To make this small-scale venture a successful joint production, both parents-to-be must work at it. And it’s never too early to begin! With proper planning and precautions, you can increase the odds dramatically in your favour!
The starting point for a healthy baby is a healthy egg and a healthy sperm. And the time to begin preparing for this happy conjunction is before the baby is conceived. After that the matter is pretty much out of your hands.
But there are other factors that must be kept in check in the early weeks following conception if the baby is to be healthy and normal. It is during the first 12 weeks that the baby’s organs are being formed, and any one of a number of hazards introduced during this time can skew or retard the formation of these organs. Unfortunately, the earliest that most pregnant women visit their gynaecologist is after they miss their period (many women make their first antenatal visit even after later) – and by this time, it is already too late in high-risk cases to control the damage.
The number of factors, and combination of factors, that can determine whether a baby is born healthy or not, is wide-ranging. But today, thanks to both modern medicine and greater awareness among people, it is possible to control many, if not all of these factors. The important thing is for the parents-in-waiting to realise that they are equal partners, with their doctors, in the making of a healthy baby. Below, the factors that play a role, and how husband and wife can play their roles to ensure a happy birth day for their baby:
The best years for child bearing are between 20 and 30. Below 18 years, there are twin dangers that threaten the baby. One is placenta (the organ formed during pregnancy, and which transfers nutrients and other materials from the mother’s body to the baby’s) either does not grow normally or does not function normally. This results in slow or delayed growth of the foetus because it gets only a restricted supply of its needs. Since the baby’s oxygen supply also arrives via the placenta, the deprived baby can even become short of oxygen and die in the womb.
The other risk in a too-young mother is premature labour with all its attendant risks to the baby: respiratory difficulty; poor temperature control; an immature gut, and consequent gastrointestinal ailments; low resistance to infections; and iron deficiency anaemia.
If the mother is over 35, too, both the above dangers threaten. As well, there has been found to be a higher incidence of Down’s syndrome babies (especially among mother over 40).
On the whole, congenital abnormalities are far more common in the children of mothers under 16 or over 40.
Smoking or excessive alcohol intake by either the husband or the wife can be damaging to the baby. In the case of the husband, it can cause abnormal sperm or weak sperm. Sometimes, this can be the cause of spontaneous abortions. What frequently happens is that the foetus fails to develop at all (a phenomenon known as ‘blighted ovum’). By around the 10th week, bleeding will be followed by complete abortion. A blighted ovum is generally considered to be caused by the fertilization of a normal ovum by an abnormal sperm. In the majority of cases where it occurs, the husband’s seminal count is deficient and contains a high proportion of abnormal sperm.
A pregnant woman who smokes curtails the oxygen supply to her baby and runs the risk of delivering a premature, low-weight baby. Smoking 30 cigarettes a day can reduce the baby’s weight by about 10 per cent, and almost definitely causes retarded mental and physical development in later childhood. The risks of smoking are especially great after the 16th week of pregnancy.
(The pregnant woman must also take care to stay away from the company of smokers – the toxins that enter the lungs through “passive smoking” are believed to be more than those from “active smoking”).
While there is no proof that the old glass of wine can harm the baby, alcohol in large amounts is definitely linked with congenital abnormalities.
WEIGHT CONTROL & DIET
Excessive weight gain is damaging to both, mother and baby. It is essential to allow only upto 28 lb of weight gain during the whole pregnancy. Weight gain between the 20th and 30th week, in particular, brings on the very real risk of pre-eclampsia (characterized by raised blood pressure, protein in the urine, swelling of the feet, ankles or hands). Pre-eclampsia increases the risk to the baby, both before and during labour. The danger varies directly in proportion to the mother’s blood pressure. Premature labour results in a high proportion of small-sized babies, many of whom do not survive.
At the same time, ‘eating right’ is important, since nourishment passes directly from the mother to her unborn child. The combination to be aimed at: a sufficient amount of proteins, moderate quantities of fats and carbohydrates, a lot of fresh fruits and vegetables to provide vitamins and minerals, and adequate fluids. Three nutritional deficiencies, in particular, must be guarded against: iron deficiency, calcium deficiency, and folic acid deficiency.
Iron deficiency can result in anaemia which carries two risks for the baby: one is placental insufficiency; the other is premature labour.
Calcium is one of the most important elements for the growth of the foetus. A baby’s teeth begin to form before it is born, and calcium is chief mineral that ensures strong, healthy teeth.
Folic acid deficiency causes megaloblastic anemia in the pregnant woman. Research in recent years also indicates that folic acid supplements may lessen the likelihood of congenital abnormalities like spina bifida in the baby.
Rh (Rhesus) is a blood factor that is present in either one of two variations: Rh positive (in the majority of the population) or Rh negative. If an Rh positive man is married to an Rh negative woman, and she is carrying an Rh positive child, the stage is set for complications if the incompatibility is not discovered in time and treated. Throughout the pregnancy, and particularly at the time of delivery, blood cells from the (Rh positive) child escape past the placenta into the circulation of the Rh-negative mother. The mother’s body, recognizing these cells as foreign invaders, proceeds to destroy them by producing antibodies. Unfortunately, these antibodies in turn also cross the placenta and enter the fetal circulation where they then begin to destroy the baby’s own Rh positive red cells. The outcome: the baby may either die in the womb itself or it may be born with severe anemia and (because the destructive antibodies ate still circulating in its blood) quickly become jaundiced and even die.
Because the mother’s body needs time to become sensitized or ‘primed’ to the baby’s Rh positive cells before antibody production can begin, the first pregnancy is generally safe enough. It is the second, and subsequent, babies that are at risk, since b this time the antibody level I the mother’s body is dangerously high.
Since the Rh factor was discovered research proceeded apace to conquer the threat posed by incompatibility. Today, the Rh negative mother can be treated (after the delivery of her first Rh positive child) with Anti-D Immunoglobulin – this rapidly destroys the Rh positive cells that have entered the mother’s blood from the baby, thus preventing her body from becoming sensitized in the first place.
If this has not been done and the woman is already pregnant with her second baby, or if she is not even aware whether she is Rh positive or Rh negative, another approach is possible to circumvent the serious risk to the baby. First, a blood test done at the beginning of pregnancy establishes whether the woman is Rh positive or Rh negative. If the latter, then further testing can determine whether there are antibodies present in her blood. Today, amniocentesis tests can accurately tell the extent to which these antibodies may have destroyed the fetal blood cells. A sample of fluid is taken from the amniotic sac which encloses the baby during pregnancy: the higher the level of bilirubin in this fluid, the greater the number of fetal blood cells that have been destroyed.
The doctor must then determine the line of treatment: affected babies are almost always delivered prematurely. They can then be treated with an exchange transfusion in which most of the baby’s positive cells are replaced with Rh negative cells – which are unchallenged by the mother’s antibodies present in his blood. The transfused cells stay in the baby’s system for about 40 days, during which time the antibodies are gradually eliminated and the baby’s own Rh positive cell supply simultaneously built up.
But since premature delivery itself carries risks to the baby, this is a decision that has to be carefully made after pros and cons have been weighed. The severely affected baby can today be treated in the womb itself with blood transfusions.
With all these advances, there is no reason why Rh negative mother should not have a healthy baby provided she begins treatment well in advance and the best time is before she conceives.
CHRONIC MATERNAL ILLNESS
Apart from anemia, other chronic illnesses in the mother can also pose a threat to the baby’s survival and well-being. One of the more serious conditions is diabetes. Without treatment, the very likelihood of conception is low; and if the woman does become pregnant, the mortality rate for both mother and child is very high. The complications that can arise range from congenital abnormality to stillbirth. It is very important that the diabetes is kept under constant and precise control.
Uncontrolled hypertension (pregnancy itself tends to aggravate the condition) reduces the blood supply to the uterus (and therefore to the baby). As a result, the bay is small, dysmature and may even fail to survive.
The rubella (German measles) virus is one of the few which can cross the placenta and cause direct infection of the fetus. The risk period is the first 12 weeks of pregnancy; if the mother contracts the illness during this time, the infection is likely to affect the development of the early fetal organs, causing congenital deafness, blindness, heart disease, etc.
Most people do get rubella during childhood, a mild attack which generally goes unnoticed but confers lifelong immunity. It is possible, through a blood test, to confirm whether this in fact has occurred. It is also possible, through rubella inoculation, to confer a mild version of the illness on a married but non-pregnant woman so that she develops antibodies against it.
If, however, this step has not been taken and a pregnant woman finds that she has not suffered the illness before, it is essential that she take precautions during the first 12 weeks of her pregnancy. In particular, she should avoid the company of very young children among whom the incidence of the illness is the most high.
If a woman does develop the disease in the first 12 weeks of pregnancy – the main sign is a rash that disappears 12-24 hours later – it is essential that she confirm the diagnosis with her doctor. If a decision to terminate the pregnancy is to be taken, it must be based on a careful consideration of several factors, from the medical to the personal, and her own gynaecologist’s advice is invaluable.
The other serious infection that can affect the fetus is syphilis. It can cause the baby to die in the uterus; if it lives, it will inevitably contract congenital syphilis in the course of labour or delivery. The syphilis virus can cross the placenta only after the 20th week of pregnancy, so it is of the utmost importance that a blood test be done at the beginning of pregnancy to determine whether the woman is infected. If syphilis is treated in time, the baby will not be affected.
The fetus’ needs are met by nutrients passing from the mother through the placenta. Unfortunately, this is also the medium by which other substances, such as drugs, pass through to the foetus, and some of them can cause harm. Those that do – the so-called teratogenic drugs – are usually harmful only at certain stages of the pregnancy.
Congenital abnormalities can result from drugs taken during the first trimester, i.e. during the first 14 weeks of pregnancy, because this is when the organs are being formed. The Thalidomide tragedy threw such effects into sharp international focus. A mild sedative given to women in the early weeks of pregnancy had resulted in over 5000 babies being born all over the world with limb defects, some with no limbs at all.
Among antibiotics, tetracyclines taken during early pregnancy are known to cause cataracts and bone abnormalities. Anti-coagulants such as warfarin can have similar effects; they can also cause mental retardation.
During the second trimester, i.e., from 14th to the 28th week of pregnancy, drugs can affect the physiological development of the foetus. Tetracyclines taken at this stage can cause yellow discolouration of the milk teeth in the growing baby. Some anti-tuberculosis drugs like streptomycin can damage the fetal ear, resulting in nerve deafness.
The third trimester lasts from 28th week until delivery. Tetracyclines taken at this stage can cause ugly, yellow staining of the permanent teeth. Thyroid drugs may result in abnormal growth of the baby’s thyroid gland. Sulphonamides, given to treat urinary tract infection, can cause jaundice in the newborn if taken after the 28th week (they are relatively safer in the earlier stages of pregnancy). If the mother has been on opiates (heroin, methadone, etc.) during late pregnancy, her baby is likely to have become addicted in the womb itself and to suffer withdrawal symptoms after birth – from irritability to vomiting, diarrhoea and feeding problems. Such a baby’s growth is generally retarded and it may even die early.
Some drugs should not be given at any stage of pregnancy. One such group is anti-cancer (cytotoxic) drugs. They have a damaging effect on the process of cell decision.
Of course, sometimes drugs may be necessary during pregnancy to save both mother and child. For instance, the diabetic mother-to-be will require large doses of insulin. At the same time, an overdose of insulin can be threatening to both, the pregnant woman and her unborn baby. So, a very delicate balance has to be maintained during the pregnancy.
In fact, the recommended approach is to limit the use of drugs in pregnancy to the barest minimum. Most of the minor discomforts and ailments that result from the changes of pregnancy can be treated with safer measures: e.g. nausea can be treated with a change in diet rather than with anti-histamines; constipation can be relieved by including more fibre in the diet rather than with laxatives; and so on.
While routine y-rays do not generally harm the baby in the womb, high levels of irradiation can cause congenital abnormalities, and can damage the baby’s genes so that subsequent generations are also at risk. They may also predispose the baby to leukaemia in childhood or adolescence. To play it safe, x-rays are best avoided during pregnancy unless absolutely essential.