complications during the birth of her daughter, Olympia<\/a>.\u00a0Why is this the case in our modern world? Watch this video to learn more:\r\n\r\n<iframe src=\"\/\/plugin.3playmedia.com\/show?mf=3935255&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=VYc-Eq-vDuA&amp;video_target=tpm-plugin-ex4sdo7y-VYc-Eq-vDuA\" width=\"800px\" height=\"520px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe>\r\n\r\n<\/div>\r\n<span style=\"color: #333333;\">The data below shows percentages of the causes of pregnancy-related deaths in the United States during 2011\u20132014:<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #333333;\">Cardiovascular diseases, 15.2%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Non-cardiovascular diseases, 14.7%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Infection or sepsis, 12.8%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Hemorrhage, 11.5%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Cardiomyopathy, 10.3%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Thrombotic pulmonary embolism, 9.1%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Cerebrovascular accidents, 7.4%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Hypertensive disorders of pregnancy, 6.8%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Amniotic fluid embolism, 5.5%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Anesthesia complications, 0.3%.<\/span><\/li>\r\n<\/ul>\r\n<span style=\"color: #333333;\">The cause of death is unknown for 6.5% of all 2011\u20132014 pregnancy-related deaths.[footnote]\u00a0Reproductive Health. Pregnancy Mortality Surveillance System. Centers for Disease Control and Prevention. Retrieved from\u00a0https:\/\/www.cdc.gov\/reproductivehealth\/maternalinfanthealth\/pregnancy-mortality-surveillance-system.htm\u00a0[\/footnote]<\/span>\r\n<h4><strong>Miscarriage<\/strong><\/h4>\r\nSpontaneous abortion\u00a0is experienced in an estimated 20-40 percent of undiagnosed pregnancies and in another 10 percent of diagnosed pregnancies.\u00a0Usually, the body aborts due to chromosomal abnormalities and this typically happens before the 12th\u00a0week of pregnancy.\u00a0Cramping and bleeding result and normal periods return after several months.\u00a0Some women are more likely to have repeated miscarriages due to chromosomal, amniotic, or hormonal problems; but miscarriage can also be a result of defective sperm (Carroll et al., 2003).\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assessments.lumenlearning.com\/assessments\/16543\r\n\r\n<\/div>\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Glossary<\/h3>\r\n[glossary-page]\r\n\r\n[glossary-term]embryo:[\/glossary-term]\r\n[glossary-definition]a multi-celled organism between two and eight weeks after fertilization[\/glossary-definition]\r\n\r\n[glossary-term]fetal alcohol spectrum disorders:[\/glossary-term]\r\n[glossary-definition]a group of abnormalities in babies born to mothers who consume alcohol during pregnancy[\/glossary-definition]\r\n\r\n[glossary-term]fetus:[\/glossary-term]\r\n[glossary-definition]an unborn human baby from nine weeks after conception until birth[\/glossary-definition]\r\n\r\n[glossary-term]mitosis:[\/glossary-term]\r\n[glossary-definition]the process of cell division[\/glossary-definition]\r\n\r\n[glossary-term]placenta:[\/glossary-term]\r\n[glossary-definition]a structure connected to the uterus that provides nourishment and oxygen from the mother to the developing embryo via the umbilical cord[\/glossary-definition]\r\n\r\n[glossary-term]pregnancy-related death:[\/glossary-term]\r\n[glossary-definition]the death of a woman while pregnant or within 1 year of the end of a pregnancy from any cause related to or aggravated by the pregnancy[\/glossary-definition]\r\n\r\n[glossary-term]teratogen:[\/glossary-term]\r\n[glossary-definition]any agent which can cause a birth defect[\/glossary-definition]\r\n\r\n[glossary-term]zygote:[\/glossary-term]\r\n[glossary-definition]a one-cell structure that is created when a sperm and egg merge[\/glossary-definition]\r\n\r\n[\/glossary-page]\r\n\r\n<\/div>","rendered":"<h2>What you&#8217;ll learn to do: explain the main stages of prenatal development<\/h2>\n<p><a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2018\/12\/19212406\/pregnancy.png\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-3600\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2018\/12\/19212406\/pregnancy-300x300.png\" alt=\"Graphic of stages of pregnancy from conception to birth\" width=\"321\" height=\"321\" \/><\/a><\/p>\n<p>How did you come to be who you are? From beginning as a one-cell structure to your birth, your\u00a0prenatal development\u00a0occurred in an orderly and delicate sequence. There are three stages of prenatal development: germinal, embryonic, and fetal. Keep in mind that this is different than the three trimesters of pregnancy. Let\u2019s take a look at what happens to the developing baby in each of these stages.<\/p>\n<div class=\"textbox learning-objectives\">\n<h3>Learning outcomes<\/h3>\n<ul>\n<li>Differentiate between development during the germinal, embryonic, and fetal periods<\/li>\n<li>Examine risks to prenatal development\u00a0posed by exposure to teratogens<\/li>\n<li>Explain potential complications of pregnancy and delivery<\/li>\n<\/ul>\n<\/div>\n<h2>Prenatal Development<\/h2>\n<blockquote><p><span style=\"color: #333333;\">&#8220;The body of the unborn baby is more complex than ours. The preborn baby has several extra parts to his body which he needs only so long as he lives inside his mother. He has his own space capsule, the amniotic sac. He has his own lifeline, the umbilical cord, and he has his own root system, the placenta. These all belong to the baby himself, not to his mother. They are all developed from his original cell.&#8221;<a class=\"footnote\" title=\"Day &amp; Liley, The Secret World of a Baby, Random House, 1968, p. 13\" id=\"return-footnote-1215-1\" href=\"#footnote-1215-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a>\u00a0<\/span><\/p><\/blockquote>\n<h3>Periods of Prenatal Development<\/h3>\n<p>Let&#8217;s take a look at some of the changes that take place during each of the three periods of prenatal development: the germinal period, the embryonic period, and the fetal period.<\/p>\n<h4>The Germinal Period (Weeks 1-2)<\/h4>\n<div id=\"attachment_580\" style=\"width: 310px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-580\" class=\"wp-image-580 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/1496\/2014\/09\/18153941\/Germinal-300x205.jpeg\" alt=\"magnified photo of sperm approaching ovum.\" width=\"300\" height=\"205\" \/><\/p>\n<p id=\"caption-attachment-580\" class=\"wp-caption-text\"><strong>Figure 1<\/strong>. Sperm and Ovum at Conception<\/p>\n<\/div>\n<p>Conception occurs when a sperm fertilizes an egg and forms a\u00a0<strong>zygote,<\/strong>\u00a0which begins as a one-cell structure. The\u00a0mother and father\u2019s DNA is passed on to the child at the moment of conception. The genetic makeup and sex of the baby are set at this point. The germinal period (about 14 days in length) lasts from conception to implantation of the zygote (fertilized egg) in the lining of the uterus.<\/p>\n<p>During the first week after conception, the zygote divides and multiplies, going from a one-cell structure to two cells, then four cells, then eight cells, and so on. The process of cell division is called <strong>mitosis<\/strong>.\u00a0After the fourth division, differentiation of the cells begins to occur as well. Differentiated cells become more specialized, forming different organs and body parts.\u00a0\u00a0After 5 days of mitosis, there are 100 cells, and after 9 months there are billions of cells.\u00a0Mitosis\u00a0is a fragile process, and fewer than one-half of all zygotes survive beyond the first two weeks (Hall, 2004).<\/p>\n<p><span style=\"color: #333333;\">After the zygote divides for about 7\u201310 days and has 150 cells, it travels down the fallopian tubes and implants itself in the lining of the uterus.<\/span>\u00a0It\u2019s estimated that about 60 percent of natural conceptions fail to implant in the uterus. The rate is higher for in vitro conceptions.\u00a0Once the zygote attaches to the uterus, the next stage begins.<\/p>\n<h3>The Embryonic Period (Weeks 3-8)<\/h3>\n<div id=\"attachment_1996\" style=\"width: 210px\" class=\"wp-caption alignright\"><a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/25050356\/548063929_d087ee4a1f_z.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-1996\" class=\"size-medium wp-image-1996\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/25050356\/548063929_d087ee4a1f_z-200x300.jpg\" alt=\"Photograph of -Week Human Embryo from Ectopic Pregnancy\" width=\"200\" height=\"300\" \/><\/a><\/p>\n<p id=\"caption-attachment-1996\" class=\"wp-caption-text\"><strong>Figure 2<\/strong>. Human Embryo<\/p>\n<\/div>\n<p>The embryonic period begins once the zygote is implanted in the uterine wall. It lasts from the third through the eighth week after conception. <span style=\"color: #333333;\">Upon implantation, this multi-cellular organism is called an\u00a0<strong>embryo<\/strong>. Now blood vessels grow, forming the placenta. The\u00a0<strong>placenta<\/strong>\u00a0is a structure connected to the uterus that provides nourishment and oxygen from the mother to the developing embryo via the umbilical cord. <\/span><\/p>\n<p><span style=\"color: #333333;\">During this period, cells continue to differentiate. Basic structures of the embryo start to develop into areas that will become the head, chest, and abdomen. During the embryonic stage, the heart begins to beat and organs form and begin to function. At 22 days after conception, the neural tube forms along the back of the embryo, developing into the spinal cord and brain.\u00a0<\/span><\/p>\n<p>Growth during prenatal development occurs in two major directions: from head to tail (cephalocaudal\u00a0development) and from the midline outward (proximodistal\u00a0development).\u00a0This means that those structures nearest the head develop before those nearest the feet and those structures nearest the torso develop before those away from the center of the body (such as hands and fingers).<\/p>\n<p>The head develops in the fourth week and the precursor to the heart begins to pulse. In the early stages of the embryonic period, gills and a tail are apparent. But by the end of this stage, they disappear and the organism takes on a more human appearance.\u00a0The embryo is approximately 1 inch in length and weighs about 4 grams at the end of this period.\u00a0The embryo can move and respond to touch at this time.<\/p>\n<p>About 20 percent of organisms fail during the embryonic period, usually due to gross chromosomal abnormalities.\u00a0As in the case of the germinal period, often the mother does not yet know that she is pregnant.\u00a0It is during this stage that the major structures of the body are taking form making the embryonic period the time when the organism is most vulnerable to the greatest amount of damage if exposed to harmful substances. Potential mothers are not often aware of the risks they introduce to the developing child during this time.<\/p>\n<h3>The Fetal Period (Weeks 9-40)<\/h3>\n<div id=\"attachment_3498\" style=\"width: 310px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/17012732\/797px-Human_fetus_10_weeks_with_amniotic_sac_-_therapeutic_abortion.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3498\" class=\"wp-image-3498 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/17012732\/797px-Human_fetus_10_weeks_with_amniotic_sac_-_therapeutic_abortion-300x226.jpg\" alt=\"44-year-old pregnant person with 6 previous children was diagnosed with carcinoma in situ of cervix (early-stage cancer of the uterus). The uterus (womb) was completely removed, including the fetus, to protect the health of the patient.\" width=\"300\" height=\"226\" \/><\/a><\/p>\n<p id=\"caption-attachment-3498\" class=\"wp-caption-text\"><strong>Figure 3<\/strong>. A fetus at 10 weeks of development.<\/p>\n<\/div>\n<p><span style=\"color: #333333;\">When the organism is about nine weeks old, the embryo is called a <strong>fetus<\/strong>. At this stage, the fetus is about the size of a kidney bean and begins to take on the recognizable form of a human being as the \u201ctail\u201d begins to disappear.<\/span><\/p>\n<p><span style=\"color: #333333;\">From 9\u201312 weeks, the sex organs begin to differentiate. By the 12th week, the fetus has all its body parts including external genitalia. In the following weeks, the fetus will develop hair, nails, teeth and the excretory and digestive systems will continue to develop. At the end of the 12th\u00a0week, the fetus is about 3 inches long and weighs about 28 grams.<\/span><\/p>\n<p><span style=\"color: #333333;\">At about 16 weeks, the fetus is approximately 4.5 inches long. Fingers and toes are fully developed, and fingerprints are visible. During the 4-6th months, the eyes become more sensitive to light and hearing develops. The respiratory system continues to develop. Reflexes such as sucking, swallowing and hiccuping develop during the 5th month. Cycles of sleep and wakefulness are present at that time as well. Throughout the fetal stage, the brain continues to grow and develop, nearly doubling in size from weeks 16 to 28. The majority of the neurons in the brain have developed by 24 weeks although they are still rudimentary and the glial or nurse cells that support neurons continue to grow.\u00a0At 24 weeks the fetus can feel pain (Royal College of Obstetricians and Gynecologists, 1997).<\/span><\/p>\n<p><span style=\"color: #333333;\">The first chance of survival outside the womb, known as the\u00a0age of viability\u00a0is reached at about 22 to 26 weeks (Moore &amp;\u00a0Persaud, 1998). By the time the fetus reaches the sixth month of development (24 weeks), it weighs up to 1.4 pounds. The hearing has developed, so the fetus can respond to sounds. The internal organs, such as the lungs, heart, stomach, and intestines, have formed enough that a fetus born prematurely at this point has a chance to survive outside of the mother\u2019s womb. <\/span><\/p>\n<p>Between the 7th and 9th\u00a0months, the fetus is primarily preparing for birth. It is exercising its muscles, its lungs begin to expand and contract. It is developing fat layers under the skin.\u00a0The fetus gains about 5 pounds and 7 inches during this last trimester of pregnancy which includes a layer of fat gained during the 8th\u00a0month.\u00a0This layer of fat serves as insulation and helps the baby regulate body temperature after birth.<\/p>\n<p><span style=\"color: #333333;\">Around 36 weeks, the fetus is almost ready for birth. It weighs about 6 pounds and is about 18.5 inches long, and by week 37 all of the fetus\u2019s organ systems are developed enough that it could survive outside the mother\u2019s uterus without many of the risks associated with premature birth. The fetus continues to gain weight and grow in length until approximately 40 weeks. By then, the fetus has very little room to move around and birth becomes imminent.\u00a0<\/span><\/p>\n<div id=\"attachment_3499\" style=\"width: 741px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3499\" class=\"wp-image-3499 size-full\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/17013105\/CNX_Psych_09_02_Stages.jpg\" alt=\"Images of fetal development from 9 weeks through 40 weeks.\" width=\"731\" height=\"763\" \/><\/p>\n<p id=\"caption-attachment-3499\" class=\"wp-caption-text\"><strong>Figure 4<\/strong>. During the fetal stage, the baby\u2019s brain develops and the body adds size and weight until the fetus reaches full-term development.<\/p>\n<\/div>\n<div class=\"textbox examples\">\n<h3>Watch It<\/h3>\n<p>This video explains many of the developmental milestones and changes that happen during each month of development for the embryo and fetus.<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Prenatal Development: What Babies Learn in the Womb\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/UA-Tk9qlG9A?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"lumen_assessment_16541\" class=\"resizable\" src=\"https:\/\/assessments.lumenlearning.com\/assessments\/load?assessment_id=16541&#38;embed=1&#38;external_user_id=&#38;external_context_id=&#38;iframe_resize_id=lumen_assessment_16541\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:400px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<h2>Environmental Risks<\/h2>\n<h3>Teratology<\/h3>\n<p>Good prenatal care is essential. The developing child is most at risk for some of the most severe problems during the first three months of development. Unfortunately, this is a time at which most mothers are unaware that they are pregnant. It is estimated that 10% of all birth defects are caused by a prenatal exposure or <strong>teratogen<\/strong>.\u00a0Teratogens are factors that can contribute to birth defects which include some maternal diseases, drugs, alcohol, and stress. These exposures can also include environmental and occupational exposures. Today, we know many of the factors that can jeopardize the health of the developing child.\u00a0Teratogen-caused birth defects are potentially preventable.<\/p>\n<p>The study of factors that contribute to birth defects is called teratology.\u00a0Teratogens are usually discovered after an increased prevalence of a particular birth defect. For example, in the early 1960\u2019s, a drug known as thalidomide was used to treat morning sickness. Exposure of the fetus during this early stage of development resulted in cases of phocomelia, a congenital malformation in which the hands and feet are attached to abbreviated arms and legs.<\/p>\n<h3><strong>A Look at Some Teratogens<\/strong><\/h3>\n<h4><strong>Alcohol<\/strong><\/h4>\n<div id=\"attachment_3501\" style=\"width: 275px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3501\" class=\"wp-image-3501 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/17015318\/Photo_of_baby_with_FAS-265x300.jpg\" alt=\"Image of a baby boy with FAS facial characteristics of small eye openings, a smooth philtrum, and a thin upper lip.\" width=\"265\" height=\"300\" \/><\/p>\n<p id=\"caption-attachment-3501\" class=\"wp-caption-text\"><strong>Figure 5<\/strong>. Some distinguishing characteristics of fetal alcohol spectrum disorders include more narrow eye openings, A smooth philtrum, meaning a smooth area between the upper lip and the nose, and a thin upper lip.<\/p>\n<\/div>\n<p>One of the most commonly used teratogens is alcohol. Because half of all pregnancies in the United States are unplanned, it is recommended that women of child-bearing age take great caution against drinking alcohol when not using birth control and when pregnant (Surgeon General\u2019s Advisory on Alcohol Use During Pregnancy, 2005). Alcohol consumption, particularly during the second month of prenatal development, but at any point during pregnancy, may lead to neurocognitive and behavioral difficulties that can last a lifetime.<\/p>\n<p>There is\u00a0no acceptable safe limit for alcohol use during pregnancy, but binge drinking (5 or more drinks on a single occasion) or having 7 or more drinks during a single week places a child at particularly high risk.\u00a0In extreme cases, alcohol consumption can lead to fetal death, but more frequently it can result in\u00a0<strong>fetal alcohol spectrum disorders\u00a0(FASD)<\/strong>. This terminology is now used when looking at the effects of exposure and replaces the term fetal alcohol syndrome. It is preferred because it recognizes that symptoms occur on a spectrum and that all individuals do not have the same characteristics. Children with FASD share certain physical features such as flattened noses, small eye openings, small heads, intellectual developmental delays, and behavioral problems.\u00a0Those with FASD are more at risk for lifelong problems such as criminal behavior, psychiatric problems, and unemployment (CDC, 2006).<\/p>\n<p>The terms alcohol-related neurological disorder (ARND) and alcohol-related birth defects (ARBD) have replaced the term Fetal Alcohol Effects to refer to those with less extreme symptoms of FASD. ARBD include kidney, bone and heart problems.<\/p>\n<div class=\"textbox examples\">\n<h3>watch it<\/h3>\n<p>Several medical experts debunk common myths about the safety of drinking alcohol during pregnancy.<\/p>\n<p><iframe loading=\"lazy\" src=\"\/\/plugin.3playmedia.com\/show?mf=3935252&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=pvFqjU43Odo&amp;video_target=tpm-plugin-z36ohj3l-pvFqjU43Odo\" width=\"800px\" height=\"520px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe><\/p>\n<\/div>\n<h4><b>Tobacco<\/b><\/h4>\n<p>Smoking is also considered a teratogen because nicotine travels through the placenta to the fetus. When the mother smokes, the developing baby experiences a reduction in blood oxygen levels. Tobacco use during pregnancy has been associated with low birth weight, placenta\u00a0previa, birth defects, preterm delivery, fetal growth restriction, and sudden infant death syndrome.\u00a0Smoking in the month before getting pregnant and throughout pregnancy increases the chances of these risks. Quitting smoking\u00a0<em>before<\/em>\u00a0getting pregnant is best. However, for women who are already pregnant, quitting as early as possible can still help protect against some health problems for the mother and baby.<a class=\"footnote\" title=\"Birth Defects Research and Tracking. Centers for Disease Control and Prevention. Retrieved from https:\/\/www.cdc.gov\/ncbddd\/birthdefects\/research.html\" id=\"return-footnote-1215-2\" href=\"#footnote-1215-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/p>\n<h4><strong>Drugs<\/strong><\/h4>\n<p>Prescription, over-the-counter, or recreational drugs\u00a0can have serious\u00a0teratogenic\u00a0effects. In general, if medication is required, the lowest dose possible should be used. Combination drug therapies and first trimester exposures should be avoided. Almost three percent of pregnant women use illicit drugs such as marijuana, cocaine, Ecstasy and other amphetamines, and heroin. These drugs can cause low birth-weight, withdrawal symptoms, birth defects, or learning or behavioral problems. Babies born with a heroin addiction need heroin just like an adult addict. The child will need to be gradually weaned from the heroin under medical supervision; otherwise, the child could have seizures and die.<\/p>\n<h4>Environmental Chemicals<\/h4>\n<p>Environmental chemicals can include an exposure to a wide array of agents including pollution, organic mercury compounds, herbicides, and industrial solvents. Some environmental pollutants of major concern include lead poisoning, which is connected with low birth weight and slowed neurological development. Children who live in older housing in which lead-based paints have been used have been known to eat peeling paint chips thus being exposed to lead. The chemicals in certain herbicides are also potentially damaging. Radiation is another environmental hazard that a pregnant woman must be aware of. If a mother is exposed to radiation, particularly during the first three months of pregnancy, the child may suffer some congenital deformities. There is also an increased risk of miscarriage and stillbirth.\u00a0Mercury leads to physical deformities and intellectual disabilities (Dietrich, 1999).<\/p>\n<h4>Sexually Transmitted Infections<\/h4>\n<p>Sexually transmitted infections (STIs) can complicate pregnancy and may have serious effects on both the mother and the developing baby. Most prenatal care today includes testing for STIs, and early detection is important. STIs, such as chlamydia, gonorrhea, syphilis, trichomoniasis and bacterial vaginosis can all be treated and cured with antibiotics that are safe to take during pregnancy. STIs that are caused by viruses, like genital herpes, hepatitis B, or HIV cannot be cured. However, in some cases these infections can be treated with antiviral medications or other preventive measures can be taken to reduce the risk of passing the infection to the baby.<a class=\"footnote\" title=\"STDs during Pregnancy - CDC Fact Sheet. Centers for Disease Control and Prevention. Retrieved from https:\/\/www.cdc.gov\/std\/pregnancy\/stdfact-pregnancy.htm\" id=\"return-footnote-1215-3\" href=\"#footnote-1215-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/p>\n<h4>Maternal Diseases<\/h4>\n<p>Maternal illnesses increase the chance that a baby will be born with a birth defect or have a chronic health problem. Some of the diseases that are known to potentially have an adverse effect on the fetus include: diabetes, cytomegalovirus, toxoplasmosis, Rubella, varicella, hypothyroidism, and Strep B. If the mother contracts Rubella during the first three months of pregnancy, damage can occur in the eyes, ears, heart, or brain of the unborn child. On a positive note, Rubella has been nearly eliminated in the industrial world due to the vaccine created in 1969. Diagnosing these diseases early and receiving appropriate medical care can help improve the outcomes. Routine prenatal care now includes screening for gestational diabetes and Strep B.<a class=\"footnote\" title=\"Maternal Illness \u2013 Birth Defect Prevention for Expecting Parents.\u00a0Birth Defect Research for Children. Retrieved from https:\/\/www.birthdefects.org\/healthy-baby\/maternal-illness\/\" id=\"return-footnote-1215-4\" href=\"#footnote-1215-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a><\/p>\n<h4>Maternal Stress<\/h4>\n<p>Stress represents the effects of any factor able to threaten the homeostasis of an organism; these either real or perceived threats are referred to as the \u201cstressors\u201d and comprise a long list of potentially adverse factors, which can be emotional or physical. Because of a link in blood supply between a mother and fetus, it has been found that stress can leave lasting effects on a developing fetus, even before a child is born.\u00a0The best-studied outcomes of fetal exposure to maternal prenatal stress are preterm birth and low birth weight.\u00a0Maternal prenatal stress is also considered responsible for a variety of changes of the child&#8217;s brain, and a risk factor for conditions such as behavioral problems, learning disorders, high levels of anxiety, attention deficit hyperactivity disorder, autism, and schizophrenia. Furthermore, maternal prenatal stress has been associated with a higher risk for a variety of immune and metabolic changes in the child such as asthma, allergic disorders, cardiovascular diseases, hypertension, hyperlipidemia, diabetes, and obesity.<a class=\"footnote\" title=\"Douros Konstantinos, Moustaki Maria, Tsabouri Sophia, Papadopoulou Anna, Papadopoulos Marios, Priftis Kostas N. (2017). Prenatal Maternal Stress and the Risk of Asthma in Children.\u00a0Frontiers in Pediatrics. Retrieved from https:\/\/www.frontiersin.org\/article\/10.3389\/fped.2017.00202\" id=\"return-footnote-1215-5\" href=\"#footnote-1215-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a><\/p>\n<h3><strong>Factors influencing prenatal risks\u00a0<\/strong><\/h3>\n<p>There are several considerations in determining the type and amount of damage that might result from exposure to a particular teratogen (Berger, 2004). These include:<\/p>\n<ul>\n<li><strong>The timing of the exposure<\/strong>: Structures in the body are vulnerable to the most severe damage when they are forming. If a substance is introduced during a particular structure&#8217;s critical period (time of development), the damage to that structure may be greater. For example, the ears and arms reach their critical periods at about 6 weeks after conception. If a mother exposes the embryo to certain substances during this period, the arms and ears may be malformed.<\/li>\n<li><strong>The amount of exposure:\u00a0<\/strong>Some substances are not harmful unless the amounts reach a certain level. The critical level depends in part on the size and metabolism of the mother.<\/li>\n<li><strong>Genetics:\u00a0<\/strong>Genetic make-up also plays a role on the impact a particular teratogen might have on the child. This is suggested by fraternal twin studies\u00a0who\u00a0are exposed to the same prenatal environment, yet do not experience the same\u00a0teratogenic\u00a0effects.\u00a0The genetic make-up of the mother can also have an effect; some mothers may be more resistant to\u00a0teratogenic\u00a0effects than others.<\/li>\n<li><strong>Being male or female:<\/strong> Males are more likely to experience damage due to teratogens than are females. It is believed that the Y chromosome, which contains fewer genes than the X, may have an impact.<\/li>\n<\/ul>\n<div id=\"attachment_586\" style=\"width: 639px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-586\" class=\"wp-image-586\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/1496\/2014\/09\/18154211\/baby-dev.png\" alt=\"Chart showing stages of prenatal development, beginning with the dividing zygote and implantation within the first two weeks, then the CNS and heart formation in week 3, then eyes, the heart, limbs, and ears between weeks 3 and 8, then genitals and increase brain development after week 9.\" width=\"629\" height=\"399\" \/><\/p>\n<p id=\"caption-attachment-586\" class=\"wp-caption-text\"><strong>Figure 6. Critical Periods of Prenatal Development.\u00a0<\/strong>This image summarizes the three developmental periods in prenatal development. The blue images indicate where major development is happening and the aqua indicate where refinement is happening. As shown, the majority of organs are particularly susceptible during the embryonic period. The central nervous system still continues to develop in major ways through the fetal period as well.<\/p>\n<\/div>\n<div class=\"textbox exercises\">\n<h3>Interactive: reducing the risk<\/h3>\n<p>Did you know that pregnant women can improve outcomes for themselves and their babies through a balanced diet and adequate exercise? Click through this interactive to learn more about the importance of maternal health.<\/p>\n<p><iframe loading=\"lazy\" src=\"https:\/\/h5p.org\/h5p\/embed\/545427\" width=\"1090\" height=\"638\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/h5p.org\/sites\/all\/modules\/h5p\/library\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script><\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"lumen_assessment_16542\" class=\"resizable\" src=\"https:\/\/assessments.lumenlearning.com\/assessments\/load?assessment_id=16542&#38;embed=1&#38;external_user_id=&#38;external_context_id=&#38;iframe_resize_id=lumen_assessment_16542\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:400px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<h2>Complications of Pregnancy and Delivery<\/h2>\n<h3>Complications of Pregnancy and Delivery<\/h3>\n<div id=\"attachment_750\" style=\"width: 269px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-750\" class=\"wp-image-750\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/1496\/2016\/03\/15195536\/PregnantWoman-195x300.jpg\" alt=\"Pregnant Woman\" width=\"259\" height=\"398\" \/><\/p>\n<p id=\"caption-attachment-750\" class=\"wp-caption-text\"><strong>Figure 7<\/strong>. Pregnancy affects\u00a0 women in different ways; some notice few adverse side effects, while others feel high levels of discomfort, or develop more serious complications.<\/p>\n<\/div>\n<p>There are a number of common side effects of pregnancy. Not everyone experiences all of these nor do women experience them to the same degree. And although they are considered &#8220;minor&#8221; these problems are potentially very uncomfortable. These side effects include nausea (particularly during the first 3-4 months of pregnancy as a result of higher levels of estrogen in the system), heartburn, gas, hemorrhoids, backache, leg cramps, insomnia,\u00a0constipation, shortness of breath or varicose veins (as a result of carrying a heavy load on the abdomen). What is the cure? Delivery!<\/p>\n<h4><strong>Major Complications\u00a0<\/strong><\/h4>\n<p>The following are some serious complications of pregnancy which can pose health risks to mother and child and that often require special care.<\/p>\n<ul>\n<li><span id=\"Gestational_diabetes\" class=\"mw-headline\">Gestational diabetes\u00a0<\/span>is when a woman without\u00a0diabetes\u00a0develops\u00a0high blood sugar\u00a0levels during\u00a0pregnancy.<sup id=\"cite_ref-7\" class=\"reference\"><\/sup><\/li>\n<li>Hyperemesis gravidarum\u00a0is the presence of severe and persistent vomiting, causing dehydration and weight loss. It is more severe than the more common\u00a0morning sickness.<\/li>\n<li>Preeclampsia\u00a0is gestational hypertension. Severe preeclampsia involves blood pressure over 160\/110 with additional signs.\u00a0<sup id=\"cite_ref-11\" class=\"reference\"><\/sup>Eclampsia\u00a0is seizures in a pre-eclamptic patient.<sup id=\"cite_ref-12\" class=\"reference\"><\/sup><\/li>\n<li><span id=\"Deep_vein_thrombosis\" class=\"mw-headline\">Deep vein thrombosis is the formation of a\u00a0blood clot\u00a0in a\u00a0deep vein, most commonly in the legs.<\/span><\/li>\n<li><span id=\"Deep_vein_thrombosis\" class=\"mw-headline\"><\/span>A pregnant woman is more susceptible to\u00a0infections. This increased risk is caused by an increased\u00a0immune tolerance in pregnancy\u00a0to prevent an immune reaction against the fetus.<\/li>\n<li>Peripartum cardiomyopathy\u00a0is a decrease in heart function which occurs in the last month of pregnancy, or up to six months post-pregnancy.<\/li>\n<\/ul>\n<h4><strong>Maternal Mortality<\/strong><\/h4>\n<p><span style=\"color: #333333;\">Maternal mortality is unacceptably high. About 830 women die from pregnancy or childbirth-related complications around the world every day. It was estimated that in 2015, roughly 303,000 women died during and following pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. The high number of maternal deaths in some areas of the world reflects inequities in access to health services and highlights the gap between rich and poor. Almost all maternal deaths (99%) occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia.\u00a0<\/span><\/p>\n<p><span style=\"color: #333333;\">Almost all maternal deaths can be prevented, as evidenced by the huge disparities found between the richest and poorest countries. The lifetime risk of maternal death in high-income countries is 1 in 3,300, compared to 1 in 41 in low-income.\u00a0<a class=\"footnote\" title=\"Maternal mortality (February 2018). World Health Organization. Retrieved from\u00a0https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/maternal-mortality\" id=\"return-footnote-1215-6\" href=\"#footnote-1215-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a><\/span><\/p>\n<div id=\"attachment_3503\" style=\"width: 697px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3503\" class=\"wp-image-3503 size-full\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/17022628\/Screen-Shot-2019-06-16-at-10.24.59-PM.png\" alt=\"Maternal mortality fel by almost half between 1990 and 2015. Bar graphs showing declining rates in al the major world regions, and rates falling in least developed countries from 903 in 1990 to 436 in 2015.\" width=\"687\" height=\"579\" \/><\/p>\n<p id=\"caption-attachment-3503\" class=\"wp-caption-text\"><strong>Figure 8<\/strong>. This graph shows declining maternal mortality rates, as measured as the number of deaths per 100,000 live births. in 1990, 903 out of 100,000 live births resulted in death in the least developed countries, but that number has improved to 436 out of 100,000 births in 2015. Globally, there were 216 deaths for every 100,000 live births in 2015. Source: UNICEF, https:\/\/data.unicef.org\/topic\/maternal-health\/maternal-mortality\/.<\/p>\n<\/div>\n<p>Even though maternal mortality in the United States is relatively rare today because of advanced in medical care, it is still an issue that needs to be addressed. The number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 18.0 deaths per 100,000 live births in 2014. The Centers for Disease Control and Prevention define a<strong>\u00a0pregnancy-related death<\/strong> as the death of a woman while pregnant or within 1 year of the end of a pregnancy\u2013regardless of the outcome, duration, or site of the pregnancy\u2013from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. The reasons for the overall increase in pregnancy-related mortality are unclear. What do you think are some reasons for this surprising increase in the United States? What can be done to change this statistic?<\/p>\n<div class=\"textbox examples\">\n<h3>Watch It: Maternal Mortality in the united States<\/h3>\n<p>In the United States, black women are disproportionately more likely to die from complications related to pregnancy or childbirth than any other race; they are three or four times more likely than white women to die due to pregnancy-related death and are more likely to receive worse maternal care.<a class=\"footnote\" title=\"Black Women\u2019s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities (April 2018). National Partnership for Women and Families. Retrieved from\u00a0http:\/\/www.nationalpartnership.org\/our-work\/health\/reports\/black-womens-maternal-health.html.\" id=\"return-footnote-1215-7\" href=\"#footnote-1215-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a> Black women from higher income groups and with advanced education levels also have heightened risks\u2014even tennis superstar <a href=\"https:\/\/www.cnn.com\/2018\/01\/10\/health\/serena-williams-birth-c-section-olympia-bn\/index.html\">Serena Williams had near-deadly complications during the birth of her daughter, Olympia<\/a>.\u00a0Why is this the case in our modern world? Watch this video to learn more:<\/p>\n<p><iframe loading=\"lazy\" src=\"\/\/plugin.3playmedia.com\/show?mf=3935255&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=VYc-Eq-vDuA&amp;video_target=tpm-plugin-ex4sdo7y-VYc-Eq-vDuA\" width=\"800px\" height=\"520px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe><\/p>\n<\/div>\n<p><span style=\"color: #333333;\">The data below shows percentages of the causes of pregnancy-related deaths in the United States during 2011\u20132014:<\/span><\/p>\n<ul>\n<li><span style=\"color: #333333;\">Cardiovascular diseases, 15.2%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Non-cardiovascular diseases, 14.7%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Infection or sepsis, 12.8%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Hemorrhage, 11.5%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Cardiomyopathy, 10.3%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Thrombotic pulmonary embolism, 9.1%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Cerebrovascular accidents, 7.4%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Hypertensive disorders of pregnancy, 6.8%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Amniotic fluid embolism, 5.5%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Anesthesia complications, 0.3%.<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #333333;\">The cause of death is unknown for 6.5% of all 2011\u20132014 pregnancy-related deaths.<a class=\"footnote\" title=\"\u00a0Reproductive Health. Pregnancy Mortality Surveillance System. Centers for Disease Control and Prevention. Retrieved from\u00a0https:\/\/www.cdc.gov\/reproductivehealth\/maternalinfanthealth\/pregnancy-mortality-surveillance-system.htm\u00a0\" id=\"return-footnote-1215-8\" href=\"#footnote-1215-8\" aria-label=\"Footnote 8\"><sup class=\"footnote\">[8]<\/sup><\/a><\/span><\/p>\n<h4><strong>Miscarriage<\/strong><\/h4>\n<p>Spontaneous abortion\u00a0is experienced in an estimated 20-40 percent of undiagnosed pregnancies and in another 10 percent of diagnosed pregnancies.\u00a0Usually, the body aborts due to chromosomal abnormalities and this typically happens before the 12th\u00a0week of pregnancy.\u00a0Cramping and bleeding result and normal periods return after several months.\u00a0Some women are more likely to have repeated miscarriages due to chromosomal, amniotic, or hormonal problems; but miscarriage can also be a result of defective sperm (Carroll et al., 2003).<\/p>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"lumen_assessment_16543\" class=\"resizable\" src=\"https:\/\/assessments.lumenlearning.com\/assessments\/load?assessment_id=16543&#38;embed=1&#38;external_user_id=&#38;external_context_id=&#38;iframe_resize_id=lumen_assessment_16543\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:400px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox key-takeaways\">\n<h3>Glossary<\/h3>\n<div class=\"titlepage\">\n<dl>\n<dt>embryo:<\/dt>\n<dd>a multi-celled organism between two and eight weeks after fertilization<\/dd>\n<dt>fetal alcohol spectrum disorders:<\/dt>\n<dd>a group of abnormalities in babies born to mothers who consume alcohol during pregnancy<\/dd>\n<dt>fetus:<\/dt>\n<dd>an unborn human baby from nine weeks after conception until birth<\/dd>\n<dt>mitosis:<\/dt>\n<dd>the process of cell division<\/dd>\n<dt>placenta:<\/dt>\n<dd>a structure connected to the uterus that provides nourishment and oxygen from the mother to the developing embryo via the umbilical cord<\/dd>\n<dt>pregnancy-related death:<\/dt>\n<dd>the death of a woman while pregnant or within 1 year of the end of a pregnancy from any cause related to or aggravated by the pregnancy<\/dd>\n<dt>teratogen:<\/dt>\n<dd>any agent which can cause a birth defect<\/dd>\n<dt>zygote:<\/dt>\n<dd>a one-cell structure that is created when a sperm and egg merge<\/dd>\n<\/dl>\n<\/div>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-1215\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Julie Lazzara for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Introduction to Prenatal Development. <strong>Provided by<\/strong>: Lumen Learning. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/courses.lumenlearning.com\/waymaker-psychology\/chapter\/stages-of-development\/\">https:\/\/courses.lumenlearning.com\/waymaker-psychology\/chapter\/stages-of-development\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Pregnancy. <strong>Authored by<\/strong>: Gerd Altmann. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/pixabay.com\/images\/id-1749858\/\">https:\/\/pixabay.com\/images\/id-1749858\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/cc0\">CC0: No Rights Reserved<\/a><\/em><\/li><li>Psyc 200 Lifespan Psychology. <strong>Authored by<\/strong>: Laura Overstreet. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"http:\/\/opencourselibrary.org\/econ-201\/\">http:\/\/opencourselibrary.org\/econ-201\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Prenatal Development content and fetal stages image. <strong>Provided by<\/strong>: Lumen Learning. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/courses.lumenlearning.com\/waymaker-psychology\/chapter\/stages-of-development\/\">https:\/\/courses.lumenlearning.com\/waymaker-psychology\/chapter\/stages-of-development\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Fetus image. <strong>Authored by<\/strong>: Jacopo Werther. <strong>Provided by<\/strong>: Wikimedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Human_fetus_10_weeks_with_amniotic_sac_-_therapeutic_abortion.jpg\">https:\/\/commons.wikimedia.org\/wiki\/File:Human_fetus_10_weeks_with_amniotic_sac_-_therapeutic_abortion.jpg<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Understanding Genetics: A District of Columbia Guide for Patients and Health Professionals.. <strong>Authored by<\/strong>: Genetic Alliance. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK132140\/\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK132140\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/pdm\">Public Domain: No Known Copyright<\/a><\/em><\/li><li>Stages of Development. <strong>Provided by<\/strong>: Lumen Learning. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/courses.lumenlearning.com\/suny-intropsychmaster\/chapter\/stages-of-development\/\">https:\/\/courses.lumenlearning.com\/suny-intropsychmaster\/chapter\/stages-of-development\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Baby with FAS. <strong>Authored by<\/strong>: Teresa Kellerman. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Fetal_alcohol_spectrum_disorder#\/media\/File:Photo_of_baby_with_FAS.jpg\">https:\/\/en.wikipedia.org\/wiki\/Fetal_alcohol_spectrum_disorder#\/media\/File:Photo_of_baby_with_FAS.jpg<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Complications of pregnancy. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Complications_of_pregnancy\">https:\/\/en.wikipedia.org\/wiki\/Complications_of_pregnancy<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>Prenatal Development: What Babies Learn Inside the Womb. <strong>Authored by<\/strong>: sprouts. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?time_continue=175&#038;v=UA-Tk9qlG9A\">https:\/\/www.youtube.com\/watch?time_continue=175&#038;v=UA-Tk9qlG9A<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><li>NOFAS Topics: Light Drinking. <strong>Provided by<\/strong>: AlcoholFreePregnancy. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?time_continue=231&#038;v=pvFqjU43Odo\">https:\/\/www.youtube.com\/watch?time_continue=231&#038;v=pvFqjU43Odo<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><li>Maternal mortality graph. <strong>Provided by<\/strong>: UNICEF. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/data.unicef.org\/topic\/maternal-health\/maternal-mortality\/\">https:\/\/data.unicef.org\/topic\/maternal-health\/maternal-mortality\/<\/a>. <strong>License<\/strong>: <em>All Rights Reserved<\/em><\/li><li>U.S. Maternal Mortality is Much Higher for African-Americans. <strong>Provided by<\/strong>: Healthcare Triage. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=VYc-Eq-vDuA%20\">https:\/\/www.youtube.com\/watch?v=VYc-Eq-vDuA%20<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-1215-1\">Day &amp; Liley, The Secret World of a Baby, Random House, 1968, p. 13 <a href=\"#return-footnote-1215-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-1215-2\">Birth Defects Research and Tracking. Centers for Disease Control and Prevention. Retrieved from https:\/\/www.cdc.gov\/ncbddd\/birthdefects\/research.html <a href=\"#return-footnote-1215-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-1215-3\">STDs during Pregnancy - CDC Fact Sheet. Centers for Disease Control and Prevention. Retrieved from https:\/\/www.cdc.gov\/std\/pregnancy\/stdfact-pregnancy.htm <a href=\"#return-footnote-1215-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-1215-4\">Maternal Illness \u2013 Birth Defect Prevention for Expecting Parents.\u00a0Birth Defect Research for Children. Retrieved from https:\/\/www.birthdefects.org\/healthy-baby\/maternal-illness\/ <a href=\"#return-footnote-1215-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-1215-5\">Douros Konstantinos, Moustaki Maria, Tsabouri Sophia, Papadopoulou Anna, Papadopoulos Marios, Priftis Kostas N. (2017). Prenatal Maternal Stress and the Risk of Asthma in Children.\u00a0Frontiers in Pediatrics. Retrieved from https:\/\/www.frontiersin.org\/article\/10.3389\/fped.2017.00202 <a href=\"#return-footnote-1215-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-1215-6\"><\/span>Maternal mortality (<span class=\"timestamp\">February 2018). World Health Organization. Retrieved from\u00a0<\/span><span style=\"color: #333333;\">https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/maternal-mortality <a href=\"#return-footnote-1215-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-1215-7\"> Black Women\u2019s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities (April 2018). National Partnership for Women and Families. Retrieved from\u00a0http:\/\/www.nationalpartnership.org\/our-work\/health\/reports\/black-womens-maternal-health.html. <a href=\"#return-footnote-1215-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><li id=\"footnote-1215-8\">\u00a0Reproductive Health. Pregnancy Mortality Surveillance System. Centers for Disease Control and Prevention. Retrieved from\u00a0https:\/\/www.cdc.gov\/reproductivehealth\/maternalinfanthealth\/pregnancy-mortality-surveillance-system.htm\u00a0 <a href=\"#return-footnote-1215-8\" class=\"return-footnote\" aria-label=\"Return to footnote 8\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":3,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Introduction to Prenatal Development\",\"author\":\"\",\"organization\":\"Lumen Learning\",\"url\":\"https:\/\/courses.lumenlearning.com\/waymaker-psychology\/chapter\/stages-of-development\/\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Pregnancy\",\"author\":\"Gerd Altmann\",\"organization\":\"\",\"url\":\"https:\/\/pixabay.com\/images\/id-1749858\/\",\"project\":\"\",\"license\":\"cc0\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Psyc 200 Lifespan Psychology\",\"author\":\"Laura 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