The Effects of Prenatal

Care on The Growth and

Development of the Infant

Jenna Gibson, Ashley Dibble, Carlie Angelo,

Maura Kennedy, Layne Black, Kat Keller
PICOT QUESTION:

What is the effect of prenatal care on

the growth and development of infants
in relation to socioeconomic status?
 Intro

The purpose of this research report was to look at the relationship between
prenatal care and the effects it can have on the growth and development of
infants. Research shows prenatal care can have a positive effect on both
mother and baby during and after pregnancy. Many multifactorial studies
have been conducted to prove the benefits of prenatal care. With this being
said, some women still do not receive prenatal care due to a multitude of
barriers. This paper also looks at barriers to care such as education,
socioeconomic class, healthcare accessibility, mental health, etc.
Prenatal Care

● The care a woman receives while pregnant

● UCR Health states, “babies of mothers who do not get prenatal care are
three times more likely to have a low birth weight and have birth
complications” (“Prenatal Care is,” 2018).
● Schedule
○ every month up to 28 weeks
○ every two weeks for the weeks 28-36
○ every week from week 36 until delivery
Prenatal Care Cont.
● Use of prenatal care lowers risk of preterm birth, low birth weight, and
NICU admissions
● Perform regular exercise, and avoid exposure to toxic substances that
can be potentially harmful to the baby. (“Prenatal Care Is,” 2018)

● Nutrition
○ diet full of vitamins
○ Minerals
○ fruits and vegetables
● “Offspring of non‐users had a monthly increase in percent fat mass of
3.45%, while offspring at the top quartile of multivitamin users had a
monthly increase in percent fat mass of 3.06%” (Sauder et al., 2016, pg
123).
Vitamins

● The types of vitamins and minerals a pregnant woman is to take

during pregnancy include
○ Folic acid
○ Calcium
○ Vitamin D
○ Iron.
● According to the Center for Disease Control, pregnant women are
prescribed 400 micrograms of folic acid daily. Folic acid has been
proven to reduce the risk of neural tube defects in a fetus (“Folic Acid
Helps,” 2020).
Vitamin D on Fetus Health
- Vitamin D has been found to have positive health benefits to
the fetus when taken during the prenatal period.
- Recommended dose: 400 IU (international Units) a day.
- In almost all prenatal vitamins
- American Journal of Clinical Nutrition states “... Vitamin D
is important for placental function, calcium Homeostasis,
and bone mineralization, which are all important
determinants for fetal growth and development” (Miliku et
al., 2016, Pg. 1514)
- Study shows that mothers with low vitamin D concentrations had an
increased risk for preterm delivery, low birth weight, and small size for
gestational age at birth.
Congenital Defects
● “Birth defects are structural changes present at birth that can affect almost any
part or parts of the body (e.g. heart, brain, foot). They may affect how the body
looks, works, or both. Birth defects can vary from mild to severe” (Data and
Statistics on Birth Defects, 2020. Pg 1).
● Obtaining prenatal care helps to prevent birth defects/ congenital defects
● Ways to help decrease the chances of congenital defects include:
○ Seek medical care from your doctor before you are attempting to get
pregnant and have regular visits during pregnancy.
○ Taking prenatal vitamins, especially folic acid!
○ Avoid harmful substances such as alcohol, smoking, and drugs while
pregnant.
○ Maintain a healthy lifestyle
○ Maintain a healthy weight
Neural Tube Defects
● “Neural tube defects are major birth defects of the brain and the spine
that occur early in pregnancy as a result of improper closure of the
embryonic neural tube, which can lead to death or varying degrees of
disability” (Updated Estimates of Neural Tube Defects Prevented by
Mandatory Folic Acid Fortification- United States, 2015, Pg. 2).
● Two most common NTDs are spina bifida and anencephaly
● Getting the right amount of folic acid before conception can help to
prevent NTDs
● Recommended amount is 400 mcg every day
Neural Tube Defects Cont.

● A recent study was done to look at the effects of mandated fortification

of enriched cereal grain products with 140 ug of folic acid per 100g, the
results are as follows:
○ Results showed that immediately after the fortification, the prevalence of NTD cases
declined. Fortification was estimated to avert approximately 1,000 NTDs annually. The
number of births occurring annually without NTDs that would otherwise have been
affected is approximately 1,326 (95% confidence interval= 1,122- 1,531). The reduction in
NTD cases inversely mirrors the increase in serum and red blood cell folate
concentrations among women of childbearing age… (Williams et al., 2015, Pg. 4).
● Foods containing folic acid include dark green leafy vegetables,
oranges, and legumes.
Infant Mortality
● Women with pre-existing conditions, such as diabetes, should visit their
healthcare provider to discuss a parental plan and a healthy lifestyle to
live in order to conceive a healthy baby and prevent mortality.
● Lack of control of diabetes (maternally) is a significant contributor to
stillbirth, fetal overgrowth, and neural tube defects (Infant Mortality
Lessons learned from a Fetal and Infant Mortality Review Program, 2017).
● Women with a history of preterm birthing are at an increased risk for
another occurrence (Brown et al., 2017).
● The weekly use of progesterone can help to decrease the risk of another
preterm birth (Brown et al., 2017).
● Prenatal care can help to prevent infant mortality and complications
related to preterm birth.
Socioeconomic Barriers to Prenatal Care
Hardships are not uncommon amongst pregnant women leading to them not
receiving prenatal care, thus putting themselves and the infants well-being
at risk.

Barriers Include:

1. Financial Uncertainties
2. Insurance Companies
3. Lack of Transportation
4. Low-Level of Education
Socioeconomic Barriers Cont.
Financial Uncertainties
● 56% of pregnant women reported some form
of material hardship (Katz at el., 2018).
○ Not enough food in the house, lack of
clothing, not enough money to pay
bills
○ These women can experience
nutritional shortfalls and have
unhealthy living conditions
● Prenatal care is less desired because of the
added stress from financial hardships they
are already facing
○ Uncertainty on how she will be able to
afford doctors appointments, prenatal
vitamins, and prenatal tests
Insurance
● Pregnant women delay prenatal care
because they do not have the means to pay
from the lack of insurance coverage they
have (Ayers et al., 2018).
○ Maternal care can be an extra charge
for some insurances
● Insurance eligibility processes can be
complicated
○ Pregnant women do not know where
to go or how to apply for Medicaid
(Ayers et al., 2018)
○ Women feel confused, overwhelmed,
and frustrated so they go without
prenatal care
Socioeconomic Barriers Cont.
Lack of Transportation
● 37.3% of women experience hardships involved
with transportation to medical appointments
(Katz at el., 2018).
○ Long distances to reach provider
■ Living in rural areas
○ The high cost of transportation
■ Can't afford a car or gas money
○ Less reliable public transportation
■ May or may not be offered for
prenatal services
■ Time conflicts
○ No transportation whatsoever
Low-Level Education
● A low level education can cause poor
reproductive health knowledge
○ Don't know what prenatal care is
○ Don't know where to recieve it
○ Don't think they need prenatal care
○ Don't know the benefits
● A low level of education can lead to low income
○ Financial hardships
Other Barriers to Prenatal Care

● Mental Health
○ It has been found that “women who suffer
from psychiatric illness during pregnancy are
less likely to receive adequate prenatal care
and are more likely to use alcohol, tobacco,
and other substances known to adversely
affect pregnancy outcomes” (Massachusetts
General Hospital, 2018, pg.11).
○ 10-13% of pregnant women report some type of
mental illness (McDonald et al., 2020).
Other Barriers cont.

● Substance Abuse
○ Many women who are dependent on substances do not
seek care due to the stigma around drug and alcohol
dependence
■ For women who are addicted to opioids,
Medication Assisted Treatment (MAT) is an
option.
○ A study showed that MAT and MAT + ALC users were
“more likely to be single/separated or divorced, to have
lower education levels, at least one medical condition,
and an unplanned pregnancy compared to controls”
(Shrestha et al., 2018, pg.37)
Other Barriers cont.

● Substance Abuse cont.

○ Substance abuse is associated with
increased intake of calories with an
inadequate intake of nutrient dense
food
■ This results in inadequate:
● Folic Acid
● Choline
● Vitamin B6 and B12
Postpartum Infant

● This is the time following childbirth

● “Prenatal care decreases the risk pregnancy complications as well
decreases the risk for complications after the pregnancy.” (“What is
Prenatal Care,” 2017, page 3).
● Going to well checks before the actual birth of the child, can help
reduce birth risk factors such as fetal heart auscultation and urinalysis.
(Liu et al., 2017).
Milestones and Measurements Postpartum

● An infant is most likely to achieve milestones and measurements if the

mother has received prenatal care
● Milestones:
○ Gain head control at four months
○ Acquire two-handed, voluntary grasp at five months
● Measurements:
○ Weight: six to eight pounds and triples in the first year
○ Height: twenty inches and increases by fifty percent by twelve months
● A premature infant can have delayed milestones. The Yale School of
Public Health has researched that having prenatal care reduces the risk
of having a preterm birth. (“Prenatal Care,” 2018, page 1).
Conclusion

Studies show that establishing early prenatal care and continuation until
the time of delivery is one of the most effective interventions in reducing
congenital deformities and health complications in the infant. These
studies display the positive effects on prenatal vitamins and nutrition on
health of the infant. In addition, there are also many barriers to care that
prevent mothers from receiving these prenatal nutrients. Not entering this
care can cause health problems in both mother and infant.
References
● Ayers, B. L., Purvis, R. S., Bing, W. I., Rubon-Chutaro, J., Hawley, N. L., Delafield, R., Adams, I. K., & McElfish, P. A. (2018).
○ Structural and Socio-cultural Barriers to Prenatal Care in a US Marshallese Community. Maternal & Child Health Journal,
22(7), 1067–1076. https://doi.org/10.1007/s10995-018-2490-5
● Brown, H., Smith, M., Beasley, Y., Conard, T., Musselman, A., & Caine, V. (2017). Infant Mortality Lessons Learned from a
○ Fetal and Infant Mortality Review Program. Maternal & Child Health Journal, 21, 107–113.
https://doi.org/10.1007/s10995-017-2384-y
● Data & Statisticcs On Birth Defects. (2020, January 23). Retrieved April 5, 2020, from https:// www.cdc.
○ gov/ncbddd/birthdefects/data.html
● Folic Acid Helps Prevent Some Birth Defects. (2020, January 2). Retrieved April 4, 2020, from
https://www.cdc.gov/ncbddd/folicacid/features/folic-acid-helps-prevent-some-birth-defects.html
● Katz, J., Crean, H. F., Cerulli, C., & Poleshuck, E. L. (2018). Material Hardship and Mental Health Symptoms Among
○ a Predominantly Low Income Sample of Pregnant Women Seeking Prenatal Care. Maternal & Child Health
Journal, 22(9), 1360–1367. https://doi.org/10.1007/s10995-018-2518-x
● Liu, X., Behrman, J. R., Stein, A. D., Adair, L. S., Bhargava, S. K., Borja, J. B., da Silveira, M. F., Horta, B. L.,
Martorell, R., Norris, S. A., Richter, L. M., & Sachdev, H. S. (2017). Prenatal care and child growth and schooling
in four low- and medium-income countries. PloS one, 12(2),
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References Cont.
● Massachusetts General Hospital. (2018, May 29). Psychiatric Disorders During Pregnancy. Retrieved from
https://womensmentalhealth.org/specialty-clinics/psychiatric-disorders-during-pregnancy/

● McDonald, L. R., Antoine, D. G., Liao, C., Lee, A., Wahab, M., & Coleman, J. S. (2020). Syndemic of Lifetime Mental
Illness,Substance Use Disorders, and Trauma and Their Association With Adverse Perinatal Outcomes. Journal of Interpersonal
Violence, 35(1/2), 476–495. https://doi-org.ma.opal-libraries.org/10.1177/0886260516685708

● Miliku, K., Vinkhuyzen, A., Blanken, L. M. E., McGrath, J. J., Eyles, D. W., Burne, T. H., Hofman, A., Tiemeier,
H.,Steegers, E. A. P., Gaillard, R., & Jaddoe, V. W. V. (2016). Maternal vitamin D concentrations during pregnancy,
fetal growth patterns, and risks of adverse birth outcomes. American Journal of Clinical Nutrition, 103(6), 1514–1522.
https://doi.org/10.3945/ajcn.115.123752

● Prenatal care is key for a healthy pregnancy. (2018, July 9). Retrieved April 2, 2020, from
https://www.ucrhealth.org/notes-news/blog/july-2018/healthy-pregnancy-the-importance-of-prenatal-care
 References Cont.
● Sauder, K. A., Starling, A. P., Shapiro, A. L., Kaar, J. L., Ringham, B. M., Glueck, D. H., & Dabelea, D. (2016). Exploring the
association between maternal prenatal multivitamin use and early infant growth: The Healthy Start Study. Pediatric Obesity,
11(5), 434–441. https://doi.org/10.1111/ijpo.12084

● Shrestha, S., Jimenez, E., Garrison, L., Pribis, P., Raisch, D. W., Stephen, J. M., & Bakhireva, L. N. (2018). Dietary intake
among opioid- and alcohol-using pregnant women. Substance Use & Misuse, 53(2), 260–269.
https://doi.org/10.1080/10826084.2016.126556

● What is prenatal care and why is it important? (2017). Retrieved from

https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care

● Williams, J., Mai, C. T., Mulinare, J., Isenburg, J., Flood, T. J., Ethen, M., Frohnert, B., & Kirby, R. S. (2015). Updated estimates of neural
○ jtube defects prevented by mandatory folic Acid fortification - United States, 1995-2011. MMWR: Morbidity & Mortality Weekly Report,
64(1), 1–5. https://doi.org/10.1007/s10995-017-2384-y