Predicting risk in pregnancy and protecting against it

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Who is at risk?

Risk can be difficult to identify early in pregnancy, particularly in first pregnancies, as often little is known about the experience and abilities of the expectant parents.

Because of this, it is important to link with other professionals who may know more about the family and their circumstances such as carers, GPs, social workers and voluntary sector agencies.

Useful predictors of risk during pregnancy

Antenatal workers should consider a range of factors:

Socioeconomic circumstances:

  • Families who are living in poverty
  • Young parenthood, which is linked to poor socioeconomic and educational circumstances
  • Being in or recently having left care
  • Educational problems – expectant parents with few or no qualifications, a history of non-attendance or learning difficulties
  • Expectant parents who are not in education, employment or training
  • Families who are living in unsatisfactory accommodation

Mental or behavioural issues:

  • Expectant parents with mental health problems
  • Expectant parents with a history of anti-social or offending behaviour
  • Low self esteem or low self-reliance
  • Temperamental characteristics, some of which may be genetic
  • Ambivalence about becoming a parent
  • Stress in pregnancy

Physical health:

  • Poor pre-conceptual health
  • Obesity
  • Underlying medical or developmental disorder, which may be genetic

Family and relationship issues:

  • Unstable partner relationships
  • Gender-based violence
  • A history of abuse, mental illness or alcoholism in the mother’s own family
  • Families with low social capital
  • Smoking by the partner (this has both direct and indirect impact on babies and children, and is the most powerful influence on the mother’s smoking habit)

Substance misuse:

  • Problem substance use by woman and or partner
  • Smoking in pregnancy (this has multiple short and long term adverse effects on both the foetus and child)
  • Consumption of alcohol, particularly in addition to substance misuse

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Protective factors

Protective factors to health build future resilience and reduce the impact of health inequalities. Professionals need to begin a process to support the development of skills that are protective to health.

Parenting skills, combined with warmth and with an affectionate bond of attachment from infancy, are an important protective factor. Others include:

  • Parental involvement in the baby’s development and learning
  • Protective health behaviour, such as smoking and alcohol cessation before or during pregnancy
  • Breastfeeding
  • Psychological resilience, including self–acceptance of the mother and partner or carers

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