Factors affecting growth and development:

Pre-natal environment:

Factors related to mothers during pregnancy:

• Nutritional deficiencies: Poor or inadequate nutrition is probably the greatest threat to
abnormal development of the unborn child. Because food supply for the developing
fetus comes from the mother’s bloodstream by way of the placenta, there is good
reason to be concerned about the expectant mother’s diet. Malnutrition during
pregnancy has been associated with still-birth, prematurity, low-birth weight and neo-
natal death. In addition to this, improper nutrition of mother is also associated with a
variety of problems after birth including rickets, mental deficiency, general weakness
and susceptibility to the diseases. Because of the importance of nutrition, it is
desirable for the woman to begin pregnancy with a history of good eating habits and
in a healthy, well-nourished state. Even though expectant mothers ordinarily plan
their diets carefully during pregnancy, it is difficult to quickly reverse the effects of a
previously inadequate diet because of the increased nutritional demands made on the
expectant mother by the unborn child.
There is consistent evidence that long term cognitive defects occur to the children
of mothers who were malnourished during pregnancy. The investigators concluded
that the stress of malnutrition disrupts the infant-caregiver relationship since both
mother and infant may lack the energy to reciprocally stimulate one another. The
result is infant behavior characterized by withdrawal from potential interactions that
support social and cognitive development.
• Maternal Emotional state: Although the blood systems of the mother and the unborn
child are separate, it is possible for the nervous system of the mother to affect the
nervous system of the fetus. When the mother experiences such emotions as rage,
anger and anxiety, her autonomic nervous system send chemicals into the blood
stream. In addition to these chemicals (acetylcholine and epinephrine), the mother’s
endocrine gland secretes hormones that combine to modify cell metabolism. As a
result, the composition of the mother’s blood changes, and the change agents are
passed through the placenta, in turn, producing changes in the fetal blood system and
in fetal activity level. Such a drop in blood to the uterus and placenta may result in a
deficient supply of oxygen for the fetus. Generally speaking, the impact of emotional
stress on the unborn child depends on the stage of pregnancy. Severe and prolonged
emotional stress early in pregnancy may result in physical abnormalities, whereas
such stress later in pregnancy is more likely to result in fetal behavioral changes.
( rather than physical deformities).
• Maternal Age and Size: The female reproductive life span extends from about an
age of 12 to 45 years. The recommended period for the child bearing is between the
ages of 20 and approximately 35 years during which highest proportion of healthy
children are born. Between twenty and thirty five years of age, there are also fewer
pregnancy complications, including spontaneous abortions, still births, maternal
deaths, and prematurity.
Women aged twenty to twenty-four are the most fertile. Fertility is reduced by
6 percent for women aged twenty-five to twenty-nine, 14 percent for women aged
thirty to thirty-four, 31 percent for women aged thirty-five to thirty-nine and, declines
much more rapidly thereafter. Fertility rates also decline with duration of marriage,
possibly because of both decreased sexual activity and reproductive impairment
connected with more pregnancies. Mothers under twenty and over thirty-five or forty
are more likely to experience irregular ovulation, which tends to be associated with
 problematic conceptions. The occurrence of problems such as miscarriages,
hydrocephalus (water on the brain) and Down syndrome are associated with the
advancing age of the mother.
Two factors relative to the maternal size may cause pregnancy difficulties for the
mother. These are shortness (less than five feet in height) and obesity. Women under
five feet tall are more likely to have difficult pregnancies, more difficult labors, and
somewhat higher fetal mortality rates. Obesity may be associated with more difficult
labor, higher fetal mortality rates, and a higher incidence of toxemia.

• Alcohol: A malformation syndrome called the fetal alcohol syndrome (FAS) has been
found among the babies of mothers who are chronic alcoholics. Infants who suffer
from FAS may demonstrate such defects as prenatal and postnatal growth
deficiencies, abnormal development of the heart, defects of the joints, mental
retardation, and facial abnormalities. Generally, the damage to the fetus caused by
alcohol appears to be the greatest during the last trimester of pregnancy.
In addition to these physical problems, infants of mothers who drink also exhibit
behavioral irregularities such as hyperactivity and irritability. These infants may also
show withdrawal symptoms such as shaking and vomiting. A study revealed that
maternal alcohol use was related to lower levels of infant arousal, increased time
spent in a non-alert awake state, and deficits in learned head-turning or sucking
responses.

• Nicotine: Cigarette smoking by pregnant women has been found to be related to some
serious consequences for the fetus and the newborn infant. Infants born to women
who smoke are on an average 200 grams lighter than infants of non-smokers.
Maternal smoking also increases the risk of spontaneous abortions, fetal death,
neonatal death, and other complications. In addition, there is evidence that SIDS
(Sudden Infant Death Syndrome, in which infants under six months of age stop
breathing and die) is more common for women who smoke, drink, or use narcotics.
Maternal cigarette smoking may deprive the fetus of oxygen. This may occur in two
ways:
1. Cigarette smoking increases the levels of epinephrine and norepinephrine in
the blood and thus reduces the blood supply (and therefore the oxygen level)
to the placenta.
2. Cigarette smoking results in a significant increase in the amount of carbon
monoxide inhaled. This in turn reduces the amount of oxygen in the blood
and, therefore, the amount of oxygen going to the placenta. Cigarette smoking
results in a significant increase in amount of carbon monoxide inhaled.

• Drugs: During pregnancy, particularly sometimes before birth use of medicine and
drugs have adverse effect on the infant. Researches show that foreign particles from
the mother’s bloodstream do pass into the blood stream of the fetus. Stage of
development is more important than the strength or amount of drugs in determining
the extent and type of damage that will occur due to these drugs. Much of the damage
from drugs occurs in first trimester.

• Heroin: The increase in the incidence of heroin addiction in the general population
has resulted in an increasing number of infants who are born with an addiction to this
drug. Mothers who are heroin addicts have infants who demonstrate withdrawal
symptoms. During withdrawal, infants may vomit, become irritable, cry shrilly,
 become hyperactive, tremble, and have rapid respiration which can result, in some
cases, in death during the first few days of life.
• Infants born to addicted mothers are frequently premature and have low birth weights.
In addition, infant withdrawal symptoms may result in negative maternal reactions
which, in turn, negatively influence mother-infant interactional patterns. The addicted
babies may not respond positively to caregiver cuddling or mother stimulation and
would thus upset mother. The problems of infants born to female addicts may be
further complicated by other factors associated with heroin addiction, including
infections, malnutrition, and the threat of Acquired Immune Deficiency Syndrome
(AIDS).
• Thalidomide: It provides a tragic example of the effects of drugs on unborn child. It
is a drug which is given to the pregnant woman to cure morning sickness. This drug
interferes with the formation of ears, legs, arms if taken during the critical period i.e.
during the first trimester of pregnancy but when this drug is taken after this critical
period, then there is no influence of this drug because arms, legs and ears are already
formed.
• Labor and Delivery Drugs: There is also evidence of the influence of drugs taken
prior to and during the delivery. Although these drugs affect the new-born, it is not
certain what a long effect might be. Analgesics and anesthetics appear to slow the
onset of newborn respiration, decrease the level of unconsciousness of the newborn,
and reduce cerebral functioning. There is a critical cut-off level of use below which
infant is unaffected by these drugs. This cut-off level appears to vary with individual
characteristics which include physiological condition of the mother, length of labor,
size of baby and also maternal attitudes towards child birth experiences.
• Rh Factor Incompatibility: The Rh factor is a genetically determined feature of the
blood. The Rh factor can become a problem in the marriage of an Rh negative woman
and Rh positive man. The Rh positive fetus produces substances, called antigens that
pass through mother’s blood stream. The mother’s bloodstream, in turn, produces Rh
antibodies in response to the Rh positive antigens of the fetus. These antibodies pass
through placenta from the mother to the unborn child and attack and destroy fetal red
blood cells. The resulting disease called, erythroblastosis fetalis, produces severe fetal
anaemia. First born are usually not affected by the erythroblastosis because it takes
the mother sometime to develop a high enough levels of antibodies.
• Diabetic mother: Diabetic mothers have an increased risk of Preeclampsia, formerly
called toxemia. Preeclampsia affects the arteries carrying blood to the placenta. If the
placenta doesn't get enough blood, your baby may receive inadequate blood and
oxygen and fewer nutrients. This can lead to slow growth known as fetal growth
restriction, low birth weight or preterm birth. In addition, they are more likely to have
abnormally large babies (weighing more than nine pounds) with resulting delivery
complications and a higher-than-average infant mortality rate. Diabetic women are
more likely to have spontaneous abortions and children with malformations.

• Exposure to radiation: Depending on the stage of fetal development, the health

consequences of exposure at doses greater than 0.5 Gy can be severe, even if such a
dose is too low to cause an immediate effect for the mother. The health consequences
can include growth restriction, malformations, impaired brain function, and cancer.
Any harm to the developing baby will depend on:
o the radiation dose – smaller doses (amounts) are safer
o the age of the fetus – the further along you are in your pregnancy, the better
 o where the radiation is administered – tests involving your abdomen or pelvis,
or where the radiation is carried in your blood, pose a higher risk than other
tests
Most radiation exposure during medical testing is unlikely to harm a developing
baby. But sometimes, depending on the radiation dose and the developmental
stage of the fetus, the effects can be serious and may result in:
 failure of the embryo to implant
 miscarriage
 abnormalities of the central nervous system
 congenital malformations
 slower than normal growth
 malformation
 cataracts
 childhood cancer

• Malposition of the fetus in the uterus refers to abnormal positioning of the baby
during pregnancy and labor.

 Occiput Posterior (OP) Position: In this position, the baby's head is down, but the
back of the head (occiput) is facing towards the mother's back. This is often referred
to as "sunny side up" or "back-to-back" position. Occiput posterior position can
sometimes lead to prolonged labor and increased discomfort for the mother.
 Occiput Transverse (OT) Position: This occurs when the baby's head is down, but it is
facing sideways rather than towards the mother's back or front. Occiput transverse
position can also lead to prolonged labor and difficulties with delivery.
 Breech Position: In a breech presentation, the baby's buttocks or feet are positioned to
emerge first during delivery, rather than the head. Breech presentation increases the
risk of complications during delivery and often requires special management or a
cesarean section.
 Face Presentation: In this position, the baby's face is positioned to emerge first during
delivery, rather than the top of the head. Face presentation is relatively rare and may
result in prolonged labor or difficulties with delivery.
 Compound Presentation: This occurs when one of the baby's extremities (such as a
hand or arm) presents alongside the head during delivery. Compound presentation can
increase the risk of complications during labor and may require assistance from
healthcare providers.
 Transverse Lie: In a transverse lie, the baby is positioned horizontally across the
uterus rather than vertically. Transverse lie can increase the risk of umbilical cord
prolapse and other complications during labor.
 Asynclitic Presentation: This occurs when the baby's head is tilted to one side, rather
than being perfectly aligned with the birth canal. Asynclitic presentation can lead to
difficulties with descent during labor.

• Faulty placental implantation:

 Placenta Previa: This occurs when the placenta partially or completely covers the
cervix, obstructing the baby's exit during delivery. Placenta previa can lead to
bleeding during pregnancy, especially in the third trimester.
 Placenta Accreta: In this condition, the placenta attaches too deeply into the uterine
wall, sometimes even penetrating through the muscle. This can lead to difficulties
during delivery and may require surgical intervention to remove the placenta safely.
 Placenta Increta: This is a severe form of placenta accreta where the placenta invades
the muscle of the uterus deeply.
 Placenta Percreta: This is the most severe form of placenta accreta where the placenta
penetrates through the uterine wall and may even extend to adjacent organs such as
the bladder.
 Vasa Previa: This condition occurs when fetal blood vessels cross or run near the
cervical opening. If these vessels rupture, it can lead to rapid fetal blood loss and is a
significant risk during delivery.
 Marginal Cord Insertion: In this condition, the umbilical cord is inserted at the edge or
margin of the placenta instead of the center. It can sometimes lead to compromised
blood flow to the baby.
 Battledore Placenta: This is a condition where the umbilical cord is attached near the
margin of the placenta, making it look like a "battle-axe." It may lead to
complications during labor and delivery.
 Velamentous Cord Insertion: This occurs when the umbilical cord inserts into the fetal
membranes rather than directly into the placenta. This can lead to the vessels being
unprotected and at risk of compression during labor.
• Post-Natal Environment
 Breastfeeding: Breastfeeding provides optimal nutrition and immune protection for
infants. It can reduce the risk of infections, allergies, obesity, and certain chronic
diseases later in life.
 Immunizations: Following recommended immunization schedules helps protect
infants from serious infectious diseases such as measles, mumps, rubella, whooping
cough, and hepatitis. Immunizations also contribute to herd immunity, protecting
vulnerable individuals in the community.
 Safe Sleep Practices: Infants should be placed on their backs to sleep in a safe sleep
environment, including a firm mattress with no soft bedding or toys that could pose a
suffocation risk. Following safe sleep guidelines reduces the risk of sudden infant
death syndrome (SIDS) and other sleep-related infant deaths.
 Regular Check-ups and Vaccinations: Regular visits to a pediatrician or healthcare
provider allow for monitoring of growth and development and the administration of
vaccinations according to the recommended schedule. Early detection and
management of health issues are crucial for ensuring optimal outcomes.
 Nutrition: Introducing appropriate complementary foods at the right time and ensuring
a balanced diet are essential for supporting growth and development. Adequate
nutrition supports the development of a strong immune system, cognitive function,
and overall health.
 Environmental Factors: Exposure to tobacco smoke, pollutants, and toxins can have
adverse effects on infant health, including respiratory problems, developmental
delays, and increased risk of infections. Maintaining a clean and safe environment is
important for promoting infant health.
 Parental Mental Health: Parental mental health has a significant impact on infant well-
being. Maternal depression, anxiety, and stress can affect infant development,
bonding, and attachment. Access to support services and resources for parents
experiencing mental health challenges is essential.
 Physical Activity and Stimulation: Providing opportunities for physical activity and
age-appropriate stimulation supports infant development, including motor skills,
cognitive abilities, and social-emotional well-being.
 Responsive Caregiving: Responding promptly to infant cues, providing nurturing
care, and fostering secure attachment relationships contribute to positive emotional
 and social development. Responsive caregiving supports infants in feeling safe, loved,
and secure, which is essential for their overall well-being.
 Hygiene and Preventive Measures: Practicing good hygiene, such as regular
handwashing, maintaining clean surroundings, and following recommended hygiene
practices, helps prevent the spread of infections and reduces the risk of illness for
infants.
 Child’s ordinal position in the family: Your position in the family can affect your
personality, behaviour and view of the world, according to the experts. Birth order is
considered by some researchers and psychologists to be one of the most powerful
influences on personality, along with genetics, gender, temperament and parenting
styles.
 Number of siblings in the family: this will determine allocation and accessibility t
resources.