14.1 Introduction Pregnancy, Growth, Development, and Aging

Figure  14.1   Newborn    A single fertilized egg develops over the span of nine months into an infant consisting of trillions of cells and capable of surviving outside the womb. (credit: “Seattleye”/flickr.com)

Chapter Objectives

After studying this chapter, you will be able to:

• List and explain the steps involved in fertilization
• Describe the major events in embryonic development
• Describe the major events in fetal development
• Discuss the adaptations of the body to pregnancy
• Describe the physiologic adjustments that the newborn must make in the first hours of extrauterine life
• Summarize the physiology of lactation

Introduction

In approximately nine months, a single cell—a fertilized egg—develops into a fully formed infant consisting of trillions of cells with myriad specialized functions. The dramatic changes of fertilization, embryonic development, and fetal development are followed by remarkable adaptations of the newborn to life outside the womb. An offspring’s normal development depends upon the appropriate synthesis of structural and functional proteins. This, in turn, is governed by the genetic material inherited from the egg and sperm, as well as environmental factors.

Louisiana Lagniappe

Nationally, maternal mortality is higher among Black women than white women, and Black women are more than three times likely to die from pregnancy-related causes. In addition, Black infants in the U.S. are at a greater risk of being born at a low birth weight than white infants, which is a leading risk factor for infant death.

In Louisiana, four Black mothers die for every white mother and two Black babies die for every one white baby. Louisiana’s maternal mortality rate also exceeds the national average, as Louisiana ranks 47th out of 48 states. Louisiana also has the fifth highest infant mortality rate in the United States.

The Centers for Disease Control and Prevention (CDC) found that, of all races, the infant mortality rate is the highest for non-Hispanic Black infants, and is more than double the non-Hispanic white infant mortality rate. In Louisiana from 2015 to 2017, non-Hispanic Black infants were 2.5 times as likely to die as non-Hispanic white infants.

Long-standing racial bias in health care plays a role in maternal outcomes, as Black women often have their concerns dismissed and may be misdiagnosed for a series of fatal conditions during pregnancy.

For years, public health agencies engaged approaches focused on individual behavior change and health education efforts; yet, after decades, disparities persist. Since 2010, the Louisiana Department of Health has been introducing efforts to identify and impact the structures and systems that lead to disparate health outcomes for Black women and infants. Some of their recent efforts include:

• Analyzing key performance measures to identify areas with disparities and reporting these to the national Center for Medicare and Medicaid Services
• Offering professional development opportunities around effectively communicating public health messages with underrepresented groups
• Training cohorts of professionals on Adverse Childhood Experiences (ACEs) to raise awareness of the impact of ACEs on communities and health.
• Improving nutrition access through Supplemental Nutrition Assistance Program (SNAP) to improve birth outcomes and reduce risk factors for infant mortality
• Reducing the rate of low birth-weight babies and increasing the health of mothers through pre- and postnatal nutrition education and screening
• Increasing the likelihood of mothers receiving adequate pre- and postnatal care through referrals to health and social services
• Offering breastfeeding support services to increase the duration of breastfeeding and reduce the risk of SIDS
• Investigating reimbursement for Community Health Workers and Doula services through Medicaid and LSUHSC Center for Healthcare Value and Equity