Fetal therapeutics‐challenges and responsibilities

It is possible to categorize fetal therapeutics into three medical goals: therapy directed at bringing the fetus to a stage of extrauterine viability as in the treatments of erythroblastosis fetalis and pregnancy complicated by diabetes mellitus; therapy directed at bringing the neonate to a stage of postnursery survival as with the use of agents administered to the mother to prevent physiologic hyperbilirubinemia and respiratory distress syndrome in the newborn infant; and therapy directed at bringing the infant to childhood and subsequent adulthood, such as changes in maternal nutrition, personal habits, and total environment. The advances in diagnosis, therapeutics, and prophylaxis of each of these diseases are derivatives of the successful application of present knowledge. Continued advancement requires increased information about the normal and pathologic processes of pregnancy, the degree of control that the fetus‐placenta exercises in regulating metabolic processes of the mother, the interdependence as well as independence of the fetal and maternal endocrine systems, and the time‐related specificity of fetal metabolic pathways. Furthermore, because most of the present prophylactic and therapeutic approaches are not enzyme‐ or process‐specific, appraisal of the steps taken by the physician managing the fetus and its environment requires a focus more refined than the relatively gross standard of perinatal survival or mere absence of disease.