Prenatal development - Links to practice

3.2 Safer environments

Through the enormous progress that has been made in biomedicine over the past half century, a very different picture of integrative physiology has emerged – one in which the social environment has a cumulative impact on physical and mental health and the progress of a number of specific diseases.” (McEwen, 2005, p. 315).

Physical and social environments are strong influences on health. According to the Public Health Agency of Canada (n.d.-c), healthier lifestyle behaviours occur within the context of social environments, which can be viewed from the perspective of how people behave in the following three intersecting spheres:

• people as individuals
• as individuals within social environments (e.g., community, workplace, peer and family contexts)
• as individuals in relationship with their social environments.

This broader perspective of social environments views health as a shared issue that should be considered when planning interventions. Of tremendous influence on gestational parent and fetal well-being may also be considerations for the quality and design of various aspects of the physical environment where people may live, work and play (such as access to safe drinking water, smoke-free air or having safe places to sleep).

Social environments

Listen to Monica’s husband Chris talk about how his personal quality of calmness is an attribute that supports Monica’s emotional well-being. He also identifies her personal attributes that contribute to effective stress management during the pregnancy.

Partners are in a key position to be a supportive influence on health and well-being during pregnancy. Unfortunately, not every individual will experience safe, trusting, helpful relationships within their social spheres. In the next video, Dr. Maggie Morris discusses the responsibility of health care providers when working with adolescent prenatal clients to screen for violence and intervene if needed. She also reveals there may be an increased risk for an exacerbation of violence within a less healthy relationship during the prenatal period.

In the next video, Dr. Pablo Nepomnaschy, associate professor in the Faculty of Health Sciences at Simon Fraser University, speaks about the importance of women understanding the need to: find balance in life, find effective ways of managing stress and feel supported within the context of their larger social environments.

Read more about the fifth Sustainable Development Goal, to “achieve gender equality and empower all women and girls”, on the United Nations website.

Having education about and access to birth control methods is one way people may be empowered in decision-making about the timing of a pregnancy. The opportunity to plan for a pregnancy may allow individuals (who would like to bear children in the future), the desired time to pursue other goals or to work at improving their health status in preparation for pregnancy. Birth control use may also decrease the occurrence of a more mature-aged pregnancy and its associated increased level of risk. According to an Ontario-wide survey on preconception health and behaviours in 2008, the Best Start Resource Centre (2009) reports 70% of women responded that their last pregnancy was planned, while 30% indicated theirs was unplanned.

Because timing of pregnancy is another influence on maternal and fetal outcomes, family planning remains an important topic. Read more about the benefits of planning for families through the use of various contraceptive methods on the World Health Organization (WHO) website.

The following example features Suzanne Reier, former technical officer with the WHO. She describes how with support, nursing students in Zimbabwe were empowered to develop and use their own birth control clinic.

Many people find themselves dealing with an unplanned pregnancy – an event the adolescent population is particularly vulnerable to experiencing. Morris provides some helpful advice on how to best support an adolescent who is facing an unexpected pregnancy.

Global binary sex ratios (the proportion of females and males in the population) are approximately equal. However, with increasing age, women outlive men, which results in a larger proportion of women in a given population. Although each year more males are born, there are higher numbers of deaths in males than in females during childhood. Increasing knowledge of genetics, development in utero, and medical advances have allowed us to radically modify this sex ratio. Using this knowledge has ethical considerations.

Many societies have allowed practices that favour male birth and survival, such as female infanticide, and the divorce or killing of wives that only yield daughters. With advances in prenatal assessment, we can determine the sex of the embryo early in development. Such knowledge has been exploited in China, where because of preferences for sons, and their one child per family policy, over one million female fetuses per year were aborted (between 1990-1993). China has now outlawed this practice. Consequently, nearly all international adoptees from China are female. As a result, men now outnumber women by 33 million in China. This binary gender imbalance is the most serious in the world (Guilmoto, 2012).

Explore more on the UNFPA – United Nations Population Fund website about how the attribution of greater value to males over females has become apparent during prenatal development in many countries around the globe. As you read, consider what strategies might promote greater gender equality.

Physical environments

Gestational parent environmental exposures to harmful substances or infections may present risks for harm during prenatal development. For example, if an infection is passed along to a person through a sexual partner (either before or during their pregnancy), this infection may also potentially be passed to a developing fetus. Sexually transmitted infections may be present in a person who is pregnant – even without physical signs or symptoms of illness. Prenatal care that screens for these types of infections can in many cases identify and treat the infection, as well as monitor the fetus as needed for potential effects. Read more on the USA government’s Centers for Disease Control and Prevention website about some of the sexually transmitted infections that may be transmitted to a fetus, how they may harm development, and what can be done in some cases to treat or potentially reduce these risks.

Many chronic conditions of a gestational parent can give rise to detrimental effects on an embryo or fetus through either disease processes or treatments for disease. In many instances, taking steps prior to pregnancy, as well as during pregnancy, with the assistance of a professional care-giver can help decrease risk of harm.

Work can influence one’s well-being through psychosocial and physical environmental influences. Most individuals are able to continue working safely throughout their pregnancies. Read more about working during pregnancy, including some possible hazards and examples of when physical demands may be excessive, on The Society of Obstetricians and Gynaecologists of Canada website.

Another environmental hazard which may be experienced in utero is through first or second-hand smoke in a gestational parent. Watch the following video as Dr. Wanda Phillips-Beck recounts a Manitoba Hydro campaign promoted by the Strengthening Families program in some First Nation communities to help reduce negative effects of second-hand smoke.

Read more about first and second-hand smoking effects and access helpful resources from the USA government’s Centers for Disease Control and Prevention website.

On the Public Health Agency of Canada website, David Butler-Jones (2009) highlights strategies that have had some success in targeting higher risk prenatal behaviours to improve health during pregnancy and create safer fetal environments. Begin by reading about the “Sheway program” on page 53 of the Report on the State of Public Health in Canada (2009): Growing Up Well – Priorities for a Healthy Future. This unique program seeks to address important determinants of health while providing prenatal care. Then, read “Targeting high-risk behaviours” on pages 54 – 55.

Watch as Sir Peter Gluckman discusses the complexity in some situations of interrelated environmental factors that can contribute to less than optimal fetal outcomes. He reiterates the concept of balance (similar to what Dr. Nepomnaschy referred to earlier on the page), suggesting that enjoying the prenatal period and striving for a balance in diet and lifestyle during pregnancy is a healthier type of prenatal goal.

Being aware of a variety of options can be helpful when considering how one might try to reduce stress during pregnancy. The next webpage on the Best Start website outlines a variety of tips for managing stress in pregnancy.

Medical Disclaimer: The Science of Early Child Development resources are intended for educational and health promotion purposes, and should not be considered a substitute for medical advice.