20 Maternal Factors

• fertility problems;
• high blood pressure;
• diabetes;
• miscarriage;
• placenta previa;
• Caesarean section;
• premature birth;
• stillbirth; and
• a baby born with 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 pregnancy. Some women over age 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 a more mature parent. Older parents are more confident, less stressed, and typically more able to provide family stability. Their children perform better on math and reading tests, and they are less prone to injuries or emotional troubles (Albert, 2013). Women who choose to wait are often well educated and lead healthy lives. According to Gregory (2007), older women are more stable, demonstrate a stronger family focus, possess greater self-confidence, and have more financial security.

Having a child later in one’s career results in higher wages overall. In fact, for every year a woman delays motherhood, she makes 9 percent more in lifetime earnings. Lastly, women who delay having children actually live longer. Sun et al. (2015) found that women who had their last child after age 33 doubled their chances of living to age 95 or older than women who had their last child before their 30th birthday. A woman’s natural ability to have a child at a later age indicates that her reproductive system is aging slowly, and consequently so is the rest of her body.

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 a low birth weight 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, and serious intestinal problems. Very low-birth-weight babies (less than 3.3 pounds) are more than one hundred times as likely to die than normal-weight babies, and moderately low-birth-weight babies (between 3.3 and 5.5 pounds) are more than five times as likely to die in their first year than normal-weight babies (March of Dimes, 2012c). Again, the risk is highest for babies of mothers under age 15. Reasons for these health issues include that teenagers are the least likely of all age groups to get early and regular prenatal care. Additionally, they may engage in risky behaviours, including eating unhealthy food, smoking, drinking alcohol, and abusing drugs. Additional concerns for teenagers are repeat births. About 25 percent of teen mothers under age 18 have a second baby within two years after the first baby’s birth.

Gestational diabetes: Among pregnant women, 7 percent develop gestational diabetes (March of Dimes, 2015b). Diabetes is a condition where the body has too much glucose in the bloodstream. Most pregnant women have their glucose level tested at twenty-four to twenty-eight weeks of pregnancy. Gestational diabetes usually goes away after the mother gives birth, but it might indicate a risk for developing diabetes later in life. 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 labour 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), which is discussed later in this chapter. Risk factors for gestational diabetes include age (being over age 25), being overweight or gaining too much weight during pregnancy, a 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 women have a higher risk). Eating healthy food 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 that 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 pressures 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. According to the March of Dimes (2015c) about eight in every one hundred pregnant women have high blood pressure. High blood pressure during pregnancy can cause premature birth and low birth weight (under 5.5 pounds), placental abruption, and preeclampsia.

Rh disease: 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 (March of Dimes, 2009). 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 blood cells may get into the mother’s bloodstream, in which case her immune system is unable to recognize the Rh factor. The immune system then starts to produce antibodies to fight off what it thinks is a foreign invader. Once her body produces immunity, the antibodies can cross the placenta and start to destroy the red blood cells of the developing fetus. As this process takes time, often the first Rh positive baby is not harmed, but as the mother’s body will continue to produce antibodies to the Rh factor across her lifetime, subsequent pregnancies can pose greater risk for an Rh negative baby. In the newborn, Rh disease can lead to jaundice, anemia, heart failure, brain damage, and death.

Weight gain during pregnancy: According to March of Dimes (2016f), during pregnancy most women need only an additional three hundred 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 weight may have a baby with a 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. Table 2.4 shows a healthy weight gain during pregnancy. Putting on the weight slowly is best. Mothers who are concerned about their weight gain should talk to their healthcare provider.

Stress: Feeling stressed is common during pregnancy, but high levels of stress can cause complications, including having a premature baby or a low-birth-weight baby. Babies born early or too small are at an increased risk for health problems. Stress-related hormones may cause these complications by affecting a woman’s immune systems, resulting in an infection and premature birth. Additionally, some women deal with stress by smoking, drinking alcohol, or taking drugs, which can lead to problems during pregnancy. High levels of stress in pregnancy have also been correlated with problems in the baby’s brain development and immune system functioning, as well as childhood problems such as trouble paying attention and being afraid (March of Dimes, 2012b).

Depression: Depression is a significant medical condition in which feelings of sadness, worthlessness, guilt, and fatigue interfere with one’s daily functioning. Depression can occur before, during, or after pregnancy, and one in seven women is treated for depression sometime between the year before pregnancy and year after pregnancy (March of Dimes, 2015a). Women who have experienced depression previously are more likely to have depression during pregnancy. Consequences of depression include the baby being born premature, having a low birth weight, being more irritable, less active, less attentive, and having fewer facial expressions. About 13 percent of pregnant women take an antidepressant during pregnancy. It is important that women taking antidepressants during pregnancy discuss the medication with a healthcare provider, as some medications can cause harm to the developing fetus. In fact, birth defects happen about two to three times more often in women who take certain selective serotonin reuptake inhibitors (SSRIs). Depression is not the same as the “baby blues.” The “baby blues” are feelings of sadness that occur three to five days after having a baby, and typically disappear within ten days of the birth. New mothers may have trouble sleeping, be moody, and feel let-down from the birthing experience. According to the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013), peripartum onset of depression, also known as postpartum depression, is a type of depression that occurs during pregnancy or in the four weeks following pregnancy. Approximately one in eight women experience postpartum depression. Changing hormone levels are thought to be a factor in its occurrence, however, risk factors include a personal history of depression, a family history of depression, being younger than age 20, experiencing stress, and substance use.

Peripartum-onset mood disorders, both depression and mania, can present with or without psychotic features. Hallucinations and delusions are associated with postpartum psychotic episodes, and have included command hallucinations to kill the infant or delusions that the infant is possessed. Psychotic features occur in approximately 1 in 500 to 1 in 1,000 deliveries, and the risk is higher for women with prior postpartum mood episodes (American Psychiatric Association, 2013).

Paternal impact: The age of fathers at the time of conception is also an important factor in health risks for children. According to Nippoldt (2015), offspring of men over age 40 face an increased risk of miscarriages, autism, birth defects, achondroplasia (bone growth disorder), and schizophrenia. These increased health risks are thought to be due to accumulated chromosomal aberrations and mutations during the maturation of sperm cells in older men (Bray, Gunnell, and Smith, 2006). However, like older women, the overall risks are small.

In addition, men are more likely than women to work in occupations where hazardous chemicals, many of which have teratogenic effects or may cause genetic mutations, are used (Cordier, 2008). These may include petrochemicals, lead, and pesticides that can cause abnormal sperm and lead to miscarriages or diseases. Men are also more likely to be a source of secondhand smoke for their developing offspring. As noted earlier, smoking either by the mother or around the mother can hinder prenatal development.