Influence of various diseases of the mother and complications of pregnancy on the fetus

Undiagnosed timely and ineffectively treated pathology of the cardiovascular system is one of the leading places among extragenital diseases (diseases of organs not related to the reproductive system of women). This pathology leads to a violation of the development of the fetus.

At present, among pregnant women, the percentage of women suffering from heart defects has increased significantly. On the one hand, this is due to the expansion of indications for the preservation of pregnancy in those types of defects in which earlier pregnancy was contraindicated, on the other hand, the successes of cardiac surgery played a role, as a result of which the number of women who underwent heart surgery increased.

But despite the successes of cardiology, the fruits of pregnant women with heart defects suffer throughout pregnancy, and significantly. Quite a frequent complication of this pregnancy is miscarriage, the birth of children functionally immature, with the phenomena of intrauterine hypotrophy. And the misfiring is directly related to the severity of the heart defect in the mother. In addition, the degree of damage to the fetus also depends on the form of the heart defect.

For women with this pathology are characterized by various abnormalities in the placenta, as well as various forms of miscarriage. As for the fetus, the changes range from banal hypotrophy or asphyxiation to congenital anomalies, among which several are separately congenital heart defects. Why "a few separately"? Yes, because very often (several times more often than women without heart defects) congenital heart defects appear in children born to mothers with a similar pathology.

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

Of great importance for obstetricians and pediatricians is the study of such formidable pathology as late toxicosis of pregnant women. And they have the leading importance in the structure of both child and maternal mortality.

Disturbances in fetal development in this pathology are caused by numerous damaging factors: a violation of the function of the nervous woman, cardiovascular, respiratory, excretory, endocrine and other systems of the body. With toxicoses of late-term metabolism is significantly impaired. 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 still 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.

Unfavorable affect the development of fetal anemia. According to statistical data, about 30% of pregnant women (and according to some data, more) suffer from anemia (anemia). At the same time, the lower the hemoglobin content in the blood of a pregnant woman, the heavier the fetus is. This is due to the fact that a reduced amount of hemoglobin in the mother leads to a decrease in the absorption of oxygen and, consequently, a decrease in its intake to the fetus. Moreover, the longer the course of anemia, the more significant the damage to the placenta and fetus. As for the violations caused by anemia, they are similar to those in the aforementioned pathology. However, it should be noted that in children born to mothers with anemia, anemia is often diagnosed, not only at birth, but also during the first year of life.

Very often, violations of fetal development are observed in women with endocrine pathology. And the greatest value in the occurrence of pathology in the fetus is diabetes. The essence of this disease is that the body of the mother, or rather her pancreas, produces an extremely inadequate amount of insulin. This leads to an increase in the content of glucose in the blood - hyperglycemia. Increased glucose and sub-cleavage leads to multiple metabolic disorders in the body of a woman, because of which many of her body's functions suffer.

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

Diabetes maternal diabetes can lead to morpho-functional disorders in the fetus. It has long been noted that such women have very large children. This is due to increased fat deposition due to profound metabolic disorders. In this case, the appearance of the child, described in the literature as a "cushingoid face," is very typical. (The Itenko-Cushing syndrome is observed with an excessive amount of adrenal cortex hormones.) People with this syndrome have a characteristic appearance: a moonlike, puffy face, increased fat deposition, especially in the waist and neck region, etc.). Increase of the heart, liver and cortex of the adrenal glands is natural.

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

Diseases of the thyroid gland can also disrupt the normal development of the fetus. And violations can occur both in the defeat of the gland (thyrotoxicosis), and as a result of the use of certain drugs used to treat thyrotoxicosis.

It should be borne in mind that the thyroid gland during pregnancy begins to function more actively and reaches a peak of activity at the time of delivery. Then within 2-3 weeks its activity decreases, returning to the norm. This process is due to the fact that the hormones produced by the thyroid gland of the mother, penetrating the placenta, stimulate the growth and development of the fetus.

In general, sporadically arising nontoxic diffuse goiter, as a rule, does not lead to significant impairment of fetal development. More unfavorable consequences for the embryo are observed in endemic goiter, typical for mountain and foothill areas (their inhabitants are more likely to drink thawed water that does not contain iodine), and diffuse toxic goiter (thyrotoxicosis), especially in those pregnant women who did not receive appropriate therapy. The most frequent complication in such women is miscarriage (almost 50%). In addition, there may be threats of miscarriage, 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 diffuse toxic goiter in the mother that children with clinical manifestations of thyrotoxicosis are born.

In addition to the above disorders, the fetus may have other types of fetopathies: changes in the cardiovascular, musculoskeletal, genital and other body systems. Clinical practice shows that violations of the development of the fetus and the newborn are mainly observed with insufficient treatment of thyrotoxicosis before and during pregnancy. Therefore, women suffering from toxic goiter need systematic observation and treatment in the endocrinologist even before the onset of pregnancy.

Diseases of the adrenal glands. Diseases such as Itenko-Cushing syndrome, Addison's disease, etc., occurring during pregnancy, can adversely affect the development of the fetus.

The Itenko-Cushing syndrome is caused by excessive production of hormones of the adrenal cortex. Sometimes, with this disease, pregnancy can be unfavorable: premature birth, stillbirth, etc. But if the child is still born, then most of its development is normal.

Addison's disease is associated with chronic insufficiency of the function of the adrenal cortex, this is most often due to the defeat of their tuberculosis. For the treatment of adrenal cortex drugs (cortisone, prednisolone), which are effective enough, and pregnancy, thanks to them, can be preserved without the risk of damage to the fetus.

In the andrenogenital syndrome, the synthesis of one of the hormones of the adrenal cortex, cortisol, is violated, which is combined with increased production of androgens (male hormones). Women who suffer from this pathology have pubis hairpieces of the male type, they have a so-called hirsutal syndrome (facial hair growth, 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 the production of androgens. If the therapy was carried out in a timely and correct manner, there are no deviations in fetal development. Considering all the above, it is necessary to note:

• the pregnant woman, who came to the obstetrician-gynecologist for the first time, should be carefully and comprehensively surveyed;
• if a woman has any physical illnesses, she should be treated promptly;
• it is necessary to consult in the medical genetic center with a geneticist about her husband's health and health in order to exclude hereditary diseases as far as possible;
• continue regular examinations during pregnancy and, with the slightest deviation towards deterioration, decide on the hospitalization of a woman in the appropriate hospital.

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