Antenatal Care as it Affects the Child in Utero

Abstract

A study of the influences of antenatal care of the mother upon the well-being of the child in utero. Amand ROUTH estimated that 1 in 5 of all pregnancies ends in abortion. Moreover in 1924 the ratio of still-births to live births was 33 to 1, 000. Intra-uterine life is divided into 3 periods by BALLANTYNE: (1) Embryonic period (1 to 8 weeks); (2) fetal period (8 weeks to onset of labour); (3) Intranatal period. In the embryonic period 3 things are of interest: - (a) Sex determination-belief that the child's sex can be arranged between husband and wife has no basis in accredited facts. (b) Deformities are produced at this time. Despite experimental successes in producing deformities in lower animals we have as yet no knowledge of the causative factors in man. (c) Causes of embryonic death during this period are very incompletely known. In the foetal period it is of interest to know whether the mother can influence the condition of the child in utero by her own physical health, occupation, etc., and various points are discussed. (a) Transmission of immunity. The idea that immunity is not acquired in utero but only from the colostrum may be true in ruminants but is not true in man and certain rodents. There is no doubt that the human fetus does obtain a certain degree of passive immunity by placental interchanges. Foetal immunization is a subject presenting great scope for development. (b) Effect of general maternal conditions. It is probably untrue that the fetal parasite will succeed in looking after itself no matter how much its host may suffer from malnutrition, etc. . (c) Effect of maternal occupation. PINARD claimed that women who abstain from work during the later months of their preganacies carry the fetus to full term and have heavier children than thuse who continued in their occupation until the onset of labour. FUCHO did not agree entirely but he also advocated rest during the latter part of pregnancy. (d) Effect of maternal hardship and privation. It is remarkable how little alteration in the size and weight of children born in Germany and Austria was produced during the war years. But there does seem to be a limit beyond which conditions of privation and hardship have a definitely detrimental effect on the child. (e) Effect of maternal diet (specific rather than general deficiencies). A diminished number of fertile matings can be shown, under experimental conditions, to occur in animals with diets deficient in protein, calcium, etc. It is possible that certain human cases of sterility or habitual abortion may be associated with some dietetic fault. Effect of Alcohol. It cannot be disputed that alcohol taken by the mother will pass into the fetal circulation, for it is an extremely diffusible drug. In experimental animals the following effects have been produced by exposing the mother to alcohol: Diminished fertility in the mothers; young diminished in vigour and power of survival; a high proportion of developmental defects, particularly in C.N.S. and sense organs; occasional transmission of defects to the 3rd generation. In man, alcoholism of the parents is one of the most important predisposing causes in the production of epilepsy and amentia. Abstinence from alcohol during pregnancy should be advised. (g) Effects of maternal disease. The author makes no attempt to deal with this subject in any detail but points out the importance of discovering and treating syphilis and latent syphilis in the pregnant woman. In the intranatal period the dangers are mainly due to birth traumatism. The author points out that hospital figures show a much higher still-birth rate than the average for the whole country-12 per cent. and 3.3 per cent. in the figures quoted, from which, too, it would appear that the fetal loss of life is higher in an industrial population. The author arrives at the true intranatal death rate as follows: First a gross rate (A) including all the dead-born is calculated. This is corrected (rate B) by deduction of all macerated cases and further corrected (rate C) by deduction of cases dying as a result of maternal complications (ante-partum haemorrhage, eclampsia, etc.); after this there must be added those neonatal deaths directly traceable to intranatal injury. In the hospital figures no great reduction is obtained by subtracting the macerated foetuses, but of the remainder approximately one half are due to craniotomy, antepartum haemorrhage and eclampsia, In the Group C. 561 cases were examined. [img 1T21359A.tif] The premature birth rate was also examined for 3 hospitals. [img 1T21359B.tif] Hospital 3 serves a large industrial centre and the table suggests that women engaged in industrial work are unable to carry their children to term in anything like the same proportion as those engaged in lighter occupations. The above table shows the greatly increased proportion of still-births in premature as compared with mature children, but it must be remembered that approximately 60 per cent, of still-births are macerated. It also shows the relatively poor chance of survival of the premature as compared with the mature child. Leslie Williams.