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COMMENTARY 

Factors/Maternal Behaviors That Affect 

Fetal Development 
 

Vladislava Milova1,2, Han Phung1,2, Victoria Cazares1,3, Victoria Guajardo1,2, Sienna Herndon1,2, 

Celeste Garza1,4, Janessa Trevino1,2, Amy Aldaz1,2, Kamyshla Galvan1,4, Ximena Munoz1,4, Jorge 

Gonzalez1,2 

 
1 3rdAnnual Junior Clinical Research Internship, South Texas Academy for Education & Training in Research, DHR Health  

   Institute for Research and Development 
2 Nikki Rowe High School, TX 
3 PSJA Collegiate School of Health Professions, TX 
4 PSJA Southwest High School, TX 

 

Received: June 16, 2023 

Accepted for publication: October 25, 2023 

Published: November 16, 2023

 

Introduction 

Since the dawn of time, birth defects have 

always been a major issue. Birth defects can be 

described as a complication that occurs during fetal 

development in the mother’s body1. According to the 

Centers for Disease Control and Prevention (CDC), 

one in thirty-three neonates are born with a birth 

defect.2 These congenital anomalies can eventually 

advance to emergency situations as their life 

progresses.2 Some of the factors that may affect birth 

outcomes are viruses, the influence of the 

environment, genetics (interbreeding), and 

complications during pregnancy/labor. Other 

contributing factors to fetal development include 

behaviors such as drugs, alcohol, smoking, and diet. 

Since 20% of newborn fatalities are due to birth 

defects, it is vital for mothers to be aware of these 

factors and behaviors.3 Therefore, our goal is to 

provide information to implement preventative 

measures for outcomes of prenatal malformations. 

Alcohol 

Consuming alcohol during fetal development 

causes a number of alcohol-induced defects known as 

fetal alcohol spectrum disorder (FASD).4 Alcohol can 

affect the fetus in its early stages even if the woman is 

not aware she is pregnant. It has been reported that 20-

30% of women drink at some point during the first  

 

trimester. Drinking may cause stunted growth of the 

brain resulting in educational, behavioral, medical, 

and social-related problems.  

Types of educational issues may include but 

are not limited to working memory, problem-solving, 

and impairments in reading, spelling, and math skills.5 

A child with FASD may experience aggressive 

behavior, extreme mood changes, hyperactivity, and 

impulsiveness.6 Some medical issues include narrow 

eye openings, a smooth area between the lip and nose, 

and a thin upper lip.7 Social-related problems include 

unresponsiveness to social cues and the inability to 

keep/make friends.8 

Drugs & Smoking 

North America is living through a rapid 

increase in opioids and cannabis consumption, 

including prescription and non-prescription drugs.9 

Since 1999, the incidence of NAS has increased by 

300%.9 Pregnant women are not immune to disorders 

resulting from drugs. It is estimated that 10% of births 

each year are affected negatively by illicit drug use.9 

During the nine-month pregnancy process, drug use 

may not only be addictive but can affect the mother 

and the fetus negatively. There are many types of 

medication that can be used in a positive manner, but 

the mothers using these medications can become 

reliant on them. Opioids are used to manage pain, 



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which can lead to addictive behaviors from the mother, 

affecting the fetus, specifically causing the newborn 

also to be dependent on the specific drug used. Other 

consequences include labor miscarriages, premature 

delivery, cognitive developmental problems, 

abnormal brain structure, and function, as well as fetal 

stress.10 

The prevalence of drug use in pregnancy is 

not accurately represented due to the small amount of 

well-validated tests.9 There are no specific guidelines 

for drug screening during pregnancy, so the number of 

affected births is unknown.9 Cooperation from the 

mothers is also very limited. Only 5% of women admit 

to the doctor that they were taking drugs during 

pregnancy.9 This can lead to invalidated results and 

inaccurate diagnoses. Although the amount is small, 

tests are still available to see if the mother is misusing 

drugs. Various tissues are tested for drug use, 

including maternal blood, urine, umbilical cord tissue, 

and hair.9 Other tests include simple 

spectrophotometry or sophisticated analytical HPLC.9 

Certain US states, including Tennessee, Alabama, and 

South Carolina, have charged the women with child 

abuse if they are found addicted to drugs, and multiple 

women have been arrested if their drug screens are 

positive.9 

Women are at the highest risk of developing 

a substance use disorder during their developmental 

age (18-24).11 In a national survey, taken in 2012 in 

the United States, results show that 5.9% of women 

use illicit drugs, and 15.9% smoke cigarettes, resulting 

in 380,000 offspring being exposed to illicit drugs and 

over one million being exposed to tobacco, though 

54% of women who smoke quit before pregnancy.11 

The most commonly used substances during 

pregnancy are tobacco and nicotine, which if used,  

expose the newborn to the risk of health problems, 

learning disabilities, and brain developmental 

abnormalities. Studies of the ACOG clinical research 

show that children born to smoker women during or 

before pregnancy are at risk of bone fractures, asthma, 

child respiratory infections, as well as hearing loss.  

Drug consumption can imply a young woman 

with health complications. Drug abuse during 

pregnancy may cause many problems such as 

miscarriage, preterm labor, birth defects, stillbirth, 

withdrawal symptoms for the mother and baby after 

birth, a high risk of sudden infant death syndrome 

(SIDS), poor fetal growth rate, and cognitive and 

behavioral problems.12 Also, women that inject drugs 

during birth are at a higher risk of contracting HIV, 

which is commonly passed down to their babies.12 

Non-prescription drugs are not the only substances 

that present risks to the woman’s health. Prescription 

drugs, specifically prescribed opioids, are also at risk 

to women, with many reports of women getting 

addicted to prescription drugs and painkillers.12 These 

drugs can also cause serious withdrawal symptoms in 

newborn babies.12 This is commonly known as 

neonatal abstinence syndrome (NAS). 

Neonatal Abstinence Syndrome (NAS) is a 

mass of symptoms that indicate a newborn is going 

through withdrawal symptoms because of exposure to 

opioids during the mother’s pregnancy.13 The most 

common drugs associated with NAS are heroin, 

codeine, fentanyl, oxycodone, and methadone.13 Some 

symptoms of neonatal abstinence syndrome are 

vomiting, fever, sleep problems, seizures, rapid 

breathing, and many more.13 NAS is treatable. Many 

doctors recommend taking medicine that helps with 

withdrawal symptoms, injecting fluids through the 

vein of the newborn so it does not get dehydrated, and 

being fed higher-calorie baby formula.14 

Although many states have introduced 

counseling and pregnancy-specific materials to help 

mothers that are dependent on a certain drug or smoke 

consistently, some women continue to use tobacco 

products and drugs.15 Many surveys show that it is also 

recommended that clinicians individualize care by 

providing psychosocial, behavioral, and 

pharmacotherapy interventions to mothers that are 

either addicted to drugs or that smoke.15. Many 

physicians and doctors are working on significantly 

decreasing the amount of drug use in North America, 

not just in pregnant women, but in the whole 

population. 

Diet 

Women have specific nutritional 

requirements during pregnancy and breastfeeding 

when the nutritional vulnerability is most common.16 

Nutrients include carbohydrates (sugars), lipids (fats), 

proteins, specific vitamins, minerals, and water.17 Poor 

diets lacking nutrients like iodine, zinc, folate, and 

calcium increase the risk of anemia, pre-eclampsia, 

and hemorrhage in mothers and can cause the child to 

be stillborn, and have a low birthweight - UNICEF 

estimates low birthweight affects about 20 million 

newborns each year - and can create many 

developmental problems.16 There are many foods that 

should be avoided during pregnancy. These foods can 

cause certain birth defects in the fetus and can increase 

the risk of foodborne illnesses for the mother. 



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Seafood can provide an amazing source of 

protein and omega-3 fatty acids for the mother. Protein 

and fatty acids can positively affect the newborn's 

brain and eye development. However, certain shellfish 

have high levels of mercury which can harm the 

newborn’s nervous system.18 The older and bigger the 

fish, the more mercury it is likely to contain.18 The 

FDA encourages mothers to stay away from bigeye 

tuna, marlin, king mackerel, shark, and wordfish to 

avoid the risk of these problems. Any raw, 

contaminated, or undercooked seafood should also be 

avoided due to the risk of contamination.18 

During pregnancy, mothers are at a higher 

risk of contracting bacterial food poisoning, and the 

reaction might be more severe than if the mother 

wasn’t pregnant.18 Undercooked meat, poultry, and 

eggs are foods that can carry bacteria that can affect 

the mother, and possibly the baby.18 

Unpasteurized foods can lead to foodborne 

illnesses. Any low-fat products, such as low-fat milk 

or mozzarella, are healthy for the diet. Raw milk, also 

known as unpasteurized milk, can contain bacteria 

such as campylobacter, E. coli, listeria, or salmonella. 

Pregnant women are at higher risk of contracting these 

types of bacteria, and the reactions resulting from them 

will be more severe.19 These bacteria are also very 

common on unwashed fruits and vegetables and raw 

sprouts of any kind.18 

The effects of caffeine and herbal teas on 

newborns are not clear, but doctors suspect they are 

negative. Although caffeine can cross the placenta, the 

effects of it on newborns aren’t clear, so doctors 

recommend avoiding excess caffeine, just to be safe.17 

There also is not much information on herbal teas and 

their effect on developing babies though doctors 

recommend that mother avoid these types of teas.18 

Despite this, there are specific herbal teas that 

encourage pregnant women to drink them.18 

There is a mass amount of vitamins the baby 

needs to have a smooth development. For example, a 

significant lack of Vitamin B may cause birth defects 

and stillbirth. Calcium during pregnancy can 

significantly decrease the risk of contracting 

preeclampsia, a disease that causes a sudden increase 

in blood pressure.17 Calcium also builds up the 

newborn’s bones and teeth. A significant lack of 

calcium can cause the baby’s bones to be brittle and 

can increase the risk of fractures and broken bones. 

Vitamin D helps the calcium in the body to build up 

the newborn’s bones and teeth.17 

A balanced diet is important for both the 

mother and the newborn. If one element or vitamin 

overweighs the others, many defects and problems can 

occur. A stabilized diet will provide the baby with 

optimal nutrition and condition for the developmental 

process to go smoothly and without any setbacks or 

problems.18 

Viruses 

The environment of the fetal development 

holds great significance in the development of the 

infant during pregnancy, more so when it includes 

viral infections in the mother’s body which will 

inevitably affect the outcome of the pregnancy.20 

Pathogens that contribute to neurodevelopmental 

disorders include the rubella virus, herpes simplex 

virus, Influenza A virus, and CMV. Studies have 

shown that infections that present during a mother’s 

pregnancy; sinusitis, pneumonia, pyelonephritis, or 

bacterial venereal disease, are linked to increasing the 

child’s neurodevelopmental risk by 2 times. This can 

be very extremely dangerous for the infant as it will 

elevate the risk of ASD, which is a main portion of 

illnesses that are discovered.21 The danger lies in the 

possible long-term effects such as congenital 

anomalies or in some cases, death. The World Health 

Organization (WHO) has stated that of the 5,000,000 

neonatal deaths that occur worldwide per year, 

approximately 2,000,000 are directly the result of 

infection.22  

Influence of Environment 

During a woman’s pregnancy, it is crucial 

that she is in a safe environment. Many small little 

things can affect the pregnancy, ultimately affecting 

the fetus's development as well, if the mother is 

exposed to certain things. Domestic violence for 

pregnant women between the ages of 18-60 negatively 

affects obstetric-related outcomes as well as mental 

health during the postnatal period.23 Exposure to 

violence during the woman’s pregnancy can lead to 

consequences such as hemorrhage, preterm rupture of 

membranes, recurrent miscarriages, premature 

placental abruption, and low birth weight.23 Both the 

baby's growth and the postpartum period may be 

seriously harmed by this. During pregnancy, it's 

crucial that the woman is in a secure setting. If the 

mother is not in a safe environment and experiencing 

domestic violence it can lead to factors of stress, 

depression, or suicidal tendencies. Depression is the 

most common causing the mother to lose interest in 

daily activity, ultimately affecting the fetus as well.24 

One most seen types of depression during pregnancy 



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is perinatal depression. This can leave the mother in a 

depressed state, which eventually leads to future 

health issues. If left untreated it can pose maternal 

risks such as preeclampsia, placental abruption, 

cesarean delivery, preterm admission, and maternal 

postpartum readmission.24 Long-term 

neurodevelopmental consequences in offspring can 

also be presented during pregnancy if perinatal 

depression is not treated right away.24 Pregnancy 

nutrition is important because it provides the fetus 

with the nutrients it needs for maturation into a healthy 

child. The fetus would also be adversely affected if the 

mother was not getting adequate nourishment. One 

major part of pregnancy is that the fetus is totally 

dependent on the mother’s vitamin status.25 Vitamin D 

is critical for bone and calcium homeostasis as well as 

preventing neonatal hypocalcemia and pre-

eclampsia.25 Studies show that vitamin D deficiency is 

associated with postpartum depression which is why 

the status of vitamins is important in brain 

development, cognitive function, fetal bone growth, 

and neonatal lung maturation.25 During stages of the 

woman’s pregnancy, there can be complications along 

the way but it is crucial that she remains in a safe 

environment as it can show to have an effect on fetal 

development. During pregnancy, a variety of 

circumstances may arise, but the mother’s decision to 

remain in a healthy environment is paramount for the 

mother and developing child.  

Genetics: Age, Interbreeding 

 Birth defects are mainly caused by 

malformations in the genetic composition of a fetus 

and are usually shown during the early stages of 

pregnancy, usually by the end of the first trimester.26 

Some of these malformations are influenced by the 

mother’s medical conditions, mutations in the genes, 

chromosomal abnormalities, single-gene defects, and 

dominant traits.27 Chromosome abnormalities occur 

during the formation of reproductive cells or during 

early fetal development. These errors usually occur 

during the cell division process (meiosis and mitosis) 

when there are problems with the duplication and 

deletion of chromosomes. Aside from numerical 

abnormalities in chromosomes, there are also 

structural changes in chromosomes that can lead to 

birth defects.27 

Chromosomes come in pairs, so the number 

becomes imbalanced when there is a missing 

chromosome (monosomy) or when there is an extra 

chromosome (trisomy).28 Fetuses that suffer from 

trisomy often lead to miscarriage, but those who 

survive are diagnosed with moderate to severe birth 

defects.28 This is commonly seen in Down Syndrome 

patients who have an extra copy of chromosome 21, 

also known as trisomy 21. Studies have shown that this 

abnormality usually originates from the mother due to 

age.29 Other medical conditions that are caused by 

chromosomal deletion include heart defects, palatal 

abnormalities, learning difficulties, facial deformities, 

and psychiatric disorders in older patients like 

schizophrenia and bipolar disorder.30 

Balanced translocations do not alter the 

number of chromosomes, but they alter the structure 

of a chromosome, affecting the pairing system.28 

Carriers of this translocation are not affected by it, but 

they can experience difficulty reproducing. Mothers 

can suffer miscarriages or in case of survival, the 

fetuses are at high risk of birth defects and other 

abnormalities.31 In the case of a family, two of three 

daughters suffered from intellectual and physical 

disabilities because they only inherited half of the 

mother’s abnormal chromosomes and half of the 

father’s normal chromosomes.28 Because they did not 

inherit the two abnormal chromosomes from the 

mother, they were not chromosomally balanced, 

leading to birth defects. 

If there is no presence of numerical or 

structural chromosome abnormalities, genetic 

mutations are another cause of birth defects. The most 

common mutations in genes include sickle-cell 

anemia, cystic fibrosis, Tay-Sachs disease, and 

Alzheimer’s.32 Recurring symptoms from patients 

with these mutations are frequent infections, 

respiratory complications, organ damage, loss of 

motor skills, and seizures, among others.33 Genetic 

mutations take place during cell division when there is 

a mistake in replacing, removing, or adding codes that 

are not readable by the cells.32 Germline mutations 

happen in the parent’s reproductive cells and affect all 

the baby’s cells, making the mutation hereditary. 

Somatic mutation occurs during the developing stage 

of the fetus and affects all the cells.32 

It is commonly known that by the age of 40, 

a woman's chances of conceiving a pregnancy 

substantially diminish by 95%.34 In contrast, a healthy 

20-year-old typically has full capabilities to get 

pregnant and that makes their chances of conceiving 

higher.35 Naturally, when the body gets older, the 

production of eggs decreases substantially. This, 

however, is not the only thing to consider when 

attempting to develop a baby around the age of 40. The 

chances of a miscarriage will also increase around this 

age due to the progressive negative chromosomal 

changes in eggs or oocytes.36 Physicians have the 



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ability to make tests of the ovarian reserve to 

determine the best way to go about the pregnancy or 

to advise individuals who want to go through 

pregnancy at that age. 

Inbreeding causes the effect of overlapping 

DNA that results from the procreating of closely 

related biological partners that are related to the same 

common ancestors.34 The excess amount of DNA 

typically is the cause of the permanent development of  

medical issues in the very early stages of fetus 

development. The chances of the infant being born 

with Autosomal recessive disorders like cystic fibrosis 

or sickle cell anemia are usually in response to the 

increased chances of both parents carrying the 

recessive genes that cause these diseases.35 

Historically, Royal families were commonly known to 

inbreed in their families to keep their blood “pure” by 

having consanguineous marriages.36 This has been 

shown to have the outcome of many body deformities 

one of which is known as the Habsburg jaw. This 

facial deformity was present in the royal family of the 

Habsburgs who ruled Germany and Austria. The facial 

deformity was a result of a recessive pattern from the 

biological parents. 

Complications During Labor 

As a mother starts to go into labor, there are 

many factors that can delay the birth of the infant. 

While in labor, the women are getting continuous 

check-ups to make sure their blood pressure, glucose, 

and temperature is going smoothly and they are 

dilating properly. Some women may experience 

complications during their labor.  

For instance, pre-eclampsia is a serious 

condition that occurs to the mother usually after the 

20-week mark or even after birth that affects the blood 

pressure and other vital organs such as the kidneys 

provoking them to not function correctly. Some 

symptoms are present such as persistent headaches, 

trouble breathing, severe nausea, and changes in 

vision. This condition affects 5 to 8 percent of 

pregnancies and may even cause death.37 

During labor, there are complications that 

occur such as the dilation process, amniotic fluid, and 

hemorrhaging. There can be complications with the 

dilation process, such as a prolonged latent phase, an 

arrest of dilation, or even precipitated dilation.38 

Others may experience the lack of being able to 

contract while in labor, prolonging labor delivery.38 

While the infant is in the womb, it must change its 

position to where its head is facing down towards the 

cervix, but at times, babies are in fetal malposition, 

making it difficult for the mother to push. The 

amniotic fluid plays an important role for the fetus 

because it is a liquid that revolves around the fetus that 

protects it from harm. The mother may lack or have 

too much of the amniotic fluid which is called 

Oligohydramnios and or Polyhydramnios.37 Although 

there are many more complications that can occur 

during labor, all of them can affect the infant and the 

mother causing them to be in critical conditions or 

even death. Childbirth is taken with great precaution 

because things can take a turn quickly whether that be 

the birth moving quickly causing a dry birth to the 

birth going slowly to where the fetus excretes inside 

the mother.  

Conclusion 

It is asserted that detecting certain defects 

early on in the pregnancy during the baby’s 

development would allow families to subject what 

care they would bring for the children. Learning the 

negative factors and maternal behaviors that cause 

birth defects can increase healthier baby development. 

What negative factors and maternal behaviors affect 

fetal development? A conclusion of certain 

circumstances that would negatively affect fetal 

development would be maternal negative behaviors 

such as alcohol, drugs, smoking, and diet, while 

negative factors are viruses, the influence of 

environment, genetics, age, and complications during 

pregnancy and labor. 

  Consuming alcohol during pregnancy 

develops FASD early on and consumption can affect 

child stunt growth. If a mother is to consume most 

types of drugs they are risking the possibility of labor 

miscarriages, premature delivery, cognitive 

developmental problems, abnormal brain structure, 

and fetal stress.10 As previously stated, an AOG study 

concluded that smoking during pregnancy opens up 

the risk for bone fracture, asthma, and child respiratory 

infections. In a case where a mother would inject drugs 

through needles, there is a high risk of obtaining HIV. 

It is confirmed that if the maternal mother does get 

HIV, the possibility of the infection being passed 

down to children is extremely high.12 A healthy diet is 

extremely vital in order to provide a steady pregnancy. 

In contrast to a healthy diet, a poor diet can increase 

anemia, preeclampsia, child stillborn, and the nervous 

system.16 Including healthy meal plans and all 

nutrients is crucial because it strengthens infants' 

bones and teeth.18 Viruses have also been a huge factor 

that may dictate negative fetal development. As 

described before, viruses have increased a child's 



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neurodevelopment by twice as much, as well as 

elevating the risk of ASD.21  

Congenital anomalies and death have 

resulted in infants from viral infections.29 In order for 

a pregnancy to run smoothly, a safe environment must 

be provided. In a violent situation, a pregnancy can 

negatively result in hemorrhage, preterm rupture of 

membranes, premature placental abruption, and low 

birth rate.23 Although a safe environment is provided 

throughout the entire term, when the time comes to 

deliver the baby, it is crucial that the birth runs as 

smoothly as possible. Not doing so, can result in a 

critical condition or death in the mother or the infant. 

Genetically, occurrences like Down syndrome, heart 

defects, and palatal abnormalities have resulted. 

Providing accurate care and consideration for the 

mother and infant can reduce the risk of congenital 

defects. 

Acknowledgements 

Monica Betancourt-Garcia, MD, Program Director; 

Melissa Eddy, MS, Program Manager  

Funding 

Funded by DHR Health Institute for Research & 

Development; DHR Health; Region One ESC 

GEARUP College Ready, Career Set!; Region One 

ESC GEARUP College Now, Career Connected; 

Region One ESC PATHS; Region One ESC Upward 

Bound Math & Science; Benavides ISD; and Jubilee 

Academy-Brownsville  

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