Ecology and pregnancyIt is known that in cities with large industrial enterprises, especially the chemical industry, the levels of perinatal mortality and morbidity is significantly higher than the national average, being one of the causes of the decrease of population growth. Environmentally dependent pathological processes are the cause of fertile decline, risk of gestational complications, fetal malformations and miscarriages, reduce the reproductive potential of the nation [Vdovenko I.A. et al. 2013]. It should be added to this the dramatic reduction in the category of healthy children, which has not only medical, social, demographic, but also economic importance.
Is not completely safe also the countryside, where feeling the effects of the use of herbicides, insecticides and other chemicals. They are not insured also residents quite affluent cities, taking in foods that are rich in these "additives", also includes the hormones and antibiotics fed to livestock and remaining in meat and dairy products. There is a clear link sanitary condition of water consumed with child and maternal mortality [Cheng J.J. et al., 2012; Benova L. et al., 2014]. This is particularly acute raises questions of water purification and recycling of toxic waste [Onishchenko G.G., 2013].
Among the harmful environmental factors there are a number of chemical compounds known embryotoxic, teratogenic and gonadotropic action. In the first case it is manifested impaired fetal growth (slowing down development, reduction in body weight and size), the second – the appearance of his deformities and birth defects, in the third – the defeat of the female or the male sex glands, which is one of the causes of infertility.
Some of the material of the book "Pregnancy and toxicants" (1986) about the harmful effects of certain industrial chemicals at the time listed below.
Organ toxicity of some industrial chemicals
2, 3 - dichloropropene
Pesticides(aldrin, dieldrin, endrin, trichlorfon, ftalofos, captan)
Aldrin, dieldrin, endrin
2, 3 - dichloropropene
It should be borne in mind the delayed effects of toxic substances. Thus, for example, butyl ester does not cause changes in the embryo, but revealed changes in the functional state of births, as well as their subsequent offspring of the first and second generations of the violation of their reproductive function [Konstantinova T.K., Antonenko T.A., 1976]. In addition, nitrites and nitrates help to reduce the viability of the first days of postnatal life, and kepon and ethylenethiourea cause offspring persistent dysfunction of the central nervous system [Tryphonas L., Khera K., 1976]. Some pesticides (epoxilonazole) cause degeneration of the placenta with subsequent fetal resorption [Rey Moreno MC et al., 2013]. In some region of France, these pesticides and their metabolites were detected in the urine of 5.3% -39.7% of pregnant women living in these areas [Chevrier C. et al., 2014].
The fetus may be affected by the consequences of the transferred immediately before pregnancy or during the first trimester of her disease. For example, after rubella about 20% of children may suffer fr om cataracts or congenital heart disease, 30-35% of children have hearing disorders [McElhaney R.D. et al., 1999].
We should not forget that many of our life-saving drugs are also chemical agents and impact on the body of the pregnant woman and the embryo is not always safe. First we need to recall the terrible thalidomide catastrophe 50s when reception during pregnancy widespread in those years and soothing analgesic drug thalidomide caused the whole epidemic of children born with congenital deformities, expressed mainly in the absence of (amelia) or hypoplasia (phocomelia) one two, and often all four limbs [Lenz W., 1965].
However, the statistics and the later period is not optimistic. Thus, according to H.L. Mafenson et al. (1974), in the United States about 7% of newborns had abnormalities, and just over 15 million. Persons had different birth defects. Of these, only 10-15% in the etiology of anomalies were found to genetic factors, and 3% – chromosomal abnormalities.
In our time, also as not all drugs are safe for pregnant and fetal organisms. So there are widespread antidepressants – imipramine and amitriptyline potentially teratogenic, causing a cleft lip, cleft palate, cerebral herniation and hydrocephalus. Tetracycline is capable of causing disturbances of enamel and tooth formation. Meprobamate causes of mental retardation in children. Salicylates, and in particular, well-known acetylsalicylic acid (aspirin), are also embryotoxic agents. Phenothiazines may cause the development of neonatal jaundice. Streptomycin, taken late in pregnancy may be the cause of hearing impairment up to complete deafness in children. Phenylbutazone, oxyphenbutazone, tolbutamide are responsible for the development of neonates toxic thrombocytopenia. Embryotoxic effects have benzodiazepines (diazepam, seduksen, Relanium, Valium). Diethylstilbestrol, takes women during pregnancy can cause birth through girls 11-15 years the occurrence of vaginal adenocarcinoma.
All this has forced J.M. Rao and R. Arulappu (1981) assume that:
- Effects of the drug on the fetus does not always coincide with the well-known pharmacological effect in the body of the mother;
- Some drugs can have long-term effects on the fetus with the appearance of disorder in the later stages of ontogeny;
- No medicine is completely safe for the developing fetus.
However, the overwhelming desire of doctors to treat, and of pregnant women themselves treatment causes one to register and take the other (including their own, without consulting a doctor) a lot of drugs, each of which is far from indifferent to the fetus. Intrigue them lies in the long-term effects, which are sometimes difficult to relate to their admission episodes during the mother's pregnancy.
And in our time, when reading the histories in the departments of pathology of pregnancy maternity hospitals in some cases it was possible to count up to 20 (!) varieties of medicines designated pregnant for various indications. Most often, such a number of medications prescribed for toxicosis and threatened abortion. However, in most of these cases can and should be had not to introduce new chemicals, and remove from the body of harmful and toxic metabolites.
Thus, only the therapeutic apheresis able to pull these pathological products of exogenous origin, as incorporated in the course of employment in hazardous occupations, and as a result of living in the contaminated territories.
In cases of infertility caused by gonadotropic substances, it is advisable to pair treatment. If, however, there were indications of the possibility of getting embryotoxic and teratogenic compounds, the efferent therapy should be carried out before the women of gestation, it is known that as a bookmark major organs and systems, and their development defects are formed in the first trimester of pregnancy. It should be borne in mind that during the first 12 weeks, the trophoblast has not yet formed a reliable barrier function, so it is in the first trimester of pregnancy are particularly dangerous potential embryotoxic and teratogenic substances, including many drugs [Chaika V.K., T. Demina T.N., 2004].
Comparative studies carried out by us in comparable climatic and demographic conditions, but differing in the concentration of industrial cities of the Volga region, showed that in ecologically unfavorable conditions, the frequency of preterm birth, late toxicosis of pregnancy, perinatal mortality and morbidity in neonates prevailed twice. Similarly, a factor of 2-3 had a higher incidence of respiratory diseases and upper respiratory tract, allergies, as well as a group of often chronically ill children during the first years of life [Voinov V.A. et al., 1993, 1994]
This indicates that in areas of environmental stress pregnant are under double press of toxic products, such as endogenous (genuine) and exogenous origin. At the same time, even in the absence of the actual toxicity pregnant eco-toxicosis creates the same unfavorable conditions for maturation of the fetal. Say the same also found the biochemical disorders of immune homeostasis and children and the general population in these industrial centers.
In particular this applies to signs of exhaustion or suppression of the antioxidant defense system, as well as immune deficiency. This is evidenced by the fact that formed in utero inferiority immunity persists in later life. The second and subsequent generations in such conditions become even less resilient, which is manifested in the growth of the so-called cumulative morbidity incidence of children, traced in the same place for the last 30 years, and it already can significantly change the demographic situation in the future.
In a study ofI.M.Morozova (1998) noted that only 7.5% of children with allergic diathesis during pregnancy their mothers were physiological. More than half of these pregnancies complicated by preeclampsia, to a lesser extent the threat of miscarriage. Complicated pregnancy has adverse effects on the immune system of the fetus. These children are born to mothers with preeclampsia. Immunogram on the 5th day of life was characterized by a high content of CD4 and ratio CD4 / CD8. Children born to mothers with threatened miscarriage, revealed a decrease of functional reserves of neutrophils and an increase in serum IgG and IgA.
There is no doubt greater risk of poisoning and more pronounced severity of intoxication during pregnancy for most expectant mother. In particular, experimental studies have found that pregnancy complicated by chronic intoxication leads to more serious violations of liver function than conventional toxic hepatitis [Taskaev I.I., 1979].
All these above facts underscore the urgency of preventive detoxification, both before and during pregnancy in cases wh ere we can expect the complicated its course and fetal abnormalities. The special importance of these activities become indications when an adverse outcome of current or previous pregnancy.
Currently holding a detoxification becomes more affordable, thanks to the development of simple and safe methods of membrane plasmapheresis on Russian Hemofenix devices, opening the possibility of their use in the most extensive network of hospitals on a municipal level, including maternity hospitals.