Problems before birth

Problems in a newborn may have begun before birth.

Problems that develop before birth may be related to conditions in the mother that existed before the pregnancy or developed during the pregnancy, or to conditions in the fetus. Appropriate medical care during pregnancy can help prevent and diagnose many problems in the fetus.

Maternal health problems

The mother's health problems during pregnancy can affect the growing fetus and negatively impact the health of the newborn. Although mothers rightly worry about the effects of medications on a developing fetus, they also must realize that failing to take necessary treatments can allow their medical disorders to harm the fetus. Women should discuss with their doctor the risks and benefits of different treatments for their specific conditions.

Anorexia and bulimia can cause the fetus to receive inadequate nutrition, as does any other situation in which the mother does not eat adequately or take appropriate vitamins.

Asthma does not usually affect the fetus as long as the mother's condition is well controlled. However, some women have significant problems with their asthma during pregnancy and must take appropriate treatment to protect the fetus.

Cancer itself does not usually affect the fetus, but drugs used to treat cancer may have side effects that may affect the fetus.

Diabetes may result in an increased risk of birth defects, a small baby, or a large baby. The most common problem for newborns is low blood sugar (hypoglycemia).

Epilepsy (a seizure disorder) increases the risk of birth defects. Some of the increased risks are due to the anticonvulsant drugs that may be necessary to control seizures. However, the mother's seizures also are dangerous for the fetus. Women should discuss with their doctor the risks and benefits of drug treatment before they stop taking their anticonvulsants.

High blood pressure, heart disease, and kidney disease may reduce the growth of the fetus and cause other complications.

Lupus (systemic lupus erythematous) increases the risk of miscarriage and prematurity and causes an abnormally slow heart rate in the fetus.

Preeclampsia can cause severe problems for the mother and fetus. The disease can cause the mother's blood pressure to become severely elevated and can affect the mother's kidney, liver, brain, and other organs. The placenta is affected and the disease can affect the nutrition of the fetus or cause the placenta to detach from the wall of the uterus. To prevent or manage such complications, doctors may recommend early delivery.

Women who have sickle cell disease may have increased sickle cell crises during pregnancy. If the father carries the sickle cell gene or is affected by sickle cell disease, there is a risk of sickle cell disease in the offspring. Testing of the parents before pregnancy can determine their risk of having a child with sickle cell disease. Genes that cause sickle cell diseases can be detected in the fetus during the pregnancy, but the disease does not start until several months after birth.

Thyroid disease that causes a low thyroid hormone level (hypothyroidism) may cause brain damage in the fetus and lead to long-term neurologic problems. Thyroid disease with a high thyroid hormone level (hyperthyroidism) may cause the fetus and newborn to have an overactive thyroid gland.

Maternal drug use

Most prescription drugs are safe during pregnancy, but women should review all their drugs with their doctor when they become pregnant or plan to become pregnant. However, even prescription drugs that cause some risk may still be necessary for women. Uncontrolled medical problems in the mother also can be dangerous to the fetus. Some common prescription drugs that can cause problems for the fetus include,

• Insulin
• Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs)
• Opioids
• Anticonvulsants (drugs that control seizures)

Smoking or being exposed to secondhand smoke during pregnancy decreases the growth of the fetus. Pregnant women should avoid exposure to tobacco smoke as much as possible.

Alcohol is particularly dangerous to the fetus because it is a teratogen (a substance that can cause birth defects). Alcohol increases the risk of miscarriage, stillbirth, poor growth of the fetus, prematurity, and birth defects. A particularly devastating effect of alcohol is fetal alcohol syndrome, which causes life-long intellectual, developmental, and behavioral disabilities. There is no safe amount of alcohol during pregnancy.

Opioid drugs such as heroin, morphine, opium, oxycodone, codeine, hydrocodone, fentanyl, hydromorphone, meperidine, buprenorphine, and methadone, affect the growth of the fetus and cause withdrawal symptoms in the newborn beginning hours to several days after birth. These and other opioids, particularly combined with other drugs such as acetaminophen, are prescribed under many different brand names (some of which in the United States include Lorcet, Lortab, Norco, Vicodin, Percocet, Endocet, Roxicet, and Tylenol #3). Mothers should be aware of the ingredients of any painkiller they take. Opioids drugs such as methadone and buprenorphine that are sometimes used to treat a mother's opioid dependence also can cause withdrawal symptoms in newborns. Newborns withdrawing from methadone may need longer treatment than newborns withdrawing from other opioids.

Cocaine increases the risk of poor growth of the fetus and prematurity. The premature separation of the placenta from the wall of the uterus (placental abruption) is more common among cocaine users and can cause stillbirth or oxygen deprivation and brain damage in the fetus. Because cocaine narrows blood vessels, it can cause a stroke or damage other organs in the fetus. Although cocaine was once widely thought to cause permanent brain injury, long-term studies have not shown that it causes significant long-term intellectual and developmental disabilities.

Maternal lifestyle

In addition to avoiding harmful substances, expectant mothers can improve the chances of having a healthy baby by taking prenatal vitamins, receiving early prenatal care, and maintaining a healthy weight and diet.

Fetal problems

Birth defects can involve almost any organ. Prenatal ultrasonography is used to diagnose many of these defects before birth.