Discussion

prenatal development
in humans, the process encompassing the period from the formation of an
embryo, through the development of a fetus, to birth (or parturition).
The human body, like that of most animals, develops from a single cell produced
by the union of a male and a female gamete (or sex cell). This union marks the
beginning of the prenatal period, which in humans encompasses three distinct
stages: the pre-embryonic stage,
the first two weeks of development, which is a period of cell division and initial
differentiation (cell maturation), the embryonic period, or period of
organogenesis, which lasts from the third to the eighth week of development,
and the fetal period, which is characterized by the maturation of tissues and
organs and rapid growth of the body. The prenatal period ends with parturition
and is followed by a long postnatal period. Only at about age 25 years are the
last progressive changes completed.The process of growth and development
within the womb, in which a single-cell zygote (the cell formed by the
combination of a sperm and an egg) becomes an embryo, a fetus, and then a
baby.
The first two weeks of development are concerned with simple cell
multiplication. This tiny mass of cells then adheres to the inside wall of the
uterus. The next three weeks see intense cell differentiation, as the cell mass
divides into separate primitive systems. At the end of eight weeks, the embryo
has taken on a roughly human shape, and is called a fetus. For the next twenty
weeks the fetus' primitive circulatory, nervous, pulmonary, and other systems
become more mature, and it begins to move its limbs. At 28 weeks, fat begins to
accumulate under the skin, toenails and fingernails

Pre-embryonic and embryonic development

The embryos of many animals appear similar to one another in the earliest
stages of development and progress into their specialized forms in later stages.
Much of the embryonic developmental machinery (the cellular apparatus) used
in human development is similar to that used by other vertebrates as well as
some invertebrates. The machinery is essential for four processes: cell
proliferation, cell specialization, cell interaction, and cell movement. During
these processes, the approximately 20,000–25,000 genes in the human genome
give rise to as many as 100,000 different proteins, which give the conceptus
form and substance.

fertilization
A sperm cell attempting to penetrate an egg (ovum) to fertilize it.The
development and liberation of the male and female gametes are steps
preparatory to their union through the process of fertilization. Active
movements first bring some spermatozoa into contact with follicle cells adhering
to the secondary oocyte (immature egg), which still lies high in the uterine tube.
The sperm then propel themselves past the follicle cells and attach to the
surface of the gelatinous zona pellucida enclosing the oocyte. Some sperm
heads successfully penetrate this capsule by means of an enzyme they secrete,
hyaluronidase, but only one sperm makes contact with the cell membrane and
cytoplasm of the oocyte and proceeds farther. This is because the invading
sperm head releases a substance that initiates surface changes in the oocyte
that render its membrane impermeable to other spermatozoa.The successful
sperm is engulfed by a conical protrusion of the oocyte cytoplasm and is drawn
inward. Once within the periphery of the oocyte, the sperm advances toward
the centre of the cytoplasm; the head swells and converts into a typical nucleus,
now called the male pronucleus, and the tail detaches. It is during the progress
of these events that the oocyte initiates its final maturation division. Following
the separation of the second polar body (one or two polar bodies are produced
during division), the oocyte nucleus typically reconstitutes and is then called the
female pronucleus of the ripe egg. It is now ready to unite with its male
counterpart and thereby consummate the total events of fertilization.
The two pronuclei next approach, meet midway in the egg cytoplasm, and lose
their nuclear membranes. Each resolves its diffuse chromatin material into a
complete single set of 23 chromosomes. Each chromosome is composed of two
chromatids held together by a centromere. During mitosis (ordinary cell
proliferation by division), the centromeres attach to a bundle of microtubules
known as the mitotic spindle, which is formed by centrioles (cylindrical cell
structures). This climax in the events of fertilization creates a joint product
known as the zygote, which contains all the factors essential for the
development of a new individual.

cleavage and blastulation

Through the process of mitosis, the relatively enormous zygote directly
subdivides into many smaller cells of conventional size, suitable as early building
units for the future organism. This process is called cleavage and the resulting
cells are blastomeres. The tendency for the progressive increase in cell numbers
to follow a doubling sequence is soon disturbed and then lost. Each blastomere
receives the full complement of paternal and maternal chromosomes.

Implantation and placentation

Six to 10 days after fertilization, the naked sticky blastocyst comes into contact
with the uterine lining and adheres to it. The site of attachment is variable and
not predetermined. The uterine lining has already been preparing, under the
influence of ovarian hormones, for the reception of the blastocyst. Among these
preparations has been the elaboration and expulsion, by the uterine glands, of a
secretion that serves as nourishment for the blastocyst, both when it is free and
during its implantation. Directly after blastocyst attachment come its
establishment within the thickened uterine lining and the participation of its
trophoblastic capsule in the differentiation of a placenta, a structure that
enables the developing embryo to enter into a direct physiological dependence
on the mother
Development of the embryo
Human embryonic development
The initial stages of human embryogenesis
Following fertilization, the embryonic stage of development continues until the
end of the 10th week (gestational age) (8th week fertilization age). The first two
weeks from fertilization is also referred to as the germinal stage or
preembryonic stage.[6

The zygote spends the next few days traveling down the fallopian tube dividing
several times to form a ball of cells called a morula. Further cellular division is
accompanied by the formation of a small cavity between the cells. This stage is
called a blastocyst. Up to this point there is no growth in the overall size of the
embryo, as it is confined within a glycoprotein shell, known as the zona
pellucida. Instead, each division produces successively smaller cells.

The blastocyst reaches the uterus at roughly the fifth day after fertilization. The
blastocyst hatches from the zona pellucida allowing the blastocyst's outer cell
layer of trophoblasts to come into contact with, and adhere to, the endometrial
cells of the uterus. The trophoblasts will eventually give rise to extra-embryonic
structures, such as the placenta and the membranes. The embryo becomes
embedded in the endometrium in a process called implantation. In most
successful pregnancies, the embryo implants 8 to 10 days after ovulation.[7] The
embryo, the extra-embryonic membranes, and the placenta are collectively
referred to as a conceptus, or the "products of conception".

Rapid growth occurs and the embryo's main features begin to take form. This
process is called differentiation, which produces the varied cell types (such as
blood cells, kidney cells, and nerve cells). A spontaneous abortion, or
miscarriage, in the first trimester of pregnancy is usually[8] due to major genetic
mistakes or abnormalities in the developing embryo. During this critical period
the developing embryo is also susceptible to toxic exposures, such as:

Alcohol, certain drugs, and other toxins that cause birth defects, such as fetal
alcohol syndrome
Infection (such as rubella or cytomegalovirus)
Radiation from x-rays or radiation therapy
Nutritional deficiencies such as lack of folate which contributes to spina bifida

Prenatal Development
1st Trimester (0-3 months)
i) 0-2 weeks from conception
The egg is released from the ovary. It is fertilized in the fallopian tube by the
sperm. The fertilized egg starts to divide & forms a Zygote which digs into the
lining of the uterus. The Zygote begins to form layers, and in this part, it is called
an embryo.

ii) 3-4 weeks

The embryo changes from a flat disk to a curved, C-shaped form. A tube forms
along the embryo, which grows into the brain & spinal cord. The heart starts to
grow as a tube. Simple structures form on the sides of the head, which will
become eyes & ears as time goes on. Limb buds start to form.

iii) 5-6 weeks

About half of the embryo's length is the head due to the rapid growth of the
brain. The heart starts to form the normal 4 chambers. A heartbeat can be seen
on ultrasound. The eyes & ears move towards their normal places on the head.
Kidneys begin to form. Rays appear in the limbs, which will form fingers & toes.
The umbilical cord joins the embryos & placenta. The neural tube that becomes
the brain & spinal cord closes.

iv) 7-8 weeks

The embryo changes shape as the face forms; the small tail bud begins to go
away. All of the essential organs, including the basic parts of the brain & heart,
are now formed. There are fingers on the hands, and toes are almost formed.
There are eyelids over the eyes, but they can't open yet. The 1st hair buds form,
and nipples can be seen. Muscles begin to form. Early bones are formed. The
intestines grow rapidly.

v) 9-10 weeks
By this time, all the main body parts are formed and present. The embryo is now
called a fetus. Fetal movements and heartbeat can be seen in ultrasound.
Various glands begin to work. The kidneys begin to make urine. At this point, the
sex of the fetus can often be seen. The fetus begins to swallow fluid from the
amniotic sack, and the placenta is fully formed. Blood cells are made in the bone
marrow. The neck can be clearly seen between the head and the body.

2nd Trimester (3-5 months)

i) 13-14 weeks
The fetal head is still large as the body straightens out. The arms & legs are
formed, and they can move & bend. Sex organs are almost fully formed. Toenail
& fingernail growth begins. The eyes & ears reach normal position, and the face
is well-formed. Tooth buds may appear. The eyelids are formed and closed.

ii) 15-16 weeks

Some women begin to feel fetal movement. The legs grow longer, so the fetus
seems less large. Slow fetal eye movements can be seen by ultrasound. The
bones gain calcium at a rapid rate. The skin is almost transparent.
iii) 17-18 weeks
Many women feel fetal movement by this time in pregnancy. The fetal skin is
covered by something called 'Vernix caseosa.' A very fine hair called 'Lanugo'
covers the fetal body. The fetus weighs about 320 gm.

iv) 19-20 weeks

The skin is red as blood vessels can be seen very clearly beneath it. Eye brow &
eyelashes start to form. Fingerprints begin to form.

v) 21-22 weeks
Fetal weight gain is fast during this time. Rapid eye movements can be seen by
ultrasound. Lung growth to a complete point. A heartbeat can be heard with a
stethoscope. The fetal weighs 630 gm.

vi) 23-24 weeks

Fat gradually builds up under the skin. The fetus will blink & act startled in
response to loud noises near the women's belly. The fetus weighs around 820
gm.

3rd Trimester (6-11 months)

i) 25-26 weeks
The fetus continues to gain weight. The brain grows & starts to do more complex
tasks. Eyelashes are fully formed. Fetal eyes will open slightly.

ii) 27-28 weeks

The fetal brain can now control body temp. & direct regular breathing. The eyes
open wide. Blood cells are made in the bone marrow.
iii) 29-30 weeks
More fat builds up under the skin, and the skin thickens. The fetus starts to look
more like a newborn baby. The 'lanugo' hair on the face grows away. The pupils
of the eyes start to react to light. The fetus weighs around 1700 gm.

iv) 31-32 weeks

Fat is still building up under the skin as the fetus grows. The lungs keep growing
& making a chemical called "Surfactant,' which is needed to keep the lungs open
between breaths after birth. Fetus muscle starts to increase. The fetus weighs
around 2.100 gm.

v) 33-34 weeks
The lungs & the nervous system keep growing. Hair on the head begins to look
normal. Testis in male fetuses start to move from the abdomen to the scrotum.
The labia in female fetuses begin to cover the clitoris. The fetus moves into a
head-down position to prepare for delivery.

vi) 35-36 weeks

In almost all cases, fetal lungs are matured at this point. The fetus drops lower
into the mother's pelvis. Lanugo hairs are almost all gone except for around the
head & shoulders.

vii) 37-38 weeks

This is full-term in pregnancy. Most babies are born during this time. The total
length is around 20 inches on average, and a full-term baby weighs around 3400
gm.
Nutrition
The embryo passes through 3 phases of acquisition of nutrition from the mother
Absorption phase: Zygote is nourished by cellular cytoplasm and secretions in
fallopian tubes and uterine cavity.[10]
Histoplasmic transfer: After nidation and before establishment of uteroplacental
circulation, embryonic nutrition is derived from decidual cells and maternal
blood pools that open up as a result of eroding activity of trophoblasts.
Hematotrophic phase: After third week of gestation, substances are transported
passively via intervillous space

Cognitive development
Electrical brain activity is first detected at the end of week 5 of gestation.
Synapses do not begin to form until week 17. Neural connections between the
sensory cortex and thalamus develop as early as 24 weeks' gestational age, but
the first evidence of their function does not occur until around 30 weeks, when
minimal consciousness, dreaming, and the ability to feel pain emerges.[
Initial knowledge of the effects of prenatal experience on later
neuropsychological development originates from the Dutch Famine Study, which
researched the cognitive development of individuals born after the Dutch
famine of 1944–45. The first studies focused on the consequences of the famine
to cognitive development, including the prevalence of intellectual disability.Such
studies predate David Barker's hypothesis about the association between the
prenatal environment and the development of chronic conditions later in
life.The initial studies found no association between malnourishment and
cognitive development,but later studies found associations between
malnourishment and increased risk for schizophrenia, antisocial disorders, and
affective disorders.
There is evidence that the acquisition of language begins in the prenatal stage.
After 26 weeks of gestation, the peripheral auditory system is already fully
formed.Also, most low-frequency sounds (less than 300 Hz) can reach the fetal
inner ear in the womb of mammals.Those low-frequency sounds include pitch,
rhythm, and phonetic information related to language.Studies have indicated
that fetuses react to and recognize differences between sounds.uch ideas are
further reinforced by the fact that newborns present a preference for their
mother's voice,present behavioral recognition of stories only heard during
gestation,and (in monolingual mothers) present preference for their native
language.[ A more recent study with EEG demonstrated different brain
activation in newborns hearing their native language compared to when they
were presented with a different language, further supporting the idea that
language learning starts while in gestation.

Ectodermal derivatives
Integumentary system
The skin has a double origin. Its superficial layer, or epidermis, develops from
ectoderm. The initial single-layered sheet of epithelial cells becomes
multilayered by proliferation, and cells nearer the surface differentiate into a
horny substance. Pigment granules appear in the basal layer. The epidermis of
the palm and sole becomes thicker and more specialized than elsewhere. Cast-
off superficial cells and downy hairs mingle with a greasy glandular secretion
and smear the skin in the late fetal months; the pasty mass is called vernix
caseosa.

Nails develop in pocketlike folds of the skin near the tips of digits. During the
fifth month specialized horny material differentiates into proliferating
ectodermal cells..

Sebaceous glands develop into tiny bags, each growing out from the
epithelial sheath that surrounds a hair. Their cells proliferate, disintegrate, and
release an oily secretion. Sweat glands at first resemble hair pegs, but the deep
end of each soon coils. In the seventh month an axial cavity appears and later is
continued through the epidermis. The mammary glands, unique to mammals,
are specialized sweat glands. In the sixth week a thickened band of ectoderm
extends between the bases of the upper and lower limb buds. In the pectoral
(chest) region only, gland buds grow rootlike into the primitive connective tissue
beneath

Mouth and anus

The mouth is a derivative of the stomodaeum, an external pit bounded by the
overjutting primitive nasal region and the early upper and lower jaw projections.
Its floor is a thin membrane where ectoderm and endoderm fuse
(oropharyngeal membrane). Midway in the fourth week this membrane
ruptures, making continuous the primitive ectodermal mouth and endodermal
pharynx (throat). Lips and cheeks arise when ectodermal bands grow into the
mesoderm and then split into two sheets. Teeth have a compound origin: the
cap of enamel develops from ectoderm, whereas the main mass of the tooth,
the dentin, and the encrusting cementum about the root differentiate from
mesoderm. The salivary glands arise as ectodermal buds that branch, bushlike,
into the deeper mesoderm. Berrylike endings become the secretory acini (small
sacs), while the rest of the canalized system serves as ducts

Abnormal development
Multiple births
It is both unusual and abnormal for the human species to produce more than
one offspring at a time. Twins and twinning are used as general terms for
multiple births of any number, as the same basic principles apply.

Fraternal twins stem from multiple ovulations in the same cycle. Each oocyte
develops singly in a separate follicle, is shed and fertilized individually, develops
within its own chorionic sac, and forms an individual placenta. In some
instances, two blastocysts implant close together, and the expanding placentas
meet and fuse. In such double placentas, however, the two blood circulations
rarely communicate. The word dizygotic technically designates two-egg twins.
Such pairs are independent in sex determination and bear no more resemblance
than do other children of the same parents. Nearly three-fourths of all American
twins are dizygotic, whereas the Japanese ratio is only one-fourth. A tendency
toward such multiple births exists in some family lines.

Wholly different are those true twins who are always of the same sex and are
strikingly similar in physical, functional, and mental traits. Such close identity is
enforced by their derivation from a single ovulated and fertilized egg and hence
by their acquisition of identical chromosomal constitutions. This twin type is
named monozygotic. Three-fourths of such pairs develop within a common
chorionic sac and share a placenta, while one-fourth have individual sacs and
placentas. The latter condition results from events before implantation, when
the cleavage cells separate into two groups and then become individually
implanting blastocysts. There is no discernible hereditary tendency toward the
production of monozygotic twins.

Occasionally, monozygotic twinning can result in fused, or conjoined, twins.

Conjoining results from divergent growth at the front or hind end of the
emerging primitive axis of an embryo, or at both ends. The degree of union
varies from slight to extensive, and the possession of a single or double set of
internal organs depends on the intimacy of fusion at any particular level. Union
occurs by the heads, upper trunks, or lower trunks; the joining may be by the
dorsal, lateral, or ventral surfaces. Sometimes there is a marked disparity in the
size of the two twins; this condition is known as nonsymmetric twinning, and
usually the much smaller twin will be dependent on the larger for nutrition. (For
more information about the development and delivery of more than one
offspring in a single birth event, see multiple birth.

Fetal deviations
Human embryos are subject to disease, abnormal development, and abnormal
growth. Decline and death can occur at any stage, but most deaths occur in the
first two or three weeks of development usually escape notice. Probably little
more than half of all zygotes reach full-term birth. Most abnormalities resulting
from faulty development originate during the embryonic period. During the pre-
embryonic period, if a severe chromosomal abnormality is present, the
conceptus will die. Indeed, abnormalities that do occur in living infants tend
toward the milder types, since the severe mishaps commonly terminate
development before birth.

Defective health of the mother can in some instances become a cause of the
physical impairment or death of a fetus. Certain infectious diseases, for example,
may result in fetal injury; such related causative organisms can be a virus
(German measles), a spirochetal microorganism (syphilis), or a protozoan
parasite (toxoplasmosis). Also, placental disorders, malformations of the
mother’s reproductive organs, and inadequate functioning of her endocrine
system may provide an unfavourable environment for normal development.
Birth itself imposes the risk of oxygen deficiency or other injury; either may
result in some malfunctioning of the brain

Teratogens
Alcohol
Image of a baby boy with FAS facial characteristics of small eye openings, a
smooth philtrum, and a thin upper lip.
Figure 6. Some distinguishing characteristics of fetal alcohol spectrum disorders
include more narrow eye openings, A smooth philtrum, meaning a smooth area
between the upper lip and the nose, and a thin upper lip.
One of the most commonly used teratogens is alcohol. Because half of all
pregnancies in the United States are unplanned, it is recommended that women
of child-bearing age take great caution against drinking alcohol when not using
birth control and when pregnant.[4] Alcohol consumption, particularly during
the second month of prenatal development, but at any point during pregnancy,
may lead to neurocognitive and behavioral difficulties that can last a lifetime.
The terms alcohol-related neurological disorder (ARND) and alcohol-related
birth defects (ARBD) have replaced the term Fetal Alcohol Effects to refer to
those with less extreme symptoms of FASD. ARBD include kidney, bone and
heart problems.
Tobacco
Smoking is also considered a teratogen because nicotine travels through the
placenta to the fetus. When the pregnant woman smokes, the developing fetus
experiences a reduction in blood oxygen levels. Tobacco use during pregnancy
has been associated with low birth weight, placenta previa, birth defects,
preterm delivery, fetal growth restriction, and sudden infant death syndrome.
Smoking in the month before getting pregnant and throughout pregnancy
increases the chances of these risks. Quitting smoking before getting pregnant is
best. However, for women who are already pregnant, quitting as early as
possible can still help protect against some health problems for the mother and
baby.[6]

Drugs
Prescription, over-the-counter, or recreational drugs can have serious
teratogenic effects. In general, if medication is required, the lowest dose
possible should be used. Combination drug therapies and first trimester
exposures should be avoided. Almost three percent of pregnant women use
illicit drugs such as marijuana, cocaine, Ecstasy and other amphetamines, and
heroin. These drugs can cause low birth-weight, withdrawal symptoms, birth
defects, or learning or behavioral problems. Babies born with a heroin addiction
need heroin just like an adult addict. The child will need to be gradually weaned
from the heroin under medical supervision; otherwise, the child could have
seizures and die. Visit this link for further information about opioid use during
pregnancy.

Environmental Chemicals
Environmental chemicals can include exposure to a wide array of agents
including pollution, organic mercury compounds, herbicides, and industrial
solvents. Some environmental pollutants of major concern include lead
poisoning, which is connected with low birth weight and slowed neurological
development. Children who live in older housing in which lead-based paints
have been used have been known to eat peeling paint chips thus being exposed
to lead. The chemicals in certain herbicides are also potentially damaging.
Radiation is another environmental hazard that a pregnant woman must be
aware of. If a woman is exposed to radiation, particularly during the first three
months of pregnancy, the child may suffer some congenital deformities. There is
also an increased risk of miscarriage and stillbirth. A pregnant woman’s exposure
to mercury can also lead to physical deformities and intellectual disabilities.[7]

Sexually Transmitted Infections

Sexually transmitted infections (STIs) can complicate pregnancy and may have
serious effects on both the pregnant woman and the developing fetus. Most
prenatal care today includes testing for STIs, and early detection is important.
STIs, such as chlamydia, gonorrhea, syphilis, trichomoniasis, and bacterial
vaginosis can all be treated and cured with antibiotics that are safe to take
during pregnancy. STIs that are caused by viruses, like genital herpes, hepatitis B,
or HIV cannot be cured. However, in some cases these infections can be treated
with antiviral medications or other preventive measures that can be taken to
reduce the risk of passing the infection to the baby.[8]

Maternal Diseases
Maternal illnesses increase the chance that a baby will be born with a birth
defect or have a chronic health problem. Some of the diseases that are known
to potentially have an adverse effect on the fetus include diabetes,
cytomegalovirus, toxoplasmosis, rubella, varicella, hypothyroidism, and Strep B.
If the pregnant woman contracts Rubella during the first three months of
pregnancy, damage can occur in the eyes, ears, heart, or brain of the developing
fetus. On a positive note, Rubella has been nearly eliminated in the industrial
world due to the vaccine created in 1969. Diagnosing these diseases early and
receiving appropriate medical care can help improve the outcomes. Routine
prenatal care now includes screening for gestational diabetes and Strep B.[9]

Maternal Stress
Stress represents the effects of any factor able to threaten the homeostasis of
an organism; these either real or perceived threats are referred to as the
“stressors” and comprise a long list of potentially adverse factors, which can be
emotional or physical. Because of a link in blood supply between a pregnant
woman and her fetus, it has been found that stress can leave lasting effects on a
developing fetus, even before birth. The best-studied outcomes of fetal
exposure to maternal prenatal stress are preterm birth and low birth weight.
Maternal prenatal stress is also considered responsible for a variety of changes
in the child’s brain, and a risk factor for conditions such as behavioral problems,
learning disorders, high levels of anxiety, attention deficit hyperactivity disorder,
autism, and schizophrenia. Furthermore, maternal prenatal stress has been
associated with a higher risk for a variety of immune and metabolic changes in
the child such as asthma, allergic disorders, cardiovascular diseases,
hypertension, hyperlipidemia, diabetes, and obesity.

Factors influencing prenatal risks

There are several considerations in determining the type and amount of damage
that might result from exposure to a particular teratogen.[11] These include:
The timing of the exposure: Structures in the body are vulnerable to the most
severe damage when they are forming. If a substance is introduced during a
particular structure’s critical period (time of development), the damage to that
structure may be greater. For example, the ears and arms reach their critical
periods at about 6 weeks after conception. If a pregnant woman exposes the
embryo to certain substances during this period, the arms and ears may be
malformed.
The amount of exposure: Some substances are not harmful unless the amounts
reach a certain level. The critical level depends in part on the size and
metabolism of the mother.
Genetics: Genetic make-up also plays a role in the impact a particular teratogen
might have after the child is born. This is suggested by fraternal twin studies
who are exposed to the same prenatal environment, yet do not experience the
same teratogenic effects. The genetic make-up of the mother can also have an
effect; some mothers may be more resistant to teratogenic effects than others.
Biological sex: Males are more likely to experience damage due to teratogens
than are females. It is believed that the Y chromosome, which contains fewer
genes than the X, may have an impact

Complications of Pregnancy and Delivery

Pregnant Woman
Pregnancy affects women in different ways; some notice few adverse side
effects, while others feel high levels of discomfort, or develop more serious
complications.
There are a number of common side effects of pregnancy. Not everyone
experiences all of these nor do women experience them to the same degree.
And although they are considered “minor” these problems are potentially very
uncomfortable. These side effects include nausea (particularly during the first 3-
4 months of pregnancy as a result of higher levels of estrogen in the system),
heartburn, gas, hemorrhoids, backache, leg cramps, insomnia, constipation,
shortness of breath or varicose veins (as a result of carrying a heavy load on the
abdomen)

Major Complications
The following are some serious complications of pregnancy which can pose
health risks to mother and child and that often require special care.
Gestational diabetes is when a woman without diabetes develops high blood
sugar levels during pregnancy.
Hyperemesis gravidarum is the presence of severe and persistent vomiting,
causing dehydration and weight loss. It is more severe than the more common
morning sickness.
Preeclampsia is gestational hypertension. Severe preeclampsia involves blood
pressure over 160/110 with additional signs. Eclampsia is seizures in a patient
who is pre-eclamptic.
Deep vein thrombosis is the formation of a blood clot in a deep vein, most
commonly in the legs.
A pregnant woman is more susceptible to infections. This increased risk is
caused by an increased immune tolerance in pregnancy to prevent an immune
reaction against the fetus.
Peripartum cardiomyopathy is a decrease in heart function which occurs in the
last month of pregnancy, or up to six months post-pregnancy

Maternal Mortality
Maternal mortality is unacceptably high. About 830 women die from pregnancy
or childbirth-related complications around the world every day. It was estimated
that in 2015, roughly 303,000 women died during and following pregnancy and
childbirth. Almost all of these deaths occurred in low-resource settings, and
most could have been prevented. The high number of maternal deaths in some
areas of the world reflects inequities in access to health services and highlights
the gap between rich and poor. Almost all maternal deaths (99%) occur in
developing countries. More than half of these deaths occur in sub-Saharan
Africa and almost one third occur in South Asia.
Almost all maternal deaths can be prevented, as evidenced by the huge
disparities found between the richest and poorest countries. The lifetime risk of
maternal death in high-income countries is 1 in 3,300, compared to 1 in 41 in
low-income. [12]
Even though maternal mortality in the United States is relatively rare today
because of advanced in medical care, it is still an issue that needs to be
addressed. The Centers for Disease Control and Prevention define a pregnancy-
related death as the death of a woman while pregnant or within 1 year of the
end of a pregnancy–regardless of the outcome, duration, or site of the
pregnancy–from any cause related to or aggravated by the pregnancy or its
management, but not from accidental or incidental causes. The reasons for the
overall increase in pregnancy-related mortality are unclear. What do you think
are some reasons for this surprising increase in the United States?

Miscarriage
Spontaneous abortion, or miscarriage, is experienced in an estimated 20-40
percent of undiagnosed pregnancies and in another 10 percent of diagnosed
pregnancies. Usually, the body aborts due to chromosomal abnormalities and
this typically happens before the 12th week of pregnancy. Cramping and
bleeding result and normal periods return after several months. Some women
are more likely to have repeated miscarriages due to chromosomal, amniotic, or
hormonal problems; but miscarriage can also be a result of defective sperm

Government of india initiative on prenatal care

The Government of India has implemented several initiatives to address
common prenatal growth problems and improve maternal and child health.
These initiatives are designed to enhance healthcare services, promote
awareness, and empower pregnant women. Some key government initiatives
include:

Janani Suraksha Yojana (JSY): Launched under the National Health

Mission, JSY is a conditional cash transfer scheme that incentivizes pregnant
women to give birth in healthcare facilities. The program aims to reduce
maternal and neonatal mortality by increasing institutional deliveries.

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): This

initiative focuses on providing comprehensive antenatal care to pregnant
women, ensuring safe motherhood. It includes free health check-ups,
counseling, and necessary medical services on the 9th of every month, known as
the "Pradhan Mantri Surakshit Matritva Diwas."

Integrated Child Development Services (ICDS): ICDS is a flagship

program addressing the nutritional and health needs of pregnant women and
children under six. It provides supplementary nutrition, immunization, and
health check-ups to pregnant women and lactating mothers.
National Nutrition Mission (Poshan Abhiyaan): Launched to address
malnutrition in pregnant women and children, this mission aims to reduce
stunting, undernutrition, anemia, and low birth weight. It emphasizes the
importance of nutrition, healthcare, and sanitation.

Matru Vandana Yojana: Under this scheme, a cash incentive is provided to

pregnant women for the first living child, with the objective of promoting
institutional delivery and ensuring better health outcomes for both mothers and
infants.

Rashtriya Kishor Swasthya Karyakram (RKSK): Focused on the

health and well-being of adolescents, RKSK includes interventions related to
nutrition, sexual and reproductive health, and mental health education. This
indirectly contributes to improving prenatal health by addressing issues before
pregnancy.

Pradhan Mantri Matru Vandana Yojana (PMMVY): This maternity

benefit program provides financial assistance to pregnant women and lactating
mothers for the first live birth. The cash incentive is aimed at reducing maternal
mortality and promoting better health practices during pregnancy.

These initiatives collectively strive to tackle common prenatal growth problems

by ensuring access to healthcare services, promoting nutrition, and raising
awareness among pregnant women and communities. Ongoing evaluation and
refinement of these programs contribute to their effectiveness in improving
maternal and child health across the country