PREGNANCY

1. PREGNANCY Conception: • Three trimesters = nine months = prenatal period • Healthy vs. at risk pregnancies • Importance of intrauterine environment

2. Stages of Childbirth • Normal vs. complicated childbirth, mismanagement. • Perinatal period: • from beginning of labour to 72 hrs. postpartum • Breastfeeding: • advantages for infant

3. PREGNANCY • Conception: • Necessary: • sperm count • vaginal mucus • open Fallopian tubes • normal ovulation • normal hormonal levels

4. PREGNANCY • 23rd pair of chromosomes: sex chromosomes • Male sperm smaller and faster • Vaginal pH (acid, neutral or alkaline) • Ovulatory mucus (vaginal) mid-cycle provides • right pH • sugars (nutrients) • conveyor

5. PREGNANCY • Only a few hundred sperm arrive where egg is, in the Fallopian tube, and surround ovum. • Only one (usually) penetrates ovum • Stages of uterine development: • zygote: • 1-14 days • embryo: • 3-8 weeks • fetus: • 9-40 weeks

6. PREGNANCY • Natural method of conception can fail • Most common reason: • STDs in both men and women, which lead to infertility (e.g. blocked Fallopian tubes or vas deferens) • Reproductive technology can help infertile couples • Most recent dramatic technology: • cloning

7. PREGNANCY • More Established Reproductive Technologies: • Artificial Insemination: • Introducing sperm into woman’s vagina or uterus by artificial means • single woman • husband low sperm count • husband dead • husband infertile: donor sperm

8. PREGNANCY • More Established Reproductive Technologies (Cont’d): • IVF: in vitro fertilization: • test tube or Petri dish is used to mix gametes; once dividing, surgically implanted into woman’s uterus • can use both parents’ gametes • one parent plus donor’s • can be implanted in surrogate’s uterus (“rent-a-womb”)

9. PREGNANCY • Testing the Conceptus for Abnormalities: • amniocentesis (11-14 weeks) • CVS: chorionic villus sampling (villi) (6-8 weeks) • ultrasound (12-16 weeks) • fetoscopy • blood test

10. PREGNANCY • Physical and Psychological Changes During Pregnancy: • Woman: • 1st trimester: • enlarged, tender breasts • amenorrhea • nausea (⅓ severe,⅓ mild, ⅓ none) • sleepiness (⅔) • aversion to some foods, odors • increased urinary frequency (hormonal) • mixed emotions, ambivalence, anxiety and exhilaration

11. PREGNANCY • Physical and Psychological Changes During Pregnancy (Cont’d): • Woman: • 2nd trimester: • “quickening” • increased girth • well-being • mostly positive outlook, energy • preparatory behaviors, prenatal classes • some who rejected pregnancy accept it

12. PREGNANCY • Physical and Psychological Changes During Pregnancy (Cont’d): • Woman: • 3rd trimester: • large abdomen, awkward • lost sleep due to: • frequent urination (weight of uterus on bladder) • difficulty turning over in bed • activity of fetus • anxiety increases (delivery, birth defects) • differences between fit and unfit women

13. PREGNANCY • Physical and Psychological Changes During Pregnancy (Cont’d): • Woman: • 3rd trimester (Cont’d): • possible pregnancy complications: • edema • proteinuria • hypertension • diabetes • threatened early labor, etc. • moodiness, irritability, tiredness • not universal

14. PREGNANCY • Physical and Psychological Changes during Pregnancy (Cont’d): • Man: • economic worries • feeling left out • “couvade”: • actual changes in hormonal levels • before birth more prolactin and cortisol • after birth, less testosterone • related to paternal role

15. PREGNANCY • TERATOGENS: • anything that causes birth defects (teratos = monster) • Critical vs. sensitive periods • Maternal Diseases: • Rubella • Toxoplasmosis (cat’s feces, raw meat) • CMV • AIDS

16. PREGNANCY • TERATOGENS (Cont’d): • Radiation • Chemicals: • absorbed through lungs or skin • High Temperature: • hot bath • General Environmental Pollution: • what we eat, drink, breathe, touch

17. PREGNANCY • TERATOGENS (Cont’d): • Drugs: • prescription, e.g. DES, thalidomide • OTC • “recreational”, illegal • caffeine • aspirin, etc.

18. PREGNANCY • TERATOGENS (Cont’d): • Smoking: • nicotine • CO: • 200 times more affinity to Hgb than oxygen • oxygen supply compromised (5% less) • decreases sperm motility: • lower fertility • less progesterone: • miscarriages • placental problems • higher morbidity and mortality • from 9/1000 to 33/1000 • higher rates of cleft palate and hare lip

19. PREGNANCY • TERATOGENS (Cont’d): • Alcohol: • FASD (fetal alcohol spectrum disorder) • brain abnormalities: • learning difficulties • ADDH • mental retardation, etc. • possible damage to eyes, ears, immune system, internal organs, joints, limbs • low birth weight • increased prematurity, miscarriage and stillbirth risk

20. PREGNANCY • TERATOGENS (Cont’d): • Alcohol: • FASD (fetal alcohol spectrum disorder) (Cont’d) • growth retardation • facial and cranial malformations • dose and timing related • no safe dose • there is no cure for FASD • leading cause of preventable mental retardation

21. PREGNANCY • TERATOGENS (Cont’d): • Dose Related: • Interactions: hard to tell main effects • Possible effects: • miscarriage • stillbirth • low birth weight • irritability, hard to soothe • shorter attention span (learning) • tremors • digestive difficulties

22. PREGNANCY • TERATOGENS (Cont’d): • Possible effects (cont’d): • organ malformation • sluggishness • future cancers • visual impairment • skeletal malformation • brain development • genital abnormalities • prematurity

23. PREGNANCY • TERATOGENS (Cont’d): • Possible effects (cont’d): • respiratory difficulties • illnesses • microcephalia • heart defects • breach births (more C-sections)

24. PREGNANCY • TERATOGENS (Cont’d): • THERE ARE NO TOTALLY SAFE DRUGS! • Most vulnerable: • brain, CNS • learning problems • ADHD • Most common mechanism: • oxygen deprivation

25. PREGNANCY • TERATOGENS (Cont’d): • Maternal stress: • acute or chronic (worse) • adrenaline, corticosteroids: • compromise oxygen supply for infant • after birth: • digestive problems • low birth weight • irritability

26. PREGNANCY • TERATOGENS (Cont’d): • Maternal age: • no more obstetrical complications (if healthy) • increased Down’s syndrome • Other effects of these variables: • affect maternal-infant interaction • abuse • neglect • rejection

27. PREGNANCY • Maternal Nutrition: • First trimester: • usually not an issue – special cases • Second trimester: • quality • Third trimester: • quality and quantity • Important: • Folic acid: prevents neural tube defects (eg. spina bifida)

28. PREGNANCY • Maternal Nutrition (Cont’d): • Infant Optimal Weight: • 7½ - 8 lbs. (European stock) • Low Birth Weight: • 5½ lbs. or 2,500 g • Montreal Diet Dispensary, Agnes Higgins: • 500 extra daily calories: • 1 qt. milk • 1 egg • 1 orange

29. PREGNANCY • Prenatal Care Essential: • Toxemia: • increased blood pressure • fluid retention • edema • can lead to eclampsia (fatal) • Gestational Diabetes

30. PREGNANCY • Sex During Pregnancy • Woman’s comfort with own body important: • 1st Trimester: • tiredness, nausea • Male partner: • MOTHER image • fear of damaging baby

31. PREGNANCY • Sex During Pregnancy (Cont’d): • 2nd Trimester: • buoyant, well-being, vaginal mucus • Individual differences: • some women feel sexy, others not • about 5th month: belly. Unattractive?

32. PREGNANCY • Sex During Pregnancy (Cont’d): • 3rd Trimester: • abdomen large, awkward • new positions for sex • edema, tiredness, lack of sleep, too hot, hard to breathe

33. PREGNANCY • Sex During Pregnancy (Cont’d): • Important: • Level of fitness, activity, diet, general health • Colostrum: some men uncomfortable • Issue of “fatness” • Fear of premature labor • Some men turned off