Effect of various maternal diseases and pregnancy complications on the fetus

Undiagnosed and ineffectively treated cardiovascular pathology occupies one of the leading places among extragenital diseases (diseases of organs not associated with the female reproductive system). This pathology leads to fetal developmental disorders.

Currently, the percentage of pregnant women suffering from heart defects has increased significantly. On the one hand, this is due to the expansion of indications for preserving pregnancy in those types of defects for which pregnancy was previously considered contraindicated, on the other hand, the successes of cardiac surgery have played a role, as a result of which the number of women who have undergone heart surgery has increased.

But despite the advances in cardiology, the fetuses of pregnant women with heart defects suffer significantly throughout the pregnancy. A fairly common complication of such pregnancies is premature birth, the birth of functionally immature children with signs of intrauterine hypotrophy. Moreover, premature birth is directly related to the severity of the mother's heart defect. In addition, the degree of damage to the fetus also depends on the form of the heart defect.

Women with this pathology are characterized by various disorders in the placenta, as well as various forms of miscarriage. As for the fetus, the changes vary from banal hypotrophy or asphyxia to congenital anomalies, among which congenital heart defects stand out somewhat separately. Why "somewhat separately"? Because very often (several times more often than in women without heart defects) congenital heart defects appear in children born to mothers with similar pathology.

As for the pathogenesis of the factor damaging the fetus, it is a type of hypoxia.

Of great importance for obstetricians and pediatricians is the study of such a formidable pathology as late toxicosis of pregnancy. Moreover, it plays a leading role in the structure of both child and maternal mortality.

Fetal development disorders in this pathology are caused by numerous damaging factors: dysfunction of the nervous, cardiovascular, respiratory, excretory, endocrine and other systems of the pregnant woman's body. In late-term toxicosis, metabolism is significantly disrupted. In addition, there is a theory that late toxicosis occurs against the background of an immunological conflict between the fetus and the mother's body.

However, despite the differences in the causes of this pathology, the factors affecting the fetus will be the same - hypoxia and placental insufficiency. Consequently, the types of damage will be the same as in the above-described pathology of the cardiovascular system.

Anemia has an adverse effect on fetal development. According to statistics, about 30% of pregnant women (and according to some data, even more) suffer from anemia. Moreover, the lower the hemoglobin content in the blood of a pregnant woman, the harder it is for the fetus. This is due to the fact that a reduced amount of hemoglobin in the mother leads to a decrease in oxygen absorption and, accordingly, a decrease in its supply to the fetus. Moreover, the longer the course of anemia, the more significant the damage to the placenta and fetus. As for the disorders caused by anemia, they are similar to those in the above-mentioned pathology. However, it should be noted that children born to mothers with anemia are often also diagnosed with anemia, not only at birth, but also during the first year of life.

Very often, fetal development disorders are observed in women with endocrine pathology. And diabetes mellitus has the greatest significance in the occurrence of pathology in the fetus. The essence of this disease is that the mother's body, or more precisely her pancreas, produces an extremely insufficient amount of insulin. This leads to an increase in the glucose content in the blood - hyperglycemia. Increased glucose content and its incomplete breakdown leads to multiple metabolic disorders in the woman's body, due to which many functions of her body suffer.

For the fetus, maternal diabetes mellitus, not treated with modern methods, is a very serious damaging factor.

Diabetes mellitus in the mother can lead to morpho-functional disorders in the fetus. It has long been noted that such women give birth to very large children. This is due to increased fat deposition due to profound metabolic disorders. In this case, the child's appearance, described in the literature as a "Cushingoid face", is quite typical. (Itsenko-Cushing syndrome is observed with an excess of adrenal cortex hormones. People with this syndrome have a characteristic appearance: a moon-shaped, puffy face, increased fat deposition, especially in the waist and neck area, etc.) Enlargement of the heart, liver and adrenal cortex is natural.

Therefore, it is very important to promptly identify diabetes mellitus and even its initial or latent forms in order to prevent the development of abnormalities in the fetus.

Thyroid diseases can also disrupt normal fetal development. Moreover, disorders can occur both when the gland itself is damaged (thyrotoxicosis) and as a result of the use of certain medications used to treat thyrotoxicosis.

It is necessary to take into account that the thyroid gland during pregnancy begins to function more actively and reaches its peak activity at the time of delivery. Then, within 2-3 weeks, its activity decreases, returning to normal. This process is due to the fact that hormones produced by the mother's thyroid gland, penetrating the placenta, stimulate the growth and development of the fetus.

In general, sporadically occurring non-toxic diffuse goiter, as a rule, does not lead to significant disturbances in fetal development. More unfavorable consequences for the embryo are observed in endemic goiter, typical for mountain and foothill areas (their residents often drink melt water that does not contain iodine), and diffuse toxic goiter (thyrotoxicosis), especially in those pregnant women who have not received appropriate therapy. The most common complication in such women is miscarriage (almost 50%). In addition, there may be threats of miscarriage and premature birth.

Fetal development disorders are expressed by changes in the central nervous system and endocrine glands (increased nervous excitability, epilepsy, micro- and hydrocephalus, congenital goiter, etc.). It is extremely rare for a mother with diffuse toxic goiter to give birth to children with clinical manifestations of thyrotoxicosis.

In addition to the listed disorders, the fetus may also develop other types of fetopathy: changes in the cardiovascular, musculoskeletal, reproductive and other body systems. As clinical practice shows, fetal and newborn development disorders are mainly observed with insufficient treatment of thyrotoxicosis before and during pregnancy. Therefore, women suffering from toxic goiter need systematic monitoring and treatment by an endocrinologist even before pregnancy.

Adrenal diseases. Diseases such as Itsenko-Cushing syndrome, Addison's disease, etc., occurring during pregnancy, can negatively affect the development of the fetus.

Itsenko-Cushing syndrome is caused by excessive production of hormones by the adrenal cortex. Sometimes with this disease, pregnancy can proceed unfavorably: premature birth, stillbirth, etc. But if the child is born, then most often its development proceeds normally.

Addison's disease is associated with chronic insufficiency of the adrenal cortex, which is most often caused by tuberculosis. Adrenal cortex drugs (cortisone, prednisolone) are used for treatment, which are quite effective, and pregnancy, thanks to them, can be maintained without the risk of damage to the fetus.

With andrenogenital syndrome, the synthesis of one of the hormones of the adrenal cortex - cortisol - is disrupted, which is combined with increased production of androgens (male hormones). Women suffering from this pathology have male-type pubic hair growth, they have the so-called hirsute syndrome (hair growth on the face, like in men), an enlarged clitoris. As a rule, the use of hormonal drugs - glucocorticoids - eliminates the deficiency of cortisol in the body and leads to a decrease in androgen production. If the therapy was carried out in a timely and correct manner, there are no deviations in the development of the fetus. Given all of the above, it should be noted:

• A pregnant woman who comes to an obstetrician-gynecologist for the first time should be carefully and comprehensively examined;
• If a woman is diagnosed with any somatic diseases, she should be treated promptly;
• It is necessary to consult a genetic specialist at a medical genetic center regarding your health and the health of your husband in order to rule out hereditary diseases if possible;
• continue regular examinations during pregnancy and, at the slightest deviation towards deterioration, decide on the issue of hospitalizing the woman in the appropriate hospital.

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