Maternal Fetal Health Issues in Idaho

College of Western Idaho

Maternal Fetal Health Issues

In Idaho

Simon Skovgard

English 102- 012W

Jewkes

3 Mar 2013

The following addresses the risk factors that can reduce fetal mortality and morbidity in Idaho. Identifying the risk and eliminating them will improve maternal health care and promote greater pregnancy outcomes. Statistical data for Idaho from local research will be utilized.  In order to reduce the rate of infant mortality and morbidity, people must increase maternal health outcomes by identifying and eliminating risk factors, requiring prenatal screening tests, and diagnosing and treating fetal anomalies.

Reducing maternal and infant morbidity and mortality and improving pregnancy outcomes throughout the state of Idaho is a major concern of physicians and patients. Morbidity refers to the incidence of disease while mortality refers to the incidence of death or the number of deaths in Idaho. There are a large number of indicators affecting maternal health in Idaho. Some of these are: blood borne diseases, cancer, cardiovascular diseases, lower respiratory disease, diabetes, enteric diseases, oral health, respiratory diseases, sexually transmitted diseases, birth defects, and injuries. Since there is such a large field of study, the primary focus here will be on infant mortality including birth defects, low birth weight and sudden infant death syndrome (SIDS).  In order to reduce the rate of infant mortality and morbidity, people must increase maternal health outcomes by identifying and eliminating risk factors, requiring prenatal screening tests, and diagnosing and treating fetal anomalies.

Pre-conception counseling and prenatal screening (prenatal testing) offers an opportunity to identify maternal risk factors before pregnancy begins. There has been a great deal of research on the risk factors that increase birth defects and infant mortality. According to Idaho Vital Statistics, “there are 16 risk factors listed on an Idaho birth certificate” (Center for Vital Statistics and Health Policy 61). In a study examining the relationship between the health behavior advice recommended by the Public Health Service Expert Panel on the Content of Prenatal Care and the risk of low birth weight, “The Expert Panel recommended that pregnant women receive advice in the following seven areas: (a) breastfeeding (b) reducing or eliminating alcohol use; (c) reducing or eliminating smoking; (d) not using illegal drugs such as marijuana, cocaine, or crack; (e) eating the proper foods during pregnancy; (f) taking vitamin or mineral supplements; and (g) gaining an appropriate amount of weight during pregnancy” (Sable 3). The study also described the type and frequency of health behavior advice offered to a group of pregnant women.  There is a direct correlation between pregnancy outcomes and prenatal care received. There is a great deal of statistical data presented that will help address the magnitude of the problem and the need for more research.

Early prenatal care can help identify risk factors and ensure proper treatment. Patients who do not seek the advice of a physician are more likely to have problems during labor and are at a greater risk for birth defects. Prenatal testing can be very useful in diagnosis and treatment of fetuses as Harms says, “still, in some instances you may wish to know specific information about your baby’s health before his or her birth… increased risk of carrying a baby with chromosomal problems or some other genetic disorder… certain test can help determine the health of your baby while her or she is still in your womb” (Harms 305). In Idaho, “the highest infant mortality rates occurred to infants of mothers who received no prenatal care (21.2 per 1,000 live births with no prenatal care): their rates were 3.5 times as high as infants whose mothers received prenatal care in the first trimester (6.0 per 1,000 live births with first trimester care…)” (Center for Vital Statistics and Health Policy 77). There are many uncontrolled factors that could also increase risk such as advanced maternal age; ethnicity of the mother, race of the mother, and teen pregnancy. With early diagnosis of risk through prenatal testing, the physician and patient can develop a plan for early treatment and reducing the effect on pregnancy outcomes.

Drinking excessive alcohol while pregnant increases the risk of miscarriage and fetal death. Once the alcohol is in the bloodstream, it passes through the placenta to the baby. It takes the fetus twice as long as the mother to eliminate alcohol from its system. When the mother is slightly buzzed the fetus would be at the point of passing out. The most serious problem caused by excessive alcohol consumption is fetal alcohol syndrome (FAS). It can also cause such birth defects as, “facial deformities, heart problems, low birth weight and mental retardation” (Harms, 48). Fetal alcohol syndrome is sometimes described as “the hangover that lasts a lifetime” (Murkhoff 71) and infants born with FAS may have growth problems, attention deficit disorders and learning disabilities as well as behavioral problems. Statewide, “2.5 percent of live births were to mothers who have used alcohol while pregnant, according to birth certificate data. Live births to women who reported drinking during pregnancy were twice as likely to have no prenatal care(2.1 percent) than were live births to women who did not drink during pregnancy (0.9 percent…)” (Center for Vital Statistics and Health Policy 59). According to the Centers for Disease Control and Prevention, National Center for Health Statistics, alcohol use during pregnancy is, “substantially underreported on the birth certificate” (Center for Vital Statistics and Health Policy 59). Patients are less likely to admit that they drink during pregnancy and therefore the statistical data is lower than actual outcomes.

Smoking during pregnancy increases the chance of miscarriage and stillbirths, decreases birth weight, increases risk for SIDS and deprives the unborn fetus of oxygen and important nutrients. “Over 14.0 percent of Idaho resident birth certificates indicated the mother smoked at some time during pregnancy. Furthermore, live births to women who smoked during pregnancy were twice as likely to have no prenatal care (91.8 percent) than were live births to women who did not smoke during pregnancy (0.8 percent …)” (Center for Vital Statistics and Health Policy 59).  When a mother smokes during pregnancy the fetus is enclosed in a smoke filled womb. “Cigarette smoke contains literally thousands of harmful chemicals. Two toxins especially – carbon monoxide and nicotine – can reduce the flow of oxygen to the developing baby” (Harms, 48). There is strong evidence showing fetal development in the womb is adversely affected by maternal smoking. The most widespread risks for babies of smokers are, “low birth weight, shorter length and smaller head circumference, as well as cleft palate or cleft lip and heart defects. And being born too small is the major cause of infant illness and perinatal death (those that occur just before, during, or after birth)” (Murkoff 72). Low fetal birth weight can cause major diseases and illness throughout the child’s life.

Streets drugs have been proven harmful to an unborn baby as well as the mother. These illicit drugs such as marijuana, cocaine, heroin, and methamphetamine have varying side effects on the fetus and the newborn. During pregnancy, drugs taken pass from mother to baby. Like alcohol it takes longer for the fetus to process these substances and therefore addition is highly likely. Drug use “can affect the development of the fetus and the future of your child as he or she grows up. It can also cause the death of a fetus or withdrawal symptoms in newborns that if untreated can lead to death” (Harms 49). Even recreational drug users should stop all use during pregnancy to reduce the risk of birth defects.

A healthy diet is critical to ensure a healthy baby. According to the Epidemiology Resource Center,  “research has accumulated, showing associations between birthweight and the risk of developing obesity, cardiovascular disease, type 2 diabetes and other health outcomes in later life” (Newnham 29). This research shows the importance of fetal nutrition for lifelong health and has spurred an interest with policy makers in improving maternal nutrition. Eating healthy during pregnancy is important and can decrease the chance of complications such as anemia, gestational diabetes and preeclampsia. A sensible diet can aid in reducing morning sickness, constipation, fatigue as well as emotional state and crazy mood swings. A baby requires more calories and more of certain nutrients but the foundation is the same, “a good balanced mix of lean protein and calcium, whole grains, a rainbow of fruit and vegetables and healthy fats” (Murkoff 89). Diet may need to be altered for vegetarian or vegan menus but it is important to get the necessary vitamins and proteins. There are many alternative diets for lactose intolerance and gluten free foods to ensure a healthy pregnancy.

There are many benefits to exercise during pregnancy. Sometimes getting too much rest makes a person feel more tired. A little exercise can provide a great energy boost.  Exercise may help prevent gestational diabetes and help aid in sleeplessness. Keeping the back and abdominal muscles strong will help during labor and stretching will help prevent sore muscles. There are also great benefits to the unborn baby. Researchers believe that, “changes in heart rate and oxygen levels in exercising moms-to-be stimulate their babies. Babies are also stimulated by the sounds and vibrations they experience in the womb during workouts” (Murkoff 217). According to Pam Carson, obstetrical nurse, “patients who are physically fit have an easier time during labor and delivery. Their return to post partum weight and a faster post partum recovery is also a benefit of staying physically fit” (Carson).  A balanced diet and exercise are important factors in prenatal health.

Over the counter medications may have harmful side effects that create problems for the unborn infant. It is best to stay away from all prescription and over the counter medications during pregnancy. If they must be taken the patient needs to consult a physician before use. Some drugs can cause miscarriages or impair the baby’s development. There aren’t many drugs that have been proven safe during pregnancy but sometimes the benefits of taking the medication out ways the minimum unknown risk. Some expectant mothers have diseases that require continuous medication like hypertension, asthma or diabetes in which case they need to be monitored by a health care professional. Sometimes it is necessary to switch medications or discontinue them during pregnancy because of the high risk of birth defects. “Some medicines have been shown to be extremely harmful to a developing fetus, even in the early weeks of pregnancy. Some of the most dangerous medications during pregnancy include: Accutane, Thalomid, and Soriatine” (Harms 49). Even herbal medicines can be harmful. Check with a physician before taking any natural, over the counter or prescription medications during pregnancy.

Physicians are concerned with low birth weight (LBW) and reducing risk factors to increase pregnancy outcomes.  As discussed in Newnham’s text, “It has long been understood that poor birth outcomes across the whole population, particularly rates of LBW, are associated with greater rates of morbidity throughout life from infancy to adulthood” (21). Table 1.1 below shows birth weight categories in correlation to the extent of prenatal advice received by mothers. The seven types of advice given are: “advice to take a vitamin/minerals supplement; eat the proper foods; gains an appropriate amount of weight; consider breastfeeding; reduce or eliminate smoking; reduce or eliminate alcohol; and not use illegal drugs as recommended by the Public Health Service Expert Panel on the Content of Prenatal Care” (Sable 3).  On the table VLBW = very low birth weight, MLBW = moderately low birth weight and NBW = normal birth weight. The following data was taken from the "The Relationship between Prenatal Health Behavior Advice and Low Birth Weight" report by Sable.

As seen in the table above, decreasing the risk factors by early detection and intervention improves the maternal health and increases the chance of giving birth to a healthy infant.

Infant mortality and morbidity can be reduced with proper prenatal care. “The United States has one of the highest overall infant mortality rates of the thirty developed nations… The infant mortality rate represents the number of infants, per 1,000 live births, who die before their first birthday” (Albrecht 377). There is overwhelming evidence that supports the idea that early pregnancy diagnoses and proper prenatal care can reduce the instances of fetal morbidity and mortality in Idaho. It is critical to begin prenatal care during the first trimester of pregnancy, “since brain development begins in the womb, good prenatal care can help ensure the healthy development of your child’s brain… Eating a balanced, healthy diet and avoiding drugs, alcohol and tobacco are just a few steps you can take to contribute to your child’s future health” (Shelov 144). Alcohol use, smoking and drug use all contribute to increased birth defects. A healthy diet and exercise and prenatal screening can aid in reducing fetal maternal problems. “Pregnancy, childbirth, and new parenthood are too anticipated, too personal, and too important not to deserve careful preparation, not just for their immediate and long-term effects on the physical health of a woman and her infant but for their long term effects on the mother’s mental health and self confidence and the family’s dynamics” (Gabriel l viii). ).  In order to reduce the rate of infant mortality and morbidity we must encourage early prenatal care and identify and eliminate risk factors by requiring prenatal screening tests and diagnosing and treating fetal anomalies.

Work Cited

Albrecht, T, D Eaton, G Quinn, C Mahan, and SZ Kabir. "Development, Ethics, and Prenatal Health Outcomes." Journal of Social Philosophy. 31.4 (2000): 376-81. Print.

Carson, Pam. "Maternal Health." Telephone interview. 15 Feb. 2013.

Center for Vital Statistics and Health Policy, Division of Health, and Idaho Department of Health and Welfare. Pre-natal Care Resources and Utilization in Idaho, 1984-1996. Boise, ID (450 W. State Street, 1st Floor, Boise, ID 83720-0036): Dept. of Health and Welfare, Division of Health, Center for Vital Statistics and Health Policy, 1998. Print.

Gabriel, Cynthia. Natural Hospital Birth. Boston: Harvard Common, 2011. Print.

Harms, Roger W. Mayo Clinic Guide to a Healthy Pregnancy. 1st ed. New York: Harper Resource, 2004. Print.

Idaho Department of Health and Welfare. Idaho Health and Safety Assessment. Idaho: IDHW, 2001. Print.

Murkoff, Heidi Eisenberg., and Sharon Mazel. What to Expect When You're Expecting. 4th ed. New York: Workman Pub., 2008. Print.

Newnham, John P., and Michael G. Ross. Early Life Origins of Human Health and Disease. Basel: Karger, 2009. Print.

Sable, MR, and AA Herman. "The Relationship between Prenatal Health Behavior Advice and Low Birth Weight." Public Health Reports (washington, D.c. : 1974). 112.4 (1997). Print.

Shelov, Steven P. Caring for Your Baby and Young Child: Birth to Age 5. 4th ed. New York: Bantam, 2003. Print.

Annotated Bibliography

Blackman, Ronald G. The Mother's Encyclopedia. 2nd ed. New York, NY: Parents' Institute, 1950. Print.

The Mother’s Encyclopedia is a collection of information for fourteen authors including many medical physicians. It offers advice for a parent that answers many questions regarding diseases, birth defects and growth and development. It was published by the Parent’s Institute as an aid for mothers who had the responsibility of making decisions regarding the health and wellbeing of her family. It offers information on emotional development as well as education. It is not organized like a traditional alphabetical encyclopedia rather it is organized by topics. I have found it useful to look up information to gain a clearer understanding or the diseases and birth defects. It has a section for babysitter information, accident prevention, and perplexing questions that children might ask.

Carson, Pam. "Maternal Health." Telephone Interview. 15 Feb. 2013.

Pam Carson an OB and GYN Registered nurse for 13 years. She also worked in the Labor and Delivery and Neonatal Intensive Care units for over 17 years. Her interview was on the Prenatal Care and her view of it as she cared for patients. She is currently employed by the Boise School District as a Registered Nurse where she deals with Sex education, nutrition and teen pregnancy. As a Neonatal Intensive Care nurse she witnessed poor pregnancy outcomes due to insufficient prenatal health. Through her extensive experience and education she lends valuable perspective to the risks presented in my paper.

Gabriel, Cynthia. Natural Hospital Birth. Boston: Harvard Common, 2011. Print.

This is written for expectant mothers to offer a step by step guide for those wishing to experience natural childbirth without intervention. It offers a different perspective from a doula or midwife. I found it helpful in seeing all the possible advantages of natural childbirth as well as the risk and complications. Home deliveries are becoming an increasingly popular alternative to hospital births. The author is well educated on the matter and considered an expert in the field.  Through her research, she provides and educational and informative view of childbirth. “The point of view of a doula is distinct from that of an obstetrician or midwife. Doulas notice different things about birth than medical care providers do” (Xiii).

Harms, Roger W. Mayo Clinic Guide to a Healthy Pregnancy. 1st ed. New York: Harper Resource, 2004. Print.

This text was written by two OBGYN Specialists at Mayo Clinic who are also parents. It provides a proactive approach to healthy pregnancy to offer a wonderful beginning to a child’s life. It offers a month to month guide for pregnancy including what to expect and weekly and monthly insights into baby’s development. It also addresses decisions to be made during pregnancy regarding anesthesia, diet, activity, working, traveling, etc.  I found it helpful as it discusses these decisions and the pros and cons of each. It takes a week by week approach during pregnancy and then addresses possible delivery options including cesarean section. Finally it describes the newborn, complications and treatments. Prenatal testing can be very useful in diagnosis and treatment of fetuses “Still, in some instances you may wish to know specific information about your baby’s health before his or her birth… increased risk of carrying a baby with chromosomal problem or some other genetic disorder… certain test can help determine the health of your baby while her or she is still in your womb” (305). This explains the value of prenatal testing to determine the treatment plan.

Murkoff, Heidi Eisenberg., and Sharon Mazel. What to Expect When You're Expecting. 4th ed. New York: Workman Pub., 2008. Print.

This book is provided by almost all obstetricians to their patients in the Treasure Valley. The book discusses what you will feel and see throughout your pregnancy. The book starts at the first prediction of pregnancy; with each chapter follows you through the months of pregnancy and even follows up in the postpartum stage. Published by Workman Publishing Company this non-fiction book provides details, sources and information to new and old mothers alike. The author Heidi Murkoff is not only a world's best-selling author of pregnancy and parenting series books but is the sole creator of WhatToExpect.com a helpful website that provides information to women without access to the book. She also is founder of the What to Expect Foundation which helps underprivileged women get the Health care they need during pregnancy, they also provide parenting classes to ensure health happy babies.

Sable, MR, and AA Herman. "The Relationship between Prenatal Health Behavior Advice and Low Birth Weight." Public Health Reports (Washington, D.C. : 1974). 112.4 (1997). Print.

The study examined the relationship between the health behavior advice recommended by the Public Health Service Expert Panel on the Content of Prenatal Care and the risk of low birth weight. It also described the type and frequency of health behavior advice offered to a group of pregnant women.  The study contained valuable research to my topic. A possible quote I may use in my introduction is, “The Expert Panel recommended that pregnant women receive advice in the following seven areas: (a) breastfeeding (b) reducing or eliminating alcohol use; (c) reducing or eliminating smoking; (d) not using illegal drugs such as marijuana, cocaine, or crack; (e) eating the proper foods during pregnancy; (f) taking vitamin or mineral supplements; and (g) gaining an appropriate amount of weight during pregnancy”(3). This quotation supports my thesis by validating the claims I am making. There is a lot of statistical data presented that will help address the magnitude of the problem and the need for more research.

Shelov, Steven P. Caring for Your Baby and Young Child: Birth to Age 5. 4th ed. New York: Bantam, 2003. Print.

This is a collection of advice for parents and caregivers from The American Academy of Pediatrics. It covers all aspects of child care from infancy to age five including: diseases, prevention, safety and emotional wellbeing. It offers explanations on many of the diseases and the causes of birth defects. It offers a brief glimpse into maternal health on outcomes of birth defects. I found it a useful tool to define and explain areas of interest in lay terms. I plan to use information to help make my points understandable to the lay person and not so technical. “Since brain development begins in the womb, good prenatal care can help ensure the healthy development of your child’s brain… Eating a balanced, healthy diet and avoiding drugs, alcohol and tobacco are just a few steps you can take to contribute to your child’s future health” (144) this quote brings but specific attributes that could have a birth defect or other disorders during prenatal care.

Bibliography

 Albrecht, T, D Eaton, G Quinn, C Mahan, and SZ Kabir. "Development, Ethics, and Prenatal Health Outcomes." Journal of Social Philosophy. 31.4 (2000): 376-81. Print.

Blackman, Ronald G. The Mother's Encyclopedia. 2nd ed. New York, NY: Parents' Institute, 1950. Print.

Carson, Pam. "Maternal Health." Telephone interview. 15 Feb. 2013.

Center for Vital Statistics and Health Policy, Division of Health, and Idaho Department of Health and Welfare. Pre-natal Care Resources and Utilization in Idaho, 1984-1996. Boise, ID (450 W. State Street, 1st Floor, Boise, ID 83720-0036): Dept. of Health and Welfare, Division of Health, Center for Vital Statistics and Health Policy, 1998. Print.

Gabriel, Cynthia. Natural Hospital Birth. Boston: Harvard Common, 2011. Print.

Harms, Roger W. Mayo Clinic Guide to a Healthy Pregnancy. 1st ed. New York: Harper Resource, 2004. Print.

Idaho Department of Health and Welfare. Idaho Health and Safety Assessment. Idaho: IDHW, 2001. Print.

Miedzybrodzka, Zosia. "Congenital Talipes Equinovarus (clubfoot): a Disorder of the Foot but Not the Hand." Journal of Anatomy. 202.1 (2003): 37-42. Print.

Murkoff, Heidi Eisenberg., and Sharon Mazel. What to Expect When You're Expecting. 4th ed.

Newnham, John P., and Michael G. Ross. Early Life Origins of Human Health and Disease. Basel: Karger, 2009. Print.

“Our Mission." Idahoperinatal.org/. Idaho Perinatal Project, n.d. Web. 12 Feb. 2013. 

Sable, MR, and AA Herman. "The Relationship between Prenatal Health Behavior Advice and Low Birth Weight." Public Health Reports (Washington, D.C. : 1974). 112.4 (1997). Print.

Shelov, Steven P. Caring for Your Baby and Young Child: Birth to Age 5. 4th ed. New York: Bantam, 2003. Print.

Swamy, R, B Reichert, K Lincoln, and M Lal. "Foetal and Congenital Talipes: Interventions and Outcome." Acta Paediatrica (oslo, Norway : 1992). 98.5 (2009): 804-6. Print.