1.1 the natal period. However, when the


1 BackgroundThe health of a fetus during intrauterine life has an important implication on the overall well-being and quality of life a person will live after birth. Fetal stress enables it to adapt and cope with life in the natal period. However, when the stress exceeds a certain level, there is a high probability of the fetus having an adverse outcome that can result in death. Pregnancy is a stressful period for a woman. The period is characterized by worries about everything ranging from food, work, exercise, and parenthood. Having some stress during pregnancy is normal, but if it becomes constant, both the mother and the fetus stand to be affected. There are many causes of stress during pregnancy, and this can be social, economic or physical and mental health.

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This therefore encompasses both maternal comorbidities, maternal illnesses and mental and psychological status. When a mother is stressed, her body will constantly be in the fight and flight mode which result in the elevation of cortisol hormone level in blood. This can cross the placenta and affect the fetus. It is thus essential to study how maternal stress affects the fetal outcome and development.1.2 Research questionHow does maternal stress affect the fetus?    1.

3 PROBLEM STATEMENTMother undergoing stressful situations are reported to be having adverse pregnancy outcomes. This has been postulated to be due to fetal stress that results from maternal response to stress due to the crossing of elevated maternal stress hormones into the fetus. These fetuses are reportedly being born prematurely or with lower birth weight compared to their gestational age. Apart from this, most of this children are reported to have developed neurodevelopmental disorders such as autism and attention deficit hyperactivity disorder.1.4 Justification Fetal stress is a condition that has been underdiagnosed for a long time. This is because of lack of a specific test that can be able to detect or assess fetal stress, maternal assumptions and the fact that it has not been given the attention it deserves particularly in earlier stages of pregnancy. Fetal stress can lead to adverse pregnancy outcomes like premature birth, low birth weight, and intrauterine fetal demise.

Maternal stress has been associated with adverse pregnancy outcomes and potential neurodevelopmental disorders in children. This research aims to establish if this relationship exists and provide recommendations that will help avoid the trend.1.5 Purpose of the studyTo assess the relationship between maternal stress and potential adverse pregnancy outcomes and neurodevelopmental disorders.1.6 AssumptionsPreterm birth and low birth weight have multi-factorial causes. At the personal level, the major risk categories include biophysical, socio-demographic, obstetric, historical, behavioral, genetic, psychosocial, and other environmental factors. Research on the effects of maternal stress and other psychosocial processes on low birth weight and preterm birth consider these other risk components as expected confounding variables and seeks to account for their supposed effects by establishing a study subject selection criteria.

1.7 Hypothesis Material stress has protection negative effect on the pregnancy and eventual neurodevelopment of a child.1.8 Theoretical Framework A research framework is a structured user of research studies to hold or support theories. The theories are usually developed to predict or understand the phenomenon and in many ways to change or expand on the current knowledge within the boundaries of certain confining assumptions. The study will be guided by Heitkemper and Shaver ecological model (Heitkemper, 2007).

The model views a person’s overall health as a function of both the external environmental factors and the internal factors. The study seeks to examine maternal external stressors, stress responses and personal resources that affect birth outcomes and a child neurodevelopment health status. Only mothers with children within three to five year of age presenting with neurodevelopmental developmental disorders will be assessed.1.

9 Rationale for choosing frameworkThis model will help highlight all the stressors a mother goes through in pregnancy. The stressors to a mother can either be internal or external. The external stresses arise from the environment the mother lived enduring pregnancy. This will include the neighborhood, family support system, financial problems and social discriminations. The internal environment encompasses both the physical and mental health status of the mother. This will address issues like maternal illnesses, comorbidities, mental illnesses and psychological/emotional well-being of the mother.

CHAPTER TWO: LITERATURE REVIEWAccording to Kinsella and Monk (2009), stress is the way the human body responds to threats or any demand. For instance, when one senses danger, imagined or real, the person’s body defense shift rapidly in what is known as the stress response or the fight and flight response. Stress biology is that adaptations that occur in responses to demands or challenges that are perceived or threaten the internal milieu of an organism.

When a fetus is subjected to stress, it responses accordingly to try deal with the changes noted in its surroundings. During pregnancy, all communication between the fetus and the mother occur via the placenta. Therefore, there is a high probability that all fetal stressors are mediated through this channel. Fetal distress if a term used in obstetrics to describe fatal stress at or during the time of delivery. It points to a fetus that is unwell hence not coping with the demand for labor. It presents commonly as abnormal heat rates or changes in fetal movements (DiPietro, 2012). It results from inadequate supply of oxygen to the fetus.Fetal stressors are mostly maternal in origin.

  The causes of stress in pregnancy vary widely and may include pregnancy discomforts like constipation, changes in the maternal hormonal environment leading to mood swings, and work. Others include maternal illnesses like diabetes, hypertension and thyroid disorders (hyperthyroidism increase the basal metabolic rate of the fetus). Maternal infections like TORCHES exert lot stress in the fetus.

Others like malaria can infect the placenta directly and thus lead to decrease the flow of oxygen and other nutrients to the fetus (Giurgescu et al., 2013). This fetus will thus show signs of fetal distress. Maternal psychological and emotional disorders like anxiety are known to lead to adverse pregnancy outcomes.

The types of stress that can result in adverse pregnancy outcomes include catastrophic events like earthquakes; negative life event like a death in family and divorce; long-lasting stress like financial constraints; racism and pregnancy-related stress. The stress a woman experiences can affect her unborn baby as early as seventeen weeks after conception. Congenital abnormalities are another cause of fetal stress. This can affect the cord thereby interfering with the flow of oxygen and nutrients to the fetus or disturbances in the production and removal of amniotic fluid.

The presence of maternal tumors like fibroids can act as a source of external stress to the fetus (Wadhwa, Entringer, Buss & Lu, 2011).Fetal stress is associated with adverse pregnancy outcomes. Stress in the first trimester is commonly associated with teratogenic effects. This can result from the maternal use of drugs like alcohol, smocking, and valproates. Stresses fetuses are at risk of being borne prematurely or with very low birth weight. This predisposes them to complications that arise from this problems. The fetal may have the potential to suffer longer neurodevelopmental disorders like schizophrenia, autism and attention deficit hyperactivity disorder (Kawakamiet al., 2014).

These children will have learning and social skills disorders. These brain disorders become more pronounced if the fetus starts experiencing fetal stress in the first trimester. Studies have shown that the IQ if children from mothers who suffered from stress during pregnancy have been consistently about ten points below average with a higher level of attention deficit and anxiety problems (DiPietro, 2012).It is essential for the mother to maintain good health, to reduce fetal stress during pregnancy. Maternal comorbidities and illnesses should be promptly treated or managed to prevent their potential effects on the fetus.

The mother must attend at least seven focused antenatal care visits to ensure that condition of the fetus is checked routinely (O’Donnell, Glover, Barker & O’Connor, 2014).). An obstetric ultrasound during the first trimester essential to rule out congenital anomalies that may subject the fetus to stress as it grows thereby increasing its morbidity and mortality.

Second and third-trimester ultrasound will help in the detection of fetal stress.  The mother should also be trained to identify fetal dangers signs like decreased or absent movement that can point to fetal distress (Kwak?Kim, Bao, Lee, Kim & Gilman?Sachs, 2014).CHAPTER THREE: METHODOLOGY3.1 Study AreaThe study will be carried out at the Massachusetts general hospital.

This is a state of the art hospital located in Boston, Massachusetts.3.2 Study Design The research will involve a qualitative study; it will be a retrospective study and mixed-methods in which the target cases will be identified, and the mother requested for an interview in addition to completing a questionnaire after consent has been obtained. In this case, the research will seek to get a snapshot of events within a time frame of three months. 3.3 Study PopulationThe study population will be women who have adverse pregnancy outcomes like low birth weight and prematurity and women who present to the hospital with children with neurodevelopmental disorders within three to five years of age.3.

4 Eligibility3.4.1 Inclusion CriteriaStudy participants will include the mother who gave birth to low birth weight infants, who given birth prematurely and those with three to five-year-old infants with neurodevelopmental abnormalities. There will be a written informed consent to participate in this study for which the respondent will have to sign.Women will be enrolled in the study if I.    Were at least 18 years of age at time of birth; ii.    Was carrying a singleton pregnancy; iii.    Are literate, at least with tenth grade; and iv.

    Are living in the study area. 3.4.2 Exclusion CriteriaThe study will exclude women with medical conditions (e.g., hypertension) or gynecological/obstetrical complications (e.

g., cervical incompetence). 3.5 Sampling MethodPurposive sampling will be used to select cases that will be used in the research. The obstetric register book will be accessed and used to identify respondents whose children had low birth weight or premature birth and then tracked back into the community to administer the questionnaire.

Consecutive sampling will be used to pediatric cases who present to the hospital with neurodevelopmental disorders to administer the questionnaire to the mother. It seeks to include all available subjects as part of the sample.3.6 Sample SizeA purposive sample of 100 cases will be used, fifty for the mother who had low birth weight infants and premature births and fifty for mothers with children with neurodevelopmental disorders.3.7 Data Collection ToolsThe data will be collected using the questionnaire tools and an oral interview with the mother for which her history during the pregnancy will be taken. The aim of this is to ensure that all the information that will be needed during the analyses process is collected.

3.8 Data Analysis SPSS Software version 19 will be used to analyze the data collected. Measures of central tendencies: mean, mode and median will be used.3.

9 Data PresentationResults from the data that is collected will be presented the form of pie charts, graphs, and tables.3.10 Dissemination of dataThe results of this research will be presented in the university and the relevant research conferences. The final report will be distributed to interested parties/institutions. The researcher also intends to publish the research findings in a peer-reviewed journal.

Ethical ConsiderationsInformed consent will be looked for from all the study participants, and the right of the client to withdraw from this study will be reserved. The purpose and nature of this study will also be explained to each participant before the study commencements. Furthermore, this study will be done under the supervision of the hospital and the faculty. Confidentiality of all the collected data from the participants is guaranteed. The Respondents identity will be concealed as they will not be required to provide their names and participation will be non-coercive and voluntary. If a respondent wishes to withdraw from the study, it will be granted.CHAPTER FOUR: CONCLUSIONThe hypothesis will have been tested at the end of the study. We will show the correlation between maternal stress and fatal adverse outcomes (low birth weight and prematurity) and the relationship between this stress and neurodevelopmental disorders.

CHAPTER FIVE: EXECUTION OF STUDYExecution1. The research proposal will first be presented to the Research Committee for approval.2. Approval from the hospital ethical committee will be sought.3.

Once a permit has been obtained, the research will be carried out as follows:A pilot study will be conducted to determine the practicality of the research.The reach will them proceed.


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