Running Head: EFFECTS OF MATERNAL RISK FACORS

Effects of Maternal Risk Factors on Infant Outcomes

Brianna Campy, Kathleen Peck, Luray Hixson, and Miranda Grace

04/06/2016

NURS 3947: Nursing Research

Dr. Valerie ODell

EFFECTS OF MATERNAL RISK FACTORS

Abstract

The purpose of this research study was to look at the relationship between maternal risk factors

and infant outcome. Both modifiable and non-modifiable risk factors were included. The risk

factors that we looked into were obesity, gestational diabetes, hypertension and smoking. These

risk factors showed to have effects on the outcome of newborns. These effects include

complicated pregnancy and labor, small for gestational age, large for gestational age, and

congenital abnormalities. This research paper is composed from eight research articles that have

been reviewed and explained, in order to show the correlations between these risk factors and

outcomes. Overall, there is significance evidence showing that maternal risk factors can

negatively affect the outcomes of the baby at birth and later throughout life.

Effects of Maternal Risk Factors on Infant Outcomes

EFFECTS OF MATERNAL RISK FACTORS

Since pregnancy is something that has always been around and will always be around, it

is important to know the risks that will affect the newborn. With more research being done it is

becoming more obvious what factors during pregnancy can influence the newborns health in

areas such as weight, congenital abnormalities and complications during pregnancy and labor. It

is important for these risks to be known by medical professionals as well as mother who are

pregnant or plan to become pregnant so that they can take the correct steps to have the best

health outcomes for their newborns. Though it is important to know, not everyone is proficient in

the areas of pregnancy risk factors and their affects. This brings forth the problem that women

and professionals can be uneducated in this area which can lead to not having proper care during

pregnancy. Therefore, this research question has been addressed: What risk factors in pregnant

women influence the newborn outcome?

Literature Review

Introduction

To explore the correlations of maternal risk factors with infant outcomes further, eight

articles were obtained from the following databases: PubMed.gov, Academic Search Complete,

CINHAL Plus, and Ebscohost. They were analyzed to collect data and reviewed to understand

the correlation between maternal risk factors and newborn outcomes. The maternal risk factors

discussed include obesity, hypertension, gestational diabetes and smoking.

Obesity
EFFECTS OF MATERNAL RISK FACTORS

Pregnancy, while a natural occurrence, has many risks and complications that come along

with it. In recent years, obesity, a growing epidemic in our country and around the world has

been complicating pregnancy even further. Obesity in women is defined as having a body mass

index of >30 with a BMI >40 being defined as extremely obese. Many recent studies have linked

maternal obesity prior to becoming pregnant and while pregnant puts the mother and her baby at

high risk for complications during pregnancy and labor, and fetal abnormalities. These

complications include, but are not limited to pre-eclampsia, hypertension, placental

abnormalities, gestational diabetes mellitus, and large for gestational age babies. These

complications can cost a mother her own life or the life of her baby if not managed properly.

Studies done in recent years stress the importance of a mother maintaining a healthy weight

before pregnancy and also maintaining a healthy weight throughout pregnancy, since gaining too

much weight during pregnancy can also put the mother and baby at many of the same risk as pre-

pregnancy obesity.

In 2015, a group of researchers conducted a study that examined the effects that obesity

has on a specific molecule called taurine. In the research, it explains the role that taurine has in

pregnancy such as transport of essential products through the placenta. In their study, they

collected placentas from full term, uncomplicated, singleton pregnancies from women with

BMI of 19-49. (Ditchfeild et al., 2015, p. 1). In the introduction to this study, there is a

comparison of mothers with a normal BMI with mothers who are classified as obese. This

comparison shows that mothers with a BMI greater than thirty more than triples their risk of

developing pre-eclampsia and that a BMI greater than 40 more than quadruples. Pre-eclampsia is

a serious complication that can lead to eclampsia with can cause many severe complications to

mother and infant such as stroke, seizure, and placental abruption.

EFFECTS OF MATERNAL RISK FACTORS

The researchers found that TauT activity (30-120 min) was significantly lower in

placentas of obese (BMI >30) as compared with ideal weight women. (Ditchfeild et al., 2015,

p. 3). This supports their claim that obesity affects the transport of essential nutrients to the fetus.

This can potentially cause fetal abnormalities and can also cause problems related to the

development of organs during gestation.

A study done by a group of researchers in Canada (2015) explored the relationship

between maternal weight and adverse outcomes of neonates. In their study, they discovered that

Women who were overweight or obese and were above their recommended [Gestational Weight

Gain] were significantly more likely to have a [large for gestational age] baby. (S. Dzakpsu et

al., 2015, p. 6). Women who give birth to large for gestational weight babies are at risk for

complicated deliveries. The risk of the newborn becoming wedged in the birth canal is

significantly higher than a newborn that is average weight. The fetus becoming lodged in the

birth canal puts the fetus at higher risk for injuries including broken bones. The most common

injury related to this complication is clavicle fractures. Many newborns that are LGA require the

use of forceps or a vacuum assist during delivery. Many doctors recommend that mothers with

suspected large for gestational age babies have a planned caesarean section to avoid these

complications.

Gestational Diabetes

Gestational diabetes is a maternal condition that can lead to an infant being large for

gestational age. Gestation diabetes is a condition that occurs around the 24th week of pregnancy,

the body is no longer able to keep up with making the amount of insulin needed during

pregnancy, when there is not enough insulin to break down glucose this leads to excess glucose

in the mothers blood stream which then passes on to the baby. This excess sugar can cause the
EFFECTS OF MATERNAL RISK FACTORS

baby to gain more weight at a more rapid pace, therefore it can lead to a baby large for

gestational age. According to a 2014 analysis by the Centers for Disease Control and Prevention,

the prevalence of gestational diabetes is as high as 9.2%. The cause of gestational diabetes is not

exactly known, but research shows it can be related to hormones. Because of the increasing rate

of gestational diabetes some studies have been done to determine the direct link between

gestational diabetes and infant birth weight and how the treatment modalities can help.

In these studies, they have found that uncontrolled gestational diabetes can lead to an

infant who is large for gestational age. Gestational diabetes has shown to have multiple negative

effects on the unborn infant, in one study it was found that Gestational diabetes mellitus (GDM)

is associated with adverse perinatal outcomes including increased birth weight, macrosomia, and

large for gestational age (LGA) neonates. (Segal et al., 2011, p.73) This increased birth weight

can also have a negative effect on the infant later in life. A study says Large for gestational age

infants appear to be at an increased risk of cardiovascular disease, diabetes and obesity later in

life. (Barnes et al., 2013, p.1040) The results of an increased birth weight are more in depth than

they seem. But not all case of gestational diabetes have to lead to an infant large for gestational

age. If the mother takes the right steps to care for herself and her child the birth weight can

normal.

When a mother is diagnosed with gestational diabetes, her doctor will have her use one of

two different treatment options. Diet changes for less severe cases and insulin, sometimes up to

three times a day, in more severe cases. The treatment and management with insulin and dietary

changes has been shown to reduce the risk of perinatal morbidity. The dietary changes help the

mother take in less glucose making it possible for the bodys insulin to be able to break it down,

lowering the free glucose in the mother and babies blood streams. Treatment with insulin
EFFECTS OF MATERNAL RISK FACTORS

provides the body with the insulin that it is unable to make or use in order to break down

glucose. The goal in treatment is to keep blood sugars within a defined limit, usually less than

120 mg/dL. Achieving these fasting glucose targets can reduce the risk of a baby who is large for

gestational age. As Barnes et al. (2013) says, Conventional treatment for gestational diabetes

mellitus concentrates on management of blood glucose levels. (p.1040) The management of

glucose levels can make all the difference.

Gestational diabetes is not something an expecting mother can stop from themselves from

being diagnosed with, because the cause is unknown, but knowing the risk of having an infant

who has an increased birth weight and the effects it can have on that infant later in life is

important. It is important for the expecting mother to take her treatment, whether it is with

dietary modifications or insulin seriously. These treatments can make the difference on the

outcome of the babys weight and health. As Barnes et al (2013) says, The ideal outcome of

pregnancy is delivery of a healthy, full term infant with a birthweight appropriate for gestational

age. (p.1041) Treating this maternal condition with care will help mothers to achieve this

outcome.

Hypertension

During pregnancy, some women may experience some complications that can affect the

newborn. Some may be less distinct in others, such as gestational hypertension, which some

women experience but may also involve preeclampsia. Preeclampsia is specifically characterized

by hypertension which is important to recognize in a patient in order to assure that this disorder

is not what they are experiencing. Characterizations of fluid retention and proteinuria are also

associated with preeclampsia; therefore hypertension is not always an immediate concern of the

disorder. With newborns, it has become a concern on maternal issues and well-being especially
EFFECTS OF MATERNAL RISK FACTORS

because it directly relates to the newborns overall outcome upon birth. Hypertension has become

an increasingly big concern as to whether or not it individually affects the mother or both her and

her newborn.

Reducing health disparities among people of minority racial and ethnic backgrounds is a

major national priority (C. ODell et al., 2006, p. 39), as stated in the study Maternal

Hypertension as a Risk Factor for Low Birth Weight Infants: Comparison of Haitian and African-

American Women. It is important to recognize that certain disorders (such as hypertension)

occur more often in certain minorities than others, and is especially important when it may affect

the newborn. This study included 16,578 women who identified themselves as Haitian or

African American, and who delivered between the years January 1996 to December 2000. The

dependent variable that was being monitored was the low birth weight of infants and three

different independent variables were monitored such as sociodemographic, maternal medical

conditions (emphasis on HTN), and prenatal services. Using a stratified analysis, it was

showed that both for the Haitian and African American women, chronic hypertension as well as

preeclampsia had a high association with low birth weight infants. This study was very in depth

with measuring the different variables such as marital status, education, HTN, diabetes,

preeclampsia, smoking, and prenatal care. Although overall, it is important to realize that

hypertensive disorders of pregnancy are important risk factors for delivering LBW infants

among black women(C. ODell et al., 2006, p. 39), as well as 6.8 times more likely in Haitian

women to deliver LBW infants. Although, factors such as smoking, high-salt diets and poor

socioeconomic status may also add to the hypertension and should be treated as risk factors as

well for LBW infants. The study concludes in stating that finding the biological reasoning for
EFFECTS OF MATERNAL RISK FACTORS

HTN leading to LBW would shed light on not only the correlation but as well as to why some

minorities have higher incidences than others.

In relation to another study and as stated above, preeclampsia is highly related to

gestational hypertension, and according to a study in The American Journal of Epidemiology, -

we observed that the overall mean birth weight was markedly lower among babies born to

mothers with preeclampsia than among babies born to normotensive mothers (X. Xiong et al.,

2011, p. 203). The study included 97,270 pregnancies and looked at the differences in newborn

birth weight to women who were hypertensive (or preeclamptic) versus women who had

normalized blood pressure. They completed an analysis and included factors that may skew the

results such as gestational age, any maternal factors that affect development, and possible

preterm births to assure accuracy in completing the data. Findings found that preeclampsia may

restrict fetal growth and/or cause preterm labor, which in conclusion leads to low birth weight

infants upon delivery. Again, preeclampsia is characterized specifically by hypertension and

other factors, but concludes that hypertension itself specifically affects the birth weight of

newborns. Studies have not been completed as to the reason and pathophysiological reasons as to

why hypertension of the mother leads to LBW, but through the studies found it is thought to be

that of growth restriction or due to preterm labor.

Smoking

Manystudieshavebeendoneresearchingtheeffectsofsmokingduringpregnancy.Two

suggestedmechanismsareavasoconstrictoreffectofnicotine,whichwoulddecreaseuterine

bloodflow,andadecreasedamountofoxygeninthebloodBothmechanismswouldleavethe

fetuswithmalnutritionandhypoxia.(M.Leiteetal,2014,p.832)Itissaidthatmaternal

smokinghasanextremelynegativeeffectonnewbornoutcomes,suchaslowbirthweightand
EFFECTS OF MATERNAL RISK FACTORS

congenitalmalformations.However,maternalsmokingduringpregnancyhaslongbeen

proposedtobeoneofthemostcriticalpreventablefactorsthatcanaffecttheintrauterine

environment.(W.Zhengetal,2016,p.2)

AstudydoneinJapanexaminedtheassociationbetweensmokingduringpregnancyand

lowbirthweightbygatheringinformationandstatisticaldatafrom92,641participantswhogave

birthbetween2004and2010.Mothersweregivenaquestionnaireoncetheirchildreached3

monthsofage.Thequestionnaireaskedifeachmothersmokedduringherpregnancyalongwith

otherquestions.Theinformationgatheredwasthenusedtodetermineifthemotherswho

smokedgavebirthtobabiesoflowbirthweight.Thestudyfoundthat2427womensmoked

duringpregnancyin20082010,and16.3%ofbabiesbornwereoflowbirthweight.Duringthe

sameyears,itwasrecordedthat38,738mothersdidnotsmokewiththeprevalenceoflowbirth

weightremarkablyreducedatonly9.5%.Theresultsindicatedthatinallbirthyeargroups,

infantswhosemotherssmokedduringpregnancyweremorelikelytobeoflowbirthweight

comparedtoinfantswithnonsmokingmothers.(W.Zhengetal,2016,p.3)

AnotherstudyperformedinDenmarkincluded838,265babiesdeliveredbetween1997

and2010.Thepurposeoftheresearchdonewastoexaminetherelationshipbetweenmaternal

smokingandtheriskforcongenitalmalformations.Thestudyfirstdividedthebabiesupinto

thosethatwereborntomotherswhosmokedatsomepointduringtheirpregnancyandthosewho

didnotsmokeatall.Next,thegroupsweredividedintothemothersthatsmokeddailyduring

pregnancy,whoquitduringthefirsttrimester,andwhostoppedsmokinginthebeginningof

theirsecondtrimester.Babiesborntomotherwhosmokeddailywerefurtherdividedintohow

manycigarettesthemothersmokedinaday.Resultsfromthisstudyindicatedtheriskfor
EFFECTS OF MATERNAL RISK FACTORS

congenitalabnormalitiesincreasedsignificantlywiththeincreasingnumberofcigarettessmoked

adaybymothers.

Thesetwostudiesexaminedtheassociationbetweenmaternalsmokingandtheeffectsof

newbornoutcomes.Thefirststudylooksatlowbirthweightasanegativeconsequenceasthe

secondstudylooksatcongenitalabnormalities.Bothstudiesprovideconcreteinformationand

methodstosupporttherelationshipbetweensmokingduringpregnancyandnewbornoutcomes.

Conclusion

Examiningmaternalriskfactorsandinfantoutcomes,researchshowsanegative

correlation.Somestudiesshowobesitycausescomplicationsinpregnancyandlaboraswellas

largeforgestationalagebabies.Researchalsoprovesthatgestationaldiabetes,too,leadstolarge

forgestationalagebabies,inadditiontohealthproblemslateroninlife.Ontheotherhand,itis

evidentthatmaternalhypertensionandsmokingduringpregnancycauseslowbirthweightin

newborns.Inadditiontolowbirthweight,smokingalsoisknowntocauseanincreasedriskof

congenitalabnormalities.Theuseoftheseeightstudiessupporthowthesematernalriskfactors

affectinfantoutcomes.
EFFECTS OF MATERNAL RISK FACTORS

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(2013). Predictors of large and small for gestational age birthweight in offspring of
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Ditchfield, A. M., Desforges, M., Mills, T. A., Glazier, J. D., Wareing, M., Mynett, K., . . .
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Dzakpasu, S., Fahey, J., Kirby, R. S., Tough, S. C., Chalmers, B., Heaman, M. I., . . . Mcdonald,
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Xiong, X. (2011). Impact of Preeclampsia and Gestational Hypertension on Birth Weight by

Gestational Age. American Journal of Epidemiology, 155(3), 203-209. doi
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Zheng, W., Suzuki, K., Tanaka, T., Kohama, M., Yamagata, Z., & null, n. (2016). Association
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