20. the Impact of Maternal Illness

8/12/2019 20. the Impact of Maternal Illness

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The Impact of Maternal

Illness on the Newborn

Julniar M. Tasli

Herman Bermawi


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Background

Improvements in obstetric care can directlyinfluence neonatal survival

Prevention of neonatal asphyxia, sepsis, preterm

birth and low birth weight can be achievedthrough improved care during pregnancy andduring delivery

In the new model of integrated perinatal care

pediatric and obstetric care occur collaborativelytowards the common goal of a safe delivery andimproved neonatal survival


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Learning Objectives

Identify maternal conditions duringpregnancy and labor that can influenceneonatal outcomes.

Understand the association betweenspecific conditions and neonatal outcomes.

Suspect and recognize neonatal clinical

presentations related to such conditions.

Decide on management plan of thenewborn based on maternal presentation


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Maternal Well-being in

Pregnancy: Spacing of pregnancy Adequacy of prenatal care including

immunizations (4 visits or more) Avoiding pregnancy at extremes of

maternal age Avoidance of extremes of maternal pre-

pregnancy weight (under-weight andmorbid obesity) Appropriate weight gain and physical

activity


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Balanced nutrition (micronutrientintake; iron, zinc, folic acid, iodine,

calcium)Avoidance of environmental

exposures (nicotine, other drugs,medications, pesticides)

Mental health including stress anddepression


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Lack of compliance can be directly andindirectly associated with :

Prematurity and low birth weight andcomplications associated with these

important contributors to infantmortality and morbidity

Higher incidence of specific neonatal

complications e.g. congenitalanomalies (neural tube defects) andin-utero growth retardation


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Prenatal care and its role: Prenatal care is designed to identify maternal

complications early and give pregnant mothersguidance to healthy behaviors during pregnancy.

Prenatal care should educate mothers and theircommunity on the identification of early dangersigns during pregnancy

Prenatal care should also help mothers prepare

for the arrival of the newborn, and give thembasic education on the early care of the neonate.


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1. Early Identification ofPregnancy:

Accurate gestational agedetermination

Promotes the early adoption ofhealthy behaviors and avoidance ofunhealthy behaviors and exposures

Early screening for infections andother risks


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Enhances the ability for early diagnosis

and treatment of maternal diseasesaffecting pregnancy:Anemia Maternal malnutrition

Pre-existing medical conditions(hypertension, diabetes, TB, malaria,STI & urinary tract infections)

Uterine conditions e.g. fibroids, andanatomic abnormalities (bicornuate

uterus) Maternal cardiac disease Thyroid disorders


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A. Maternal Nutrition

Evaluating nutritional status

Low pre-pregnancy weight (less than50Kg?)

Adequate weight gain (10-15 Kg)

Maternal anemia (Hgb =


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Recommendations Balanced dietary intake

Vit. D supplementation (severe deficiency may beassociated with neonatal hypocalcemia).

Adequate folic acid intake (starting beforepregnancy) reduces the risk for neural tubedefects.

Adequate iron supplementation especially incases with anemia.

Avoiding Vit. A in high doses (teratogenic effects)


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B. Perinatal Infections


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Viral Infections:

Cytomegalovirus

Transmitted trans-placentally, breastmilk

Associated with IUGR,hepatosplenomegaly, microcephaly,retinopathy, and hydrops

May present in the neonate also with:

Jaundice, LBW, thrombocytopenia withskin petechiae, and hearing loss


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Rubella:

Transplacentally transmitted

Dangerous effects on the fetus in the

first trimester

Effects on the fetus include congenitalheart disease, IUGR, retinopathy,

auditory nerve hearing loss, cataract,purpura, and hepatosplenomegaly


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Herpes simplex (HSV)

Ascending infection (intrapartum)

Effects on the fetus/neonate include:IUGR, Encephalitis/meningitis, seizures,retinitis, mental retardation


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Varicella Zoster

Transmitted transplacentally (


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HIV

Transmitted transplacentally, during

labor and in breast milk Neonatal HIV/AIDS mostly

asymptomatic in the immediateneonatal period although some manifest

IUGR


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Hepatitis B

Transmitted mainly as an ascending

infection, and through breast feeding,rarely transplacentally.

Associated with post-natal chronichepatitis, cirrhosis and hepatocellular

carcinoma.


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Non-viral infections:


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Neisseria Gonorrhoea

Ascending infection intrapartum

Ophthalmia neonatorum (early)


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Treponema pallidum (syphilis)

Transmitted transplacentally, anytimeduring pregnancy (worst effects with

early infection)

Associated with fetal loss and still birth,and congenital syphilis (skin and

mucous membrane lesions, hepato-splenomegaly, anemia andthrombocytopenia, bone lesions)


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Toxoplasma gondii

Transplacentally transmitted with the

worst effects in early transmissionAssociates with

Hydrocephalus/microcephaly, braincalcifications, hepatosplenomegaly,

retintis/blindness hearing loss andmental retardation.


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C. Thyroid Diseases


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Hypothyroidism

Suspected after thyroid surgery, andin cases with goiter (thyroid

swelling)Associated with Hashimoto

thyroiditis

May cause still birth, IUGR, placentalabruption, and preeclampsia.

Thyroxine replacement is indicated


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Hyperthyroidism

Much more common than hypothyroidism Should be suspected in cases with goiter Most commonly due to Graves disease

If untreated can be dangerous to motherand fetus. Maternal complications include severe

preeclampsia and heart failure, andcardiac arrythmias

Fetal complications include preterm birthand neonatal thyrotoxicosis


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2. Identifications of IllnessesComplicating of Pregnancy:

Identification and early treatment ofhypertension in pregnancy as a continuumof Pre/eclampsia

Identification and treatment ofGestational Diabetes

Identification and treatment of infectionscomplicating pregnancy (UTI, systemic,malaria, TB, HIV)


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A. Impact of maternalhypertension

IUGR

Asphyxia

Prematurity and LBW/ SGA

Congenital anomaly

Multiple gestation

Polycytemia + Hypebilirubinemia


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B. Impact of maternal diabetes

Maternal diabetes type AC :

+ LGA

+ Birth injuries+ Hyalin membran disease

+ Polycythemia

+ Hyperbilirubinemia+ Hypoglycemia

+ Congenital anomaly


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Maternal diabetes type DF&R :

+ LBW / SGA

+ Congenital anomaly+ Hypoglcemia

+ Polycythemia

+ Hyperbilirubinemia

20. the Impact of Maternal Illness

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