2.8: Maternal Factors
- Page ID
- 233822
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Image Source: Petar Milošević. Pregnant Woman, Third Trimester. Wikimedia Commons. Licensed under the Creative Commons Attribution-Share Alike 4.0 International license.
Maternal Factors and the Outcome of Pregnancy
Maternal factors significantly impact prenatal development, including age, health conditions, lifestyle choices, and environmental exposures which can affect fetal growth, development, and overall health outcomes for both mother and child.
Mothers over 35
Most women over 35 who become pregnant are in good health and have healthy pregnancies. However, women over age 35 may have an increased risk of:
- fertility problems
- high blood pressure
- diabetes
- miscarriages
- placenta previa (placenta completely or partially covers the opening of the uterus/cervix)
- Cesarean section
- premature birth
- stillbirth
- baby has a genetic disorder or other birth defects
Because a woman is born with all her eggs, environmental teratogens can affect the quality of the eggs as women get older. Also, a woman’s reproductive system ages which can adversely affect the pregnancy. Some women over 35 choose special prenatal screening tests, such as a maternal blood screening, to determine if there are any health risks for the baby.
Although there are medical concerns associated with having a child later in life, there are also many positive consequences to being an "older" parent. Mature parents tend to less stressed, more stable, demonstrate a strong family focus, possess greater self-confidence, and have more income. Having a child later in one’s working life means overall higher wages. As a result, their children perform better on math and reading tests, and may be less prone to injuries or emotional troubles.
Teenage Pregnancy
A teenage mother is at a greater risk for having pregnancy complications including anemia, and high blood pressure. These risks are even greater for those under age 15. Infants born to teenage mothers have a higher risk for being premature and having low birthweight or other serious health problems. Premature and low birthweight babies may have organs that are not fully developed which can result in breathing problems, bleeding in the brain, vision loss, serious intestinal problems, and higher likelihood of dying.
Risks for teenage issues are due to the fact that teens
- are the most unlikely of all age groups not to early and regular prenatal care
- engage in negative behaviors including
- eating unhealthy food
- smoking or vaping
- drinking alcohol
- taking drugs
Gestational Diabetes
Gestational diabetes (GD or GDM) is a type of diabetes that develops exclusively in pregnancy when blood sugar levels get too high (hyperglycemia). It happens when the hormones from the placenta block your ability to use or make insulin. Insulin helps your body maintain the right amount of glucose in your blood. Too much glucose in your blood can lead to pregnancy complications. GD usually appears during the middle of pregnancy, between 24 and 28 weeks. Your pregnancy care provider will order a blood test to check for gestational diabetes.
If untreated, gestational diabetes can cause premature birth, stillbirth, the baby having breathing problems at birth, jaundice, or low blood sugar. Babies born to mothers with gestational diabetes can also be considerably heavier (more than 9 pounds) making the labor and birth process more difficult. For expectant mothers, untreated gestational diabetes can cause preeclampsia (high blood pressure and signs that the liver and kidneys may not be working properly).
Risk factors for gestational diabetes include age (being over age 25), being overweight or gaining too much weight during pregnancy, family history of diabetes, having had gestational diabetes with a prior pregnancy, and race and ethnicity (African-American, Native American, Hispanic, Asian, or Pacific Islander have a higher risk).
Eating healthy and maintaining a healthy weight during pregnancy can reduce the chance of gestational diabetes. Women who already have diabetes and become pregnant need to attend all their prenatal care visits and follow the same advice as those for women with gestational diabetes as the risk of preeclampsia, premature birth, birth defects, and stillbirth are the same.
High Blood Pressure (Hypertension)
Hypertension is a condition in which the pressure against the wall of the arteries becomes too high. There are two types of high blood pressure during pregnancy, gestational and chronic. Gestational hypertension only occurs during pregnancy and goes away after birth. Chronic high blood pressure refers to women who already had hypertension before the pregnancy or to those who developed it during pregnancy, and it did not go away after birth.
High blood pressure during pregnancy can cause premature birth and low birth weight (under five and a half pounds), placental abruption, and mothers can develop preeclampsia.
Rh Disease
Rh disease, also known as hemolytic disease of the fetus and newborn (HDFN).
Rh is a protein found in the blood. Most people are Rh-positive, meaning they have this protein. Some people are Rh-negative, meaning this protein is absent. Mothers who are Rh-negative are at risk of having a baby with a form of anemia called Rh disease.
- A father who is Rh-positive and mother who is Rh-negative can conceive a baby who is Rh-positive. Some of the fetus’s Rh positive blood cells may get into the mother’s Rh negative bloodstream and her immune system is unable to recognize the positive Rh factor. The mother's immune system then begins to produce antibodies to fight off what it thinks is a foreign invader. When her body produces immunity, the antibodies can cross the placenta and start to destroy the red blood cells of the developing fetus.
Often the first Rh positive baby is not harmed, because the process of developing antibodies takes time, but since the mother’s body will continue to produce antibodies to the Rh factor across her lifetime, subsequent pregnancies can pose greater risk for a Rh-positive baby. Rh disease can lead to jaundice, anemia, heart failure, brain damage or death to the newborn.
Weight Gain during Pregnancy
During pregnancy most women need only an additional 300 calories per day to aid in the growth of the fetus. Gaining too little or too much weight during pregnancy can be harmful. Women who gain too little may have a baby who is low-birth weight, while those who gain too much are likely to have a premature or large baby. There is also a greater risk for the mother developing preeclampsia and diabetes, which can cause further problems during the pregnancy.
Putting on the weight slowly is best. Healthy food choices will help:
- Fresh fruits and vegetables make good snacks. They are full of vitamins and low in calories and fat.
- Eat breads, crackers, and cereals made with whole grains.
- Choose reduced-fat dairy products. You need at least 4 servings of milk products every day. However, using skim, 1%, or 2% milk will greatly reduce the amount of calories and fat you eat. Also choose low-fat or fat-free cheese or yogurt.
Stress
Some stress can be normal during pregnancy, but ongoing stress may create health issues for both the mother and infant. High levels of stress can cause complications including premature birth or a having a low-birthweight baby which places them an increased risk for health problems. Stress hormones released into the mother's system may cause complications by impacting a woman’s immune systems resulting in an infection, and studies show findings consistent with theories that suggest that exposure to stress hormones in utero can affect children’s brain development, immune system functioning, and childhood problems such as ADHD and anxiety.
Symptoms of stress in pregnancy can differ but may include:
- sleeping difficulties
- headaches or GI problems
- increased heart rate, fast or shallow breathing, feeling faint
- persistent worry, anxiety, or anger
- panic attacks
- obsessive or unpleasant thoughts
- repetition of certain actions, such as counting or checking
- eating too much or too little, or eating unhealthy foods
- difficulty unwinding or relaxing
Dealing with stress by smoking, drinking alcohol, or taking drugs, which can lead to problems in the pregnancy. There are no firm guidelines for how much stress is too much during pregnancy, but mothers-to-be should reach out to a healthcare professional if they find themselves struggling and unable to cope. Prompt treatment can improve the outcomes for both the pregnant woman and the developing fetus.
Depression
It is normal to feel a mix of emotions during pregnancy and about being pregnant. In addition pregnant women have a higher risk of depression due to increased stress, physical and hormonal changes in the body, as well as other life factors.
Depression is a significant medical condition in which feelings of sadness, worthlessness, guilt, and fatigue interfere with one’s ability to function in daily life. It can occur before, during, or after pregnancy. Many women are treated for depression sometime between the year before pregnancy and year after pregnancy. Women who have experienced depression previously are more likely to have depression during pregnancy.
Signs of depression include:
- sadness, frequent crying, or unexplained anger
- new or worsening feelings of self-esteem, worthlessness, or hopelessness
- difficulty following prenatal health recommendations because of feelings of helplessness or hopelessness
- not enjoying activities that were once fun or meaningful
- withdrawing from friends, family, school, work, or hobbies
- new physical health symptoms, such as headaches or stomach aches
- changes in eating/sleeping habits - eating/sleeping more or less than usual
- relationship stress
- difficulty feeling excited about the pregnancy or bonding with the baby after childbirth
- thoughts of death or suicide
Many women who experience depression during pregnancy have healthy pregnancies. Depression does not mean the baby will be unhealthy or make any particular pregnancy outcome inevitable. However, studies show that depression during pregnancy may raise the risk of:
- postpartum depression
- depression in the baby’s father
- premature birth or low birth weight
- behavior problems or a difficult temperament in the baby
- changes in the baby’s brain development
It's important to know that depression during pregnancy is treatable. Mothers-to-be should reach out to a healthcare professional if they find themselves struggling with depression. Prompt treatment can improve the outcomes for both the pregnant woman and the developing fetus.
Sources
- Lally, Martha and Suzanne Valentine-French. Lifespan Development: A Psychological Perspective(pages 52-55). Licensed under CC BY-NC-SA 3.0
- Villines, Dawn. Depression during pregnancy: Symptoms, treatment, and more. Medical News Today. December 2019.
- What is gestational diabetes? Gestational Diabetes. Cleveland Clinic Health Library. August 2024.