Socio-biological factors of non-pregnancy

Socio-biological factors significantly affect the course of pregnancy and therefore can be associated with miscarriage. Many researchers associate miscarriage with the place of residence. This indicator is especially high among visiting women who are not adapted to the extreme conditions of the North. Women who have lived in these areas for less than 3 years experience premature births and miscarriages 1.5-2 times more often than local residents and those who have lived in these regions for more than 3 years. The frequency of miscarriage is explained not only by the complexity of the adaptation processes to new, more severe climatic conditions, but also by the difficulties of providing specialized care in remote areas.

Seasonal variability in premature termination of pregnancy has been noted. The incidence of this complication increases in the autumn and spring months.

In industrial cities and large populated areas, the incidence of miscarriage is statistically higher than in small populated areas.

Working conditions have a certain impact on the course of pregnancy. When studying the impact of production factors, a direct dependence of premature termination of pregnancy on the mother's profession, the nature of work, the presence of occupational hazards, even under the condition of light work during pregnancy, was established. Apparently, the impact of harmful working conditions (chemical hazards, vibration, radiation, etc.) significantly disrupts the reproductive function and can subsequently lead to miscarriage.

Currently, about 56 teratogens are known for humans, the most significant of which are high doses of radiation, mercury and lead.

Studies conducted after the atomic bombings in Japan showed that, many years later, there was an increased risk of children being born with microcephaly, with both mental and general developmental delays in their offspring. Spontaneous abortions, premature births, and stillbirths were still higher in the region than in the general population.

But long-term exposure to low doses of radiation also has an adverse effect on the reproductive function of women. As shown by the research of Sokur T.N. (2001), in the regions affected by the Chernobyl accident, in conditions of constantly acting low doses of radiation, changes in the reproductive health of women and their offspring are clearly visible. An increase in spontaneous abortions by 2-3.5 times was noted, the frequency of threatened termination increased by 2.5 times. In the zones of the greatest radiation contamination, the frequency of termination of pregnancy was 24.7%.

Diagnostic X-ray examination in the first trimester of pregnancy does not have a teratogenic effect if it is less than 5 rad (Creasy et al., 1994). Large doses (360-500 rad) used for therapeutic purposes cause miscarriage in most cases. Non-ionizing reaction (microwaves, short waves) cause a thermal effect and can have an adverse effect on the fetus through hyperthermia. Even in large studies using microwave and shortwave diathermy in pregnancy, pregnancy losses were the same as in the control group.

Heavy metal salts such as mercury and lead can accumulate in the body, they penetrate the placenta to the fetus and can have an adverse effect, especially on the development of the central nervous system. It is known from animal experiments that long-term exposure to mercury salts, even in small doses, leads to miscarriage. In humans, mercury does not cause structural developmental abnormalities and is not always accompanied by miscarriage, but its effect on the neurological condition becomes apparent only after birth.

The toxic effect of lead on pregnancy has been known for over 100 years. According to many researchers, the frequency of miscarriages among workers whose occupations involve lead (printers) is many times higher than in the population (1991 SDS). Legislation in many countries does not allow women to work with lead.

There are currently many studies on the role of pesticides in pregnancy complications, but there are no randomized data on the role of pesticides in termination of pregnancy and, according to the latest data, they do not have a teratogenic effect.

Insecticides are generally neurotoxic: their role in reproductive losses has been extensively studied in many agricultural areas. Most studies show that working with insecticides for more than 6 months leads to a significant increase in miscarriage rates.

Premature births are more common among women engaged in physical labor, and among young women who combine work with study. Habitual miscarriage is more common among women engaged in intellectual labor. Among women working more than 42 hours a week in the first trimester of pregnancy, the incidence of premature births is 8.5%, while among women working less than 42 hours a week - 4.5%. However, working women do not have an increased risk of spontaneous abortions, stillbirths, and intrauterine growth retardation.

Among women who use several types of transport on their way to work, premature births are observed in 22%, with a lower workload - in 6.3%. Among women who work standing up, the incidence of premature births is 6.3%, with sedentary work - 4.3%.

Factors influencing the miscarriage rate include the mother's age and parity. The contingent with miscarriage is mainly young, but older than among women who give birth on time, and averages 29.8±0.8 years versus 25.7+0.1 years. Relatively low rates of premature births are observed in women aged 20-24 and 25-29 years (7.1 and 7.4%, respectively).

The miscarriage rate is higher in women under 20 and over 35, reaching 15.6% in both groups. There are conflicting data on the effect of parity on miscarriage. With an increase in the number of births, the frequency of premature births increases: 8.4% for the second birth, 9.2% for the third and subsequent births. Other authors note a tendency for the number of premature births to decrease with increasing parity, believing that it is not the parity that is of greater importance, but the interval between births (the shorter it is, the more frequent complications are). A certain way of life in the family, the amount of housework, and the nature of the relationship between the spouses have a significant impact on the course and outcome of pregnancy. Among those who gave birth prematurely, a significant number of women were in unregistered marriages, as well as those who had unresolved housing problems, or who experienced stressful situations during pregnancy. A dependence of miscarriage on the mother's body weight and her diet during pregnancy has been established.

Bad habits, especially smoking, alcohol, and drugs, have a significant impact on the course of pregnancy.

Smoking during pregnancy increases the frequency of miscarriages, placental abruption, placenta previa, fetal growth retardation, and increases perinatal mortality. The effect of nicotine is dose-dependent: the more cigarettes smoked per day, the greater the adverse effect on pregnancy.

Alcohol has a teratogenic effect on the fetus (fetal alcohol syndrome), chronic alcoholism has a particularly severe effect on the course of pregnancy and the condition of the fetus. It, like nicotine, is dose-dependent. Even moderate levels of alcohol consumption lead to an increase in the number of miscarriages and premature births.

The frequency of spontaneous abortions in women who consume alcohol was 29%, perinatal mortality was 12-25%, premature birth was 22%, and fetal alcohol syndrome was 0.1-0.4%.

The combined effects of alcohol and smoking and drug use exacerbate adverse pregnancy outcomes. According to the authors, the effects of drugs may be secondary to those of alcohol and cigarettes.

Many researchers associate miscarriages with stressful situations. Others believe that stress is not directly related to spontaneous miscarriage, since the nature of stress and reactions to stress are very individual. Pathophysiological mechanisms that could be responsible for miscarriage induced by stress reactions are difficult to identify. Stress may be associated with an increase in catecholamines, which can result in a vasoconstrictive effect and lead to impaired nutrition and respiration of the fetus. The role of the psychocytokine mechanism of pregnancy loss is possible.

Habitual loss of pregnancy is often accompanied by severe depression in women and severe emotional experiences in the married couple.

Thus, taking into account the significant influence of social factors on the course of pregnancy, during dispensary observation of pregnant women it is necessary to take into account not only their health status, but also their social and hygienic characteristics and psychological situations.

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