Stage Ages covered 1.

0 Introduction
Prenatal period Conception to birth
Infancy Birth to 18-24 months of age As a baby born, he/she will develop
from stage to stage. He/she will
Toddlerhood 12-15 months to 2-3 years of age
develop in many fields such as
Preschool period 2 years to 6 years of age
social, emotional, physical, mental
Middle childhood 6 years to about 12 years of age dan cognitive development. Every
Adolescence 12 years to 18-21 years of age human growth and change during
Young adulthood 18-21 years to 40 years of age each stage. Developments begin with

Middle adulthood 40 years to 60-65 years of age conception and continue throughout
the life. (See table 1). However,
Older adulthood 60-65 years to age to death
lifespan development takes as many
TABLE 1
different courses as there are people
in the world. Every human develops
in a unique way, embedded in the context of his/her environment. Besides that, development is
profoundly affected by the different worlds that the child and later the adult experience all along the
way.

On the stage of young adulthood, girls will find their soul mate, then marriage, live forever
with her husband. After marriage, a family will plan to have a few children. Then how was the child
form? Thus, when a sperm produce by male and meet with an ovum that produce by women, the
fertilization occurs and start the journey of prenatal development. The sperm and the ova contain or
carry exactly half of the new individual’s genetic makeup. After that, implantation occurs, and
implantation will complete at about 2 weeks after fertilization. Only 50% of the implantation will
success, if 2 week later, the implantation unsuccessful, the women will have a heavy menstrual
period, sometimes the women may not even realize that she was temporarily pregnant.

On the other hand, if the implantation is successful, then the embryo is form. Embryo grows
rapidly and changes daily in the 6 weeks, then become a fetus. Miscarriages will happen by the 12-
14 weeks, so the pregnant women have to be careful and have a balances diet. In the second
trimester (15-27 weeks), the fetus already has their hand, leg, brain, and organ and just like a
human. Lastly is third trimester (28-40 weeks), the fetus in placenta will move when someone talk
to him/her. The nervous system of the fetus is mature enough to control breathing and swallowing.
The pregnant women will deliver the baby after 10 months. A new life is coming out! What a
wonderful thing in life.
 In the pregnancy process, the pregnant women have to go prenatal care five or times to
comfirm the fetus is safe and develop in a normal way. Besides that, the pregnant women have
control her balanced diet to supply nutrition for her unborn child. The pregnant women also have to
control their emotional, always have positive thinking. Additional, in the pregnancy process, the
women have to take attention on her health, disease, or teratogen agent that may affect the unborn
child. Some of the pregnant women have healthy histories like diabetes or heart attack and other
disease have to discuss with the doctor. So that the doctor Therefore to have a healthy baby, the
pregnant women have to think before do. Live a healthy life style.
2.0 Nutrition

Mothers who begin pregnancy in good health and fitness, eat a balanced diet rich in protein, fat,
carbohydrates and calcium, and gain about 25 pounds (11.33kilograms) are more likely to give birth
to health babies. Energy needed for pregnant women during the first trimester will increase by 100
calories a day, and during the second and third trimester, by intake extra 300 calories a day, to an
optimum 2300-2700 calories, spread across three meals and two or three snacks. A pregnant woman
needs to eat something from all these food groups every day in order to get the proper amounts of
energy.
• Approximately 10 per cent of calories should come from protein.
• Approximately 35 per cent of calories should come from fat.
• Approximately 55 per cent of calories should come from carbohydrates.

But some of the mother, they don’t care about this, thus they are undernourished or malnourished
and don’t gain enough weight during pregnancy.

Malnutrition can be caused by the mother's imbalanced diet and vitamin or protein or other
deficiencies, as well as by deficiencies in the mother's digestive processes and overall metabolism.
Malnutrition usually happened during the last trimester because the fetus making rapid gains in
weight. If mother have diet problems then it would lead to low birth weight, prematurity, stunth
growth, retardation of brain development, cognitive deficiencies, and behavioral problems (Bhutta
et al., 2002; Hynes et al., 2002; Christian et al., 2003). Malnutrition can cause the unborn baby
reduce in the brain development both in the late fetal period and in early infancy. Although give
good later nutrition, it is also difficult to overcome the problem. Besides that, malnutrition pregnant
women also more often have spontaneous abortions, give birth prematurely, or lose their babies
shortly after birth.

On the other hand, if well-nourished mothers go through a temporary period of malnutrition during
pregnancy but the baby has a good diet and responsive caregivers after birth, there may be no long
lasting effects (Stein & Susser, 1976). As pregnant women, she has to eat foods rich in nutrients and
have three meals and two or three snacks every day. Several specific minerals and vitamins are
needed for pregnant women to ensure and maintain a healthy pregnancy and give birth to a healthy
baby. These nutrients can be obtained from food sources, but you may need to take a supplement.
Eat well rounded diets do not require food supplements but most doctor still recommend them to be
safe. (Balluz et al., 2000). It is important what supplement the pregnant mother take, because if the
mother taking too much of supplement may be harmful to the fetus. The healthy snacks for pregnant
women are fresh fruit, raw vegetable, cereal, milkshake, raisins, nut and others.

Iron

Low iron can cause low birth weight. It can make the pregnant women feel tired, make it hard to
flight infection, and cause difficulty coping with blood loss during birth. Besides that, iron can also
lower the immunity, increase the risk of infection and illness, producing extra blood needed by both
mother and baby. Hence, doctor will advice to the pregnant mother intake more iron supplement
and eat food that are extra high in iron. But have to remember that cannot eat iron supplement when
on an empty stomach because it may cause nausea. Iron supplements often lead to constipation,
though it may help if you take your supplements with food. Iron is also needed to prevent anemia.
The example food that contain iron such as liver, meat, seafood, prune juice, dry beans, wheat germ,
oatmeal, tofu, soy nuts, grain product such as whole-grain cereal or bread, cream of wheat, enriched
cereals and spinach

Zinc and Cobalt

The trace minerals zinc and cobalt is needed for the development of the embryo. Essential for blood
cell development and required by both the fetus and the mother. This mineral is highly important
for cell growth in your unborn baby. Zinc also promotes the production of enzymes such as insulin
in pregnant women. Seafood contains the most zinc and cobalt.

Calcium

Pregnant women need approximately 1500 mg of calcium per day. The mother need calcium and
vitamin D for her baby’s healthy bones and teeth, it can also protect and prevents the mother from
losing her bone density later in life. Calcium is essential for the growth of the fetus. Calcium is best
absorbed when take with food. The foods that contain calcium such as bread, dairy products,
cheese, yogurt, dark leafy greens, fortified juices and cereals.

Folic acid

If the pregnant women taking in 400mg of folic acid ever day can prevent more than 70% of birth
defects commonly found in newborn baby. It will less the risk of having a baby with neural tube
defects, such as spina bifida. Folic acid is important for healthy growth and development. Folic acid
is essential for growth and cell division and plays an important role in formation of red blood cell.
Leafy green vegetables, dried beans, peas, lentils, oranges, bananas, avocado, dark leafy greens, soy
nuts, avocados, broccoli and asparagus, this entire thing contain the most folic acid.

Protein
Protein is one of the core building blocks in all your baby's body cells. The need for protein
increases during the second and third trimester of your pregnancy. Many dietary products are rich in
protein including meat, fish, eggs, cheese, dairy foods, beans and legumes, nut and tofu. It can also
be found in supplements such as bars and shakes.

Fibre

Fibre is helps to prevent constipation. To prevent constipation, the pregnant women can eat more
fibre cereal, potatoes, corn, kiwi, peas, nut and seeds.

Vitamin B

Vitamin B6 (Pyridoxine)

This vitamin helps your baby's brain and nervous system develop. In some cases it has also been
noted to reduce morning sickness. Pyridoxine can be sourced in bananas, watermelon, chick peas
and chicken breast.

Vitamin B1 (Thiamin)

This vitamin is essential for the development of your baby's central nervous system. Not getting
enough Thiamin can put your baby at risk of beriberi which can damage the baby's heart and lungs.
Essential for energy metabolism and fetus call development. Foods which contain Thiamin include;
whole grain foods, wheat germ, whole grain breads and liver

Vitamin C

Adequate doses of vitamin C are linked to healthy birth weights and a lowered risk of premature
rupture of membranes. Vitamin C cannot be stored, so it should be taken daily via a large variety of
fresh fruit and vegetables. Examples for food product like citrus fruits and juices, strawberries, bell
peppers, tomatoes, dark leafy greens, broccoli and brussel sprout.

Vitamin D

Vitamin D is taken in mostly through drinking milk and exposure to sunshine and leads to an
increased chance of giving birth to a healthy child. It is essential for healthy teeth and bones and
helps to absorb calcium. Vitamin D also enhances calcium absorption. Vitamin D is found in foods,
such as sardines, fortified orange juice and fortified milk

Vitamin E

Vitamin E helps a baby's muscles and red blood cells to develop. A lack of Vitamin E has been
linked with low birth weight, whilst getting too much of this vitamin has been associated with
stillbirth. It is therefore vital that you ask for your doctor's advice before considering Vitamin E
supplementation. You can get Vitamin E in a number of foods including vegetable oil, nuts,
fortified cereals, whole grain, vegetables, eggs, and peanuts.

Moreover, I think a pregnant woman is “eating for two”, because pregnancy is a time when
your body begins to undergo sudden and rapid change and hence whatever the mother eat, the
foetus will receive the same nutrient. So, the nutrient requirements do increase. These days, it is
common for pregnant women to take in large doses of supplement. Although some amount of
fortified foods is helpful, large doses can cause health problem, but always discuss with the doctor
before start taking supplements of any sort. Thus, the mother have to take attention and have a
balanced diet to give birth a healthy baby. So there is some do and don’t guideline (refer to table 2),
pyramid (refer to pg ) and food guide serving per day (refer to pg ) for the mothers to refer and
take action on it.

DO DONT
Have a carefully balanced diet with plenty of Have a lot of snack which have little
foods containing protein, vitamin, calcium nutritional value, such as crisps
and iron and plenty of fluid
Take food a little and often Have a lot of fatty foods which are difficult
to digest
Use fresh foods as opposed to processed food Have a lot of foods which contain high
from which nutrients may have been lost levels of added chemicals
Find out the food which suit her and avoid Have drinks with high caffeine content, such
those which are hard to digest, such as highly as coffee or colas
spiced or acidic foods
Eat sufficient to satisfy hunger, but avoid Take much sweet food and drink, such as
putting on too much weight. The chart lemonade, cakes and biscuit, which contain
opposite shows an acceptable level of weight a lot of ‘empty calories’
gain

Table 2
3.0 Anxiety

Anxiety is defined as “apprehension without apparent cause” just like fearful expectation without
any reason. I think anxiety is a vague unpleasant emotion that is experienced in anticipation of some
misfortune. Maybe some of us will think the emotion of the mother how to have the connection
exist between the mother and the unborn child. When a pregnant women experiences intense fears,
anxieties, and other emotions or negative mood states, physiological changes occur that may affect
her fetus (Glynn & others, 2008; Talge & others, 2007). But, it is possible that the emotion of the
pregnant women will affect the child. This is because when the mother expresses her emotion like
anger, anxiety, confusion or stress for something, the nervous system will transmit the impulses
from the brain and spinal cord to the muscle and glands. Thus, the adrenal hormones will release
and go into her bloodstream. Maternal stress may increase the level of corticotrophin-releasing
hormone (CRH), a precursor of the stress hormone cortisol, early in pregnancy (Nakamura, Sheps,
& Clara Arck, 2008). Elevated levels of CRH and cortisol in the fetus have been linked to
premature delivery in infants (Field, 2007). Furthermore, when some of the pregnant mother stress,
they want to release they tension, they engage in some unhealthy behaviors such as taking drugs,
smoking and engaging in poor prenatal care. All of these activities have been shown to increase the
risk of premature birth and low birth weight.

Pregnant women very sensitive or extreme reaction to unimportant things, like her husband
didn’t cleaning up the bedroom, she will get angry and have arguing. Besides that, pregnant women
always swings of mood, from the height of pleasure and excitement to the depths of despair and
unhappiest. If the pregnant women can’t get rid of it, high maternal anxiety and stress can have
long term consequences for the offspring. A recent research review indicated that pregnancy women
with high level of stress are at increased risk for having a child with emotional or cognitive
problem, attention deficit hyperactivity disorder (ADHD), and language delay (Talge & other,
2007).

Not only will affect the emotional or cognitive problem of the unborn child, but also affect
the physical abnormalities such as cleft lip and palate or infant stomach disorder. Anxiety in
mothers during pregnancy is linked to fetus having emotional and behavioral problem. For example
many people will advice the pregnant women not to angry and try to be good temperament, because
the unborn child will feel it and learn. Stress having later in pregnancy can result in fetal behavioral
changes such as increase movement or hiccupping (Revill & Dodge, 1978). Emotional stress in the
prenatal period as well as the postnatal period affects the infants.
 Pregnancy can be a time of great stress, both physically and emotionally. Some stress is
normal but too much stress can be unhealthy for the pregnant women and the unborn child. Stress
doesn’t have to be bad but just regularly finding healthy outlet to relieve stress and anxiety. When
the pregnant women is emotional or stress can try to talk with someone who are close like her
husband, maybe he can help to comfort you and communicating regularly in times of high stress.
The pregnant mother can also make time for herself every day, get enough sleep and eat healthy
foods. The less sleep pregnant mother get the more stressed. If there is an environment no sound, a
comfortable pillow and taking a relaxing bath before sleep. I think it will promote more restful
sleep. Remember that avoid eating up to one hour before bed to prevent heartburn, which can
disrupt the sleep and it will increase the level of stress. The family can also try to plan ahead for the
unborn child like how to decorate the baby room or buy some baby clothes. I think this will made
the whole family happy. Besides that, the pregnant mother advice to attend prenatal classes to learn
more about pregnancy, birth dan parenting, they can communication to exchange they experience.

Actually, exercise is an ideal way to help release tension, anxiety and stress. It will let you
remove the attention and more energetic in a day. In pregnancy process, eat a healthy balanced diet
is important. Eating well will provide the energy needed throughout the day, especially when the
pregnant women feel tired, confuse or overwork. Sometimes, a pregnant woman will suddenly want
to eat chocolate or whatever, as the partner or friend try to get it. It will brighten up the day of the
women. Free your life of extra stress and find an outlet to release the stuff that the pregnant women
just can’t get rid of. Positive emotional states also appear to make a difference to the fetus. Pregnant
women who are optimistic thinkers have less adverse outcomes than pregnant women who are
pessimistic thinkers (Loebel & Yali, 1999). Optimists are more likely to believe that they have
control over the outcomes of their pregnancies. So, concluded that as a pregnant women, one way to
prevent health problem in unborn child and adult is to focus on the prenatal period and don’t have
too much of feeling. Maybe happy go lucky and have optimistic thinking is the best way to release
the stress.
4.0 General Health

Many decision have to made when pregnancy. So, many people said about parenting would be not
easy, but if you have properly prepared for it, it will certainly be easier. To make sure the mother
and the unborn child is in healthy and safe condition.

4.1 Paternal care

One of the best ways is have five or more prenatal visit to a doctor health-care facility beginning in
the first trimester of pregnancy. Thus, who can monitor the pregnant women and assist with the
baby's birth? A family doctor, a midwife, or an obstetrician. Good prenatal care usually includes a
careful health history, a full medical examination, and counseling about potential risks. It will also
include assessment and recommendations regarding good nutrition during pregnancy. All of this
professional can help to check and advice the pregnant women to have early detection and treatment
of health condition like rubella test, HIV test, ultrasound test and so on. Public-health outreach
programs to provide prenatal health care to expectant mothers who might not otherwise receive it
have been shown to be effective in reducing in reducing infant-mortality and premature-birth rates
(Murphy, 1993) However, before the doctor made any decision, it have to based on the mother
health histories, like toxemia, diabetes, high blood pressure, high cholesterol and so on. This is
because to prevent significant health problem in baby.

4.2 Air Travelling

Besies that, sometime we have emergency or having a holiday, we have to fly over to another
country. So, when the pregnant women want to buy an air ticket, the women have to inform the
airline about her condition. Before 36 weeks of pregnancy, and have a letter from doctor then the
pregnant women can fly. If you are flying while pregnant, the pregnant women try to ask for aisle
seat so that can get up easily and walk frequently. Besides that, remember to drink plenty of water
and bring along your own healthy snacks. If necessary, keep the medication with you on the plane.

4.3 Exercise

Besides food, the pregnant women also have to do exercise. Staying active during pregnancy will
cut down on swelling, leg cramp, fatigue, shortness of breath, backache and constipation. In
pregnancy process, in the beginning, the pregnant mother maybe exercising three times a week,
then slowly increase to four or five time s a week. Low-impact, moderate-intensity exercise
activities are great choices. Exercises that can be done by the pregnant women like walking,
swimming, yoga, prenatal exercise classes and low-impact aerobics. Before start the exercise, have
to remember to do the warming up and last have to do the cooling down. When exercising, the
pregnant mother has to breathe throughout an exercise, breathing out on exertion and breathing in
when relax. Pregnant women should limit high-impact activities and avoid certain sports and
activities that pose a risk of falling or abdominal injury. Do not strain while holding your breath. If
the pregnant women feel short of breath, then have to stop the activity immediately. This is because
scared that the oxygen supply is not enough for the unborn child and will cause changes in your
blood pressure and can also create pressure on your pelvic floor and abdominal muscles. When the
pregnant women are exercising, the person besides have to take care of her, as she much easier to
lose her balance. Sometimes the pregnant mother scare that the weight is increase or over increase,
so try to do more exercise, hope that can keep the weight down. Pregnancy is a time when you need
a balance of rest and activity, so cannot overdo it. When having a pregnancy, weight gain is a
normal thing. Underweight women need to gain more an overweight should gain less. The weight
will gain gradually. If the pregnant women are overweight, she may be eating the wrong kinds of
food or too much food, or not enough exercise. Remember that pregnant women cannot on diet
during pregnancy, have to focus on nutrition but not weight.

4.4 Posture

When having a poor posture, it will cause discomfort in your back, shoulder and hip. It is same as
the pregnant women. A pregnant woman has to have a good posture so that back, shoulder and hip
will not pain. When standing up or walking, the pregnant mother have to pulling their shoulder back
and straightening you spine, standing up straight and walking tall. To protect the back of the
pregnant women, don’t lift or move heavy thing, do not twist when lifting, lift with the legs and not
the back, by bending your knees, and so on. The pregnant women also cannot wear high hills, this is
because they much more easier to lose their balance

4.5 Constipation
A normal person also often have constipation problem. In first or second trimester maybe the
pregnant women still not are used to, so just only sit and lay on the bed have less movement.
Constipation during pregnancy can be caused by hormonal changes that cause the intestines to
move less. Iron supplements can also cause constipation. Intestinal movement is slowed during
pregnancy, and this may result in, or worsen, digestive disorders. To avoid constipation, eat lots
of fibre-rich foods such as fruit, vegetables, wholemeal bread and cereal, prunes and prune
juice. The pregnant women remember to drinking two to three litres of water each day will also
help prevent constipation by keeping stools moist. The women have regular exercise will also
help get the intestines moving. The pregnant women have to eat at fibre-rich food like whole-
grain bread, vegetables, fruit, legumes. Brisk walking two to three times a week is a good level
of exercise to aim for. A pharmacist will be able to provide advice about over-the-counter
preparations that are safe to use during pregnancy to relieve constipation.

4.6 Food borne illness

Food borne illness is referred to food poisoning. It is any illness resulting from the consumption of
contaminated food. Food borne illness usually arises from improper handling, preparation or food
storage. Some of the foods can carry bacteria or parasites that may make you sick. Some can affect
your baby too. So, the mother has to take attention. As we know, before eating and after eating we
have to wash our hand well with soap and warm water, the pregnant mother also has to do so. The
pregnant mother also has to take attention about the raw and uncooked meat, fish, beef and seafood,
don’t let the cooked food left ay the room temperature. The pregnant women don’t eat food in the
refrigerator that maybe already keeps for 2 days. If take the food from refrigerator, please reheat the
food really well, in the temperature about 74ºc. Good hygiene practices before, during and after
food preparation can reduce the chance of contracting an illness. Some infections have serious
effects on the embryo, so the pregnant women have to smart in manage the hygiene. Remember that
always carefully peel and wash raw vegetables, fruit, and herbs and wash your hands carefully
before cooking, eating, after you have handled raw meat, or have touched sand or soil. Avoid cats
and their litter, as toxoplasmosis pathogens propagate in the cats' intestines. Do not eat uncooked
fish, meat, milk, and eggs.
5.0 Maternal Age

Some of us are worry about what is the suitable age to have a baby. All of us scared that if too
young, don’t have experiences to take care of the baby, but too old also worry about cannot
communicate with child or no energy to teach. Many question marks appear. A study linked that the
age of female influences the unborn child because more children with developmental problem tent
to be born to women who are under the age of 20 or over 35 years of age (Goodman, 1996).

The pregnant women that under age of 20 are consider a young mother. A young mother
maybe is the first time to have pregnancy. So, no experiences, no responsibility and sometimes feel
that never mind, didn’t give attention to a serious matter. Young mothers are more likely to drop out
of high education, maybe only finish secondary-level schooling or post-secondary education, hence
is low educational aspirations. Young mother stop schooling so early or failure to complete high
school, this will affect their future like opportunities of career. When the young mother didn’t work,
there is no income, so her economic become the problem. Young mother may actually make
economic sense for poorer young women. Research found out that young mother commit suicides
are seven times more than other. Furthermore, usually the young mother do not get enough prenatal
care, which cause by do not have a balanced diet or health. Young mother must not foolow a
restrician diet. Do not skip meals, have to eat enough to gain weight at the recommended rate.
Besides that, young mother are at risk for having miscarriages or having children with birth defects,
possibly because their bodies aren’t yet mature or the reproductive system of the women doesn't
meet the requirement.

On the other hand, the older mothers often worry that their age will affect their pregnancy,
and the birth of their baby. So, some of them feel that the extra test and treatment are needed
because of their age. But it is real that the pregnant women who are over age of 35 will experiences
irregular ovulation or infertility. It is unfortunately that the older women have more chance to
develop medical disorders such as diabetes, high blood pressure and other diseases, which will
affect pregnancy and birth. There is a greater risk of damage to the ova, because aging allows more
time for exposure to harmful agents. Moreover, it is well-known that older women higher chance
and increased risk of having a baby with a disease or condition that is inherited. Because it is
carried through the genes, this is known as a genetic abnormality, such as Down's syndrome. The
occurrences of problems such as miscarriages and chromosomal abnormalities such as Down's
syndrome increases with advancing age (March of Dimes Birth Defeats Foundation, 1989). Down’s
syndrome causes mental retardation, a characteristic facial appearance, and multiple malformations.
Down syndrome is a relatively common birth defect. The chromosome abnormality affects both the
physical and intellectual development of the individual. Figures for England and Wales show that
your chance of having a baby with a genetic abnormality rises from 1 in 500 between the ages of
35-39, to 1 in 250 between the ages of 40-44, up to approximately 1 in 70 if you are in the ages of
45 or over. Older women have to consider this statistic in deciding whether to have a child. But,
Down syndrome’s baby is rarely born from a mother in ages 16-34.

There is also some evidence that older mothers are more likely to have a longer second stage
of labor, because the muscles of the uterus do not work as well as a young mother. Besides that,
there is another small but serious risk to the babies of more mature mothers. More babies die in the
uterus right at the end of pregnancy in mothers aged over 40. This increased risk cannot be
explained by complications in the pregnancy or other illnesses alone. Despite the increased risk
with increased age, it is important to remember that the vast majority of babies are fine. Except for
the factor of chromosomal abnormalities, figures suggest that babies of older mothers are no more
at risk of most birth defects than those of younger mothers. Maternal age is also linked to the risk
that a child will have Down syndrome (Soergel & others, 2006).

On the plus side, the pregnant women may have some physical and psychological benefits
over her younger counterparts. Women starting a family in their 30s or 40s might lead a healthier
life-style, they are often more highly educated and better off financially. They may understand the
needs of their bodies, and look after themselves better in terms of exercise and nutrition. Mature
women can have more positive perceptions of their bodies, and more readily tolerate the symptoms
of pregnancy. At this age too, women often have more autonomy - independence and confidence to
know what they want, and enhanced people skills to get it.

So, I can conclude that the greatest success rate for women get pregnancy is in their
twenties. Age of 20-35 is the better age to have a pregnancy. Although it is a success rate, but the
pregnant women also have to regularly have prenatal care.

6.0 Teratogens
Teratogen refers to an environmental agent that causes damage during the prenatal period. Many
things can be listed as teratogens like caffeine, alcohol, tobacco, marijuana and others. Some
teratogens are benign until they build to "threshold concentration" levels in the mother and then the
effects are seen. Some teratogens are dangerous throughout a pregnancy and some are dangerous
only at specific points of embryonic development. The only safe course of action is to actively
avoid known teratogens before and during pregnancy.

6.1 Tobacco
Exposure to tobacco is, of course, common through smoking cigarettes or otherwise ingesting
tobacco or being the recipient of second hand smoke. The risk to a developing foetus, whose mother
is exposed to tobacco, is that the placenta may not develop normally causing conditions like a
placenta previa that can cause severe complications, including death, during pregnancy and/or
delivery. The foetus is also at increased risk of developing heart defects and being born at a low
birth rate. Babies that do survive are often difficult to comfort and are sometimes described as
nervous or "jittery". Another tangential point is that babies that continue to be exposed to tobacco
(second hand smoke) after birth have increased risk of SIDS, asthma, and other lung related
problems.
With each inhalation from a cigarette, nicotine enters the mother's circulatory system and also that
of the foetus through the placenta. The blood vessels contract and the oxygen supply of the foetus is
compromised. For this reason, tobacco is contraindicated during pregnancy.

6.2 Caffeine
Caffeine is found in coffee, black tea, cola drinks, energy drinks, and cocoa (chocolate) as well as
other foods. It has a stimulating effect and therefore speeds up the heart rate. Caffeine in the blood
of a pregnant woman affects the heartbeat of the baby, which almost doubles. Pregnant women may
take two cups of coffee or four cups of tea a day without endangering the fetus. Caffeine
consumption during pregnancy concluded that a small increase in the risks for spontaneous abortion
and low birth weight occurs for pregnant women consuming more than 150 milligrams of caffeine
per day. (Fernandez & other, 1998). Besides that, if pregnant women consumed 200 or more
milligrams of caffeine a day had an increased risk of miscarriage (Weng, Odouli, & li, 2008).

6.3 Nicotine
Nicotine is a drug commonly found in cigarettes. Cigarette smoking by pregnant women has been
related to varios consequences for the unborn child. Cigarette smoking by pregnant women can also
adversely influence prenatal development, birth, and postnatal development ( Cooper & Moley,
2008). Child that born by women who smokes is smaller and weight less than the normal. Preterm
births and low birth weight, fetal and neonatal deaths, respiratory problems and sudden infant death
syndrome (SIDS, also known as crib death) are all common among the offspring mother who
smoked during pregnancy (Roza & other, 2007). Cigarette smoking also results in the increase of
the amount of carbon monoxide, which means the decrease of oxygen. A recent study also revealed
that children whose mothers mothers smoked during pregnancy were more likely to have a higher
level of inattention and hyperactivity than children whose mother did not smoke in pregnancy.
(Obel& other,2008).

6.4 Alcohol
When a pregnant woman drinks alcohol, so does her unborn baby? There is no known safe amount
of alcohol to drink while pregnant and there also does not appear to be a safe time to drink during
pregnancy either. Therefore, it is recommended that women abstain from drinking alcohol at any
time during pregnancy. Pregnant women who drink 3 or more drinks a day faced an increased risk
of preterm birth( Parazzini&other, 2003). Heavy drinking by pregnant women can be devastating to
their offspring (Borowski & Nieby, 2008). Prenatal exposure to alcohol can cause a range of
disorders, known as fetal alcohol spectrum disorders (FASDs). One of the most severe effects of
drinking during pregnancy is fetal alcohol syndrome (FAS). Fetal alcohol spectrum disorders
(FASD) are a cluster of abnormalities and problems that appear in the offspring of mother who
drink alcohol heavily during pregnancy. (Olson, King,& Jirkowic). FAS is one of the leading
known preventable causes of mental retardation and birth defects. If a woman drinks alcohol during
her pregnancy, her baby can be born with FAS, a lifelong condition that causes physical and mental
disabilities. In one a study, children those mother drunk moderately(one or two drink a day) during
pregnancy were less attentive and alert, even 4 year of age( Streissguth &other, 1984). FAS is
characterized by abnormal facial features, growth deficiencies, and central nervous system (CNS)
problems. People with FAS might have problems with learning, memory, attention span,
communication, vision, hearing, or a combination of these. These problems often lead to difficulties
in school and problems getting along with others. FAS is a permanent condition. It affects every
aspect of an individual's life and the lives of his or her family.

6.5 Accutane
Accutane is a prescribed medication that controls and prevents some of the mechanisms in the
glands that contribute to acne. A person suffering from severe acne may be exposed to Accutane
during treatment. Accutane is an inflammatory disease involving the sebaceous glands of the skin;
characterized by papules or pustules or comedones. A developing fetus, whose mother is exposed to
Accutane, is extremely likely to develop facial deformities, heart defects, a small head, a cleft lip
and palate, a buildup of fluid in the brain, or mental retardation. This is an extraordinarily
dangerous substance for a developing fetus.

6.6 Cocaine
Cocaine exposure during prenatal development is associated with reduced birth weight, length, and
head circumference (Smith& other, 2001). This also linked to lower arousal, less effective self-
regulation, higher excitability, lower quality of reflexes, to slower growth rate guage development
and others. Pregnant women who use cocaine (such as poverty, malnutrition, and other substance
abuse) often cannot be ruled out as possible contributors to the problems found in their children
(Hurt &other, 2005).

6.7 Marijuana
Marijuana use by pregnant women has negative outcomes for offspring. Marijuana use by pregnant
women is related to deficits in memory and information processing in their offspring ( Kalant,
2004). A recent study revealed that prenatal marijuana exposure was linked to lower intelligence in
children (Goldschmidt&others, 2008), depressive symptoms at 10 years of age.(Gray&others,
2005).
Further, a recent study indicated that prenatal expose to marijuana was linked to marijuana use at 14
years of age. So, the pregnant women are not recommended to use marijuana.

6.8 Methamphetamine
Methamphetamine is a stimulant for speeding up an individual’s nervous system. Babies born to
mothers who use methamphetamine, or "meth," during pregnancy are risk for number of problems,
including high infant mortality, low birth weight, and developmental and behavioral
problems(Forrester& Merz, 2007). Meth use during pregnancy is increasing and some expert
conclude that it has become a greater problem.
 6.9 Heroin
The pregnant women are addicted to heroin to show some behavioural difficulties includes
abnormal crying, disturbed sleep and impaired motor control. The behavioural difficulties that
infants whose mothers are addicted to heroin include withdrawal symptoms, such as tremors,
tremors, irritability, abnormal crying, disturbed sleep, and impaired motor control. The most
common treatment for heroin addiction methadone is associated with very severe withdrawal
symptons in newborns. (Binder & others, 2008)

6.10 Arsenic
Arsenic is a metal like mercury. Exposure can occur when drinking well water that is contaminated
with arsenic, living near or working at an industrial incinerator that burns waste containing arsenic,
or living near or working at industrial metal smelters. Building lumber was treated with arsenic
until 2003, so even walking barefoot on a backyard deck may allow exposure to arsenic. A fetus,
whose mother is exposed to high levels of arsenic, has an increased risk of being spontaneous
aborted, being born with a low birth rate, and even stillbirth

6.11 Mercury
Mercury is a shiny silver metal that is in liquid form at room temperatures. Exposure to mercury
might happen around broken thermometers, dental fillings, broken florescent light bulbs and eating
fish that have high levels of mercury (especially swordfish, shark, king mackerel and tilefish). A
fetus, whose mother is exposed to mercury, could be in serious danger. Mercury can stop the
duplication process of cells and lead to the death of the fetus. It can also alter the cells as the divide
and introduce a variety of unpredictable mutations in the developing fetus, especially to their
nervous system.
7.0 Disease
7.1 H1N1
Pregnant women, even ones who are healthy, can have medical complications from the seasonal and
H1N1 (Swine) flu. If you are pregnant, have to prepare the upcoming H1N1. The pregnant women
should get both the seasonal flu vaccine and H1N1 flu vaccine as soon as possible. Pregnant women
are among the priority groups to receive the H1N1 flu vaccine. Besides that, pregnant women
should pay close attention to her body and how is the feeling. If feel like flu such as confusion,
severe vomiting, high fever, pain or pressure in the chest or abdomen, the women have to stay at
home, limit contact with others, and call the doctor. Doctor will decide if testing or treatment is
needed. Tests may include a nasal swab which is best to do within the first 4-5 days of getting sick.
If the pregnant women are diagnosed with the flu, get treatment immediately. The pregnant women
have to drink plenty of fluid to replace those you lose when you are sick. Doctor will decide if the
women need antiviral drug to protect baby and mother.

A mother’s milk is made to fight diseases in her baby. This is highly important in young babies
whose immune system is still growing. Do not stop breastfeeding if you are ill. Mothers who are
breastfeeding can continue to nurse their babies while being treated for the flu. Limit formula feeds
if you can. This will help protect your baby from infection. If you do get the flu, be careful not to
cough or sneeze in the baby’s face and wash your hands often with soap and water. Your doctor
might ask you to wear a mask to keep from spreading this new virus to your baby. If you are too
sick to breastfeed, pump and have someone give the expressed milk to your baby.

7.2 Rubella (German measles)

Rubella is very contagious disease caused by a virus. Exposure can happen through normal
interaction with an infected person where fluid from the nose or throat of the infected person gets
passed like shaking hands, sharing drinks, and others. There is a vaccine for the disease but for a
pregnant woman who has not been vaccinated, there are serious and sundry risks to her foetus. A
vaccine that prevents German measles is now routinely administered to children, and women who
plan to have children should have a blood test before they become pregnant to determine if they are
immune to the disease (Dontigny & others, 2008).

Rubella outbreak in 1964-1965 resulted in 30,000 prenatal and newborn deaths, and more than
20,000 affected infants were born with malformations, including mental retardation, blindness,
deafness, and heart problems. Besides that, the effect for foetus of the pregnant women who didn’t
have rubella injection is vision and hearing problems, heart abnormalities, mental retardation, even
death and stillbirth. If the baby survives they are still at risk for diarrhea, pneumonia, meningitis and
anemia. They are even at risk for diabetes and cerebral palsy. The greatest damage occurs if a
mother contracts rubella in the third or fourth week of pregnancy, although infection during the
second month is also damaging (Kobayashi& others, 2005). So, before getting pregnant go and get
the vaccine immediately, so that the mother can gives birth a healthy baby.

7.3 HIV
What is HIV? The human immunodeficiency virus, it is also a sexually transmitted disease (STD)
of course, is the virus that causes AIDS. A person typically becomes infected with HIV by having
vaginal or anal sex with a carrier or being exposed to infected blood. So, an infected mother can
pass the virus on to her baby during breastfeeding. Being born infected with HIV is probably the
most common birth defect in the world today. Medications like antiviral can reduce the virus levels
in the mother's blood. A short delivery by caesarean section can greatly reduce the risk to the
baby. Additionally, avoid using any birthing instruments that may puncture the newborns skinand
minimize the mixing blood with the mother. Women who are infected with HIV are at greater risk
of passing the infection on to their babies. Approximately 25% of all babies born to HIV-positive
pregnant women are infected with the virus.

Early symptoms for HIV tend to includes muscle aches, low fever, headache and swollen glands.
Sometimes people will mistaken about it is just flu. Afterward, the virus can lie dormant in your
system for many years. The pregnant women should have HIV test, so that the child will not
infected and help to protect the developing of baby.

7.4 Syphilis (a sexually transmitted infection)

Syphilis is a sexually transmitted disease caused by a bacterium. The risk is that the foetus becomes
infected with the bacteria. This can cause stillbirth or death shortly after birth. Syphilis is more
damaging later in prenatal development when four months or more after conception. Pregnancy
offers no protection against Syphilis leaving pregnant women vulnerable to the same Syphilis as
women who are not pregnant. Syphilis can cause devastating consequences women who are not
pregnant; the consequences of sexually transmitted diseases can be significantly more dangerous for
pregnant women.
Although the consequences of Syphilis for pregnant women can be the same as for non-pregnant
women; these consequences may have devastating effects that can lead to cervical cancer and other
cancers, chronic hepatitis, cirrhosis, and other complications. Sadly, there are often no symptoms in
women with sexually transmitted diseases and a woman may not be aware she is infected until she
is already pregnant.

Transmission of Syphilis from the pregnant women to her foetus, newborn, or infant can occur
before, during, or after birth. Syphilis are able to cross the placenta and infect the foetus--
potentially affecting fetal development. Other sexually transmitted diseases including gonorrhea,
chlamydia, hepatitis B, and genital herpes can be transmitted to the infant during vaginal delivery.
Women who are HIV positive can transmit the virus that causes AIDS to the foetus through the
placenta during pregnancy or infection can occur during the process of birth.

Syphilis can cause devastating consequences to the baby that includes stillbirth, low birth weight, an
eye infection called conjunctivitis, pneumonia, neurologic damage such as brain damage or motor
function disorder, blindness, deafness, or other congenital abnormalities, chronic liver disease and
others. When this disease is present at birth, problems can develop in the central nervous system
and gastrointestinal tract (Johnson, Erbelding, & Ghanem, 2007).

On the positive side for pregnant women, syphilis can be treated and cured during pregnancy.
Treatment for these bacterial is with prescribed antibiotics. Pregnant women infected with HIV who
receive treatment during pregnancy can significantly reduce the risk of transmitting the virus to
their infants. If a women infected by genital herpes has active genital herpes lesions at the time of
delivery, a cesarean section is often recommended to protect the newborn against infection.

7.5 Varicella Virus (Chickenpox)

Chicken pox is a highly contagious viral infection caused by the varicella virus. The varicella virus
is an envelope, double-stranded DNA virus. It attaches to the wall of the cell it invades, and then
enters the cell. The virus uncoats and is transported to the nucleus where the viral DNA replicates
creating new virions that are eventually released from the cell to infect other cells. Exposure to
chickenpox virus, obviously, is very common as it's a common airborne disease and close proximity
to an infected person can cause exposure - exposure can also occur by coming into direct contact
with the rash of an infected person. The danger to a developing foetus, whose mother is first time
infected, can be severe, including: skin scarring, a small head, blindness, seizures, low birth weight,
and mental retardation. is usually a benign, self-limited, viral infection caused by the varicella virus.
However, chicken pox acquired during pregnancy causes an increase risk of complications to the
mother and the infant. The time of infection, during early pregnancy or near delivery, determines
the risk to mother and child.

7.6 High blood pressure

High blood pressure is also known as pregnancy-induced hypertension (PIH). Blood pressure is the
amount of force exerted by the blood against the walls of the arteries. In general, high blood
pressure, or hypertension, contributes to the development of coronary heart disease, stroke, heart
failure and kidney disease. It can lead to toxaemia and pre-clampsia. Although many pregnant
women with high blood pressure have healthy babies without serious problems, high blood pressure
can be dangerous for both the mother and the foetus. High blood pressure can harm the mother's
kidneys and other organs, and it can cause low birth weight and early delivery. In the most serious
cases, the mother develops preeclampsia--or "toxemia of pregnancy"--which can threaten the lives
of both the mother and the fetus.

7.7 Diabetes
Due to reduced production of the hormone insulin in the mother’s body, gestational diabetes
develops as the deficiency in the production of insulin checks the breaking down of sugar, which
acts as a fuel for the body. As a consequence, the blood sugar level rises which are passed on to the
placenta to the developing body. This can be a serious threat to the mother as well as the baby. This
form of diabetes generally starts in the second half of pregnancy and it goes away after the baby is
born.

The disease affects the women who are above the age of 35 and have family history of type 2
diabetes. At the same time, obese woman and those who have given birth to a large baby and that
too with an abnormality are likely to be affected by gestational diabetes. Effects on the fetus during
pregnancy If the blood glucose level is high, the baby may come out with a larger frame which is
perilous for both, mother and the baby. As a consequence, in some cases, a caesarean delivery is
needed.
Pregnant mother who have diabetes have to control blood sugar level and maintaining a planned
diet and exercise. Home glucose testing kits are available from chemists. These usually involve
taking a tiny blood sample with a pinprick device. The blood is put onto a strip and inserted into a
glucose-measuring device, which gives the blood glucose level.To help reduce the risk of getting
gestational diabetes, women should make healthy lifestyle choices, such as eating a balanced diet,
taking regular exercise and maintaining the correct weight for their height.

Some of the diet tips for pregnant women suffering from gestational diabetes have to avoid food
items like cakes, cookies, ice-cream, candy, etc. or food containing high amount of simple sugar, try
to eat lots of fresh fruits and vegetables as they good source of fibre and contain sufficient amount
of natural sugar. It is advisable to eat healthy food choices like fresh fruits, dry fruits, salads, carrot,
whole grain, pasta and bread for between the meal snacking. Lastly drink plenty of water and make
sure that you eat carbohydrate and protein based bed-time

7.8 Cytomegalovirus (CMV)

CMV is an extraordinarily common herpes virus. Exposure to this virus can occur through sexual
contact, kissing, or contact with the saliva, urine, tears, or nearly any other bodily fluid of an
infected person. The danger to a developing fetus, especially a fetus whose mother is firth time
infected, include hearing loss, mental retardation, vision loss, liver/lung/spleen problems and dental
anomalies. CMV can be passed from person to person through contact with infected body fluids,
such as saliva, mucus, urine and blood. It also can be transmitted sexually or through infected blood
products. Pregnant women can pass the virus to their babies before or during birth. Breastfeeding
moms can pass the virus to their baby through breast milk. However, babies who become infected
from breastfeeding rarely have any serious problems from the virus.

Infected newborns show symptoms of CMV at birth. Symptoms may include enlarged spleen, liver
problems, jaundice (yellowing of the skin and eyes), distinctive rash, small size and seizures. If a
pregnant woman is diagnosed with CMV, doctor can test the foetus for the infection
using amniocentesis. In amniocentesis, doctor will inserts a thin needle through the pregnant
woman’s abdomen to withdraw a small amount of amniotic fluid. The lab tests the fluid for CMV.
However, cannot tell whether a fetus has severe symptoms of the disease. For this reason, providers
use an ultrasound to identify brain abnormalities and other signs that a fetus may be severely
affected.

To help prevent CMV, pregnant women should wash their hands thoroughly after any contact with
urine, nasal secretions and saliva of young children, including after changing diapers, wiping noses
or drool, and picking up toys, avoid kissing young children on the mouth or cheek and avoid
sharing food, drinking glasses and eating utensils with young children.

7.9 Phenytoin (or Dilantin)

Phenytoin is a medication used to treat epilepsy and prevent seizures. Exposure to this medication
is common for mothers suffering from epilepsy and therefore who have been prescribed the
medication. The danger to the foetus occurs, in part, because Phenytoin metabolizes differently for
the foetus and the foetus receives a much higher dose than the mother. An exposed foetus has
increased risk for developing a cleft palate, developing heart defects, having small heads,
abnormalities in the fingers and nails, and some mild developmental disabilities. This indicates that
there is clear evidence of risk to the human fetus, but the benefits may outweigh the risk for
pregnant women who have a serious condition that cannot be treated effectively with a safer drug.

Some babies born to mothers taking phenytoin have had inadequate blood clotting within the first
24 hours after birth. It is recommended that the mother be given about 10 mg of vitamin K per day
during the last month of pregnancy to prevent this problem. The vitamin K given to babies when
they are born may be too late to prevent this disorder.

Breast-feeding by mothers taking phenytoin should be safe for healthy, full-term newborns,
although a small amount of the medication will appear in the milk. Since 90% of phenytoin is
bound to plasma proteins in the mother's blood, the level in breast milk is about 10% of the level in
the mother's blood.

8.0 Conclusions

In my opinion, I think to become pregnant women that responsible is quite hard. There have many
things have to pay attention on it just like the general knowledge about health, nutrition, disease,
teratogens and others. Foetus will grow rapidly and change day by day in mother’s placenta for 40
weeks.

Therefore, any substance the mother is exposed to or ingests that across the placenta will
affects the unborn child. For examples, the food and medicine that intake by mother, will also pass
through umbilical cord and send to the unborn child. If mother have a balanced diet that contain
protein, fat, carbohydrates and calcium, the child will as healthy as he/she can. On the opposite side,
fetal malnutrition can be cause by a mother’s imbalanced diet and vitamin or protein or other
deficiencies, as well as by deficiencies in the mothers’ digestive process and overall metabolism.
The single best predictor of healthy, full term babies is prenatal visits to a doctor when beginning in
the first trimester of pregnancy.

Besides that, the incidence of prenatal defects or abnormalities increases steadily with age,
especially for first-time mothers. So the best time to have a baby is in age 20-35. Miscarriage will
not so easily happen and the amount of deliver a Down syndrome kid will also decrease. Some of
the mother’s use teratogens like drugs, alcohol, tobacco and others can adversely affect the health
and development of the unborn child. Drug and many over-the-counter medications can harm the
fetus. Heavy drinking can cause extensive damage to the fetus. Smoking has been clearly linked to
fetal abnormalities as well as higher rates of spontaneous abortion, stillbirth and prematurity.

Additionally, there are critical period during which the developing child is at greater risk for
different kinds of defect by diseases such as H1N1, rubella, HIV, diabetes and others. Some of the
disease can cross the placenta and cause defect to the unborn child like brain damage. As pregnant
women, have to stay still in the mood of happy and positive thinking. Don’t have too much stress or
anxiety and try to release stress through many ways like exercising. Besides all this things, the
father also has to responsible to take care of his wife, so that the women can give births a healthy
baby. As the father, he also has to prepare for the coming baby like where the baby sleeps or what is
the environment. Not only pay attention when in pregnancy, but is how to teach and love the child.
Let us learn together to build a warm and happy family!
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