Toxicosis in pregnancy: Pathologies of the placenta
Talcum Powder Toxicosis in Pregnancy
. 2018 Oct;8(4):e384-e386.
Epub 2018 Dec 28.
- 1 National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Georgetown University, Washington, D.C.
- 2 Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio.
- 3 Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
- 4 Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, California.
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Jon F Pennycuff et al.
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. 2018 Oct;8(4):e384-e386.
Epub 2018 Dec 28.
- 1 National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Georgetown University, Washington, D.C.
- 2 Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio.
- 3 Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
- 4 Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, California.
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Background Pica is a relatively common phenomenon in pregnancy and typically includes consumption of nontoxic substances such as earth/clay, raw starches, and ice. Occasionally, substances may be toxic or have unintended consequences. Case A nulliparous woman presented to our facility complaining of numerous, vague symptoms that are common in pregnancy. She had multiple work-ups and an admission to our antepartum unit without clear etiology of her symptoms. Ultimately, she was diagnosed with talcum powder toxicosis secondary to talc ingestion as a coping mechanism for her anxiety, which was heightened in pregnancy. Conclusion This case highlights the importance of screening for mental health disorders, which may be exacerbated during the peripartum period. Patients’ coping mechanisms for mental health disorders may have unintended consequences.
pica; pregnancy; talcum; toxicosis.
Conflict of interest statement
Conflict of Interest None.
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Management of T3-toxicosis in pregnancy | SFEEU2018 | Society for Endocrinology Endocrine Update 2018
Case history: Pre pregnancy: A 31-year-old female with no family history of thyroid disease presented with clinical hyperthyroidism and large goitre with bruit. Graves Disease was confirmed: TSH <0.01 (0.355.0 mU/l), free T4 53.4 (9.021.0 pmol/l), TSH Receptor Antibodies (TRAB) >40 (01.9 U/l), TPO 32.2 (<6 U/ml). She started on carbimazole (CBZ: 20 mg BD) and propranolol. She then switched to propylthiouracil (PTU: 150 mg BD) at 2 months due to desire for future pregnancy. US thyroid showed a >5 cm, hyper-vascular lobulated goitre.
First trimester: Booked to obstetric/endocrine clinic at 78 weeks gestation, four months after original presentation. Booking bloods: T4 (fT4 7.1 pmol/l), Total T3 >12.3 nmol/l, TSH <0.01 mU/l). Due to low T4 in very early pregnancy, PTU and propranolol were continued but T4 considered, then eventually added, to maintain the mothers T4.
Second trimester: Mother continued anti-thyroid medication (PTU then CBZ) with supressed TSH, raised T3 and clinically improved but ongoing signs of thyrotoxicosis. Foetal thyroid scanning was commenced at 18 weeks. Foetal goitre (>95th centile) was seen from 21/40 with radiological evidence of thyrotoxicosis (central vascularization on Doppler) but normal foetal heart rate. Cordocentesis was offered but declined. In conjunction with obstetrics, CBZ was increased. Foetal goitre increased, therefore cordocentesis and foetal MRI were undertaken at 27/40. MRI confirmed a foetal goitre (right lobe 1.4 cm×1.2 cm, left lobe 1.4 cm×1.1 cm) with minor airway flattening. Cordocentesis suggested foetal hypothyroidism: TSH 36.45, fT4 9.8, total T3 0.3. Maternal CBZ was down-titrated to 5 mg with reduction in foetal goitre from 31/40; thyroid circumference <50th centile by 37/40. Foetal growth scans were normal throughout.
Delivery and postnatal: Maternal biochemistry at 39/40: TSH <0.01 mU/l, fT4 15.0 pmol/l, total T3 3.2 nmol/l, TRABs 3.7 U/l. Baby was delivered by uncomplicated SVD. Neonatal biochemistry was nominally euthyroid at birth but showed neonatal thyrotoxicosis at 5 days (TSH 0.31 mU/l, fT4 40.1 pmol/l, total T3 2.7 nmol/l, TRAB 6.1 U/l).
Conclusions and points for discussion: We describe a rare case of resistant T3 toxicosis in pregnancy. A number of discussion points include 1. Pre-pregnancy planning in women with Graves Disease, 2. Consideration of need for T4 supplementation when levels are low in T3 toxicosis in pregnancy, 3. Foetal monitoring with role of fetal ultrasound (for size and signs of hypo- and hyperthyroidism) and cordocentesis, 4. Neonatal thyrotoxicosis.
Experience in treating early toxicosis of pregnancy » Obstetrics and Gynecology
Siberian State Medical University, Ministry of Health of Russia, Tomsk 634021, Moscow highway, 2, Russia
Ginger (Zingiber officinale) has gained widespread acceptance in culinary practice and is often used as a food additive, improving the taste of products. It is also a well-known and well-proven nonpharmacological agent for pregnant women, which is used to treat nausea and vomiting. The highest-quality numerous studies and publications (Medline, PubMed) (randomized double-blind placebo-controlled studies, meta-analyses) show the efficacy and safety of ginger-containing agents used in pregnant women, while any risks to the mother and her unborn child have not been found. In vivo studies have shown no toxicity of the agent. The available data demonstrate the safety and efficacy of ginger for early toxicosis in pregnancy.
1. Sukandar E., Qowiyah A., Purnamasari R. Teratogenicity study of combination of ginger rhizome extract and noni fruit extract in Wistar rat. Indones. J. Pharm. 2009; 20(1): 48-54.
2. Plengsuriyakarn T., Viyanant V., Eursitthichai V., Tesana S., Chaijaroenkul W., Itharat A., Na-Bangchang K. Cytotoxicity, toxicity, and anticancer activity of Zingiber officinale Roscoe against cholangiocarcinoma. Asian J. Cancer Prev. 2012; 13(9): 4597-606.
3. Wang Y., Yu H., Zhang X., Feng Q., Guo X., Li S. et al. Evaluation of daily ginger consumption for the prevention of chronic diseases in adults: a cross-sectional study. Nutrition. 2017; 36: 79-84.
4. Petersen I., McCrea R.L., Lupattelli A., Nordeng H. Women’s perception of risks of adverse fetal pregnancy outcomes: a large-scale multinational survey. BMJ Open. 2015; 5: e007390.
5. Sharifzadeh F., Kashanian M., Koohpayehzadeh J., Rezaian F., Sheikhansari N., Eshraghi N. A comparison between the effects of ginger, pyridoxine (vitamin B6) and placebo for the treatment of the first trimester nausea and vomiting of pregnancy (NVP). J. Matern. Fetal Neonatal Med. 2018; 31(19): 2509-14.
6. Heitmann K., Nordeng H., Holst L. Safety of ginger use in pregnancy: results from a large population-based cohort study. Eur. J. Clin. Pharmacol. 2013; 69(2): 269-77.
7. Choi J.S., Han J.Y., Ahn H.K., Lee S.W., Koong M.K., Velazquez-Armenta E.Y., Nava-Ocampo A.A. Assessment of fetal and neonatal outcomes in the offspring of women who had been treated with dried ginger (Zingiberis rhizoma siccus) for a variety of illnesses during pregnancy. J. Obstet. Gynaecol. 2015; 35(2): 125-30.
8. Boltman-Binkowski H. A systematic review: Are herbal and homeopathic remedies used during pregnancy safe? Curationis. 2016; 39(1): 1514.
9. Saberi F., Sadat Z., Abedzadeh-Kalahroudi M., Taebi M. Acupressure and ginger to relieve nausea and vomiting in pregnancy: a randomized study. Iran. Red Crescent Med. J. 2013; 15(9): 854-61.
10. Saberi F., Sadat Z., Abedzadeh-Kalahroudi M., Taebi M. Effect of ginger on relieving nausea and vomiting in pregnancy: a randomized, placebo-controlled trial. Nurs. Midwifery Stud. 2014; 3(1): e11841.
11. Ensiyeh J., Sakineh M.A. Comparing ginger and vitamin B6 for the treatment of nausea and vomiting in pregnancy: a randomised controlled trial. Midwifery. 2009; 25(6): 649-53.
12. Mohammadbeigi R., Shahgeibi S., Soufizadeh N., Rezaiie M., Farhadifar F. Comparing the effects of ginger and metoclopramide on the treatment of pregnancy nausea. Pak. J. Biol. Sci. 2011; 14(16): 817-20.
13. Basirat Z., Moghadamnia A., Kashifard M., Sharifi-Ravazi A. The effect of ginger biscuit on nausea and vomiting in early pregnancy. Acta Med. Iran. 2009; 47(1): 51-6.
14. Ding M. , Leach M., Bradley H. The effectiveness and safety of ginger for pregnancy-induced nausea and vomiting: a systematic review. Women Birth. 2013; 26(1): e26-30.
15. Campbell K., Rowe H., Azzam H., Lane C.A. The management of nausea and vomiting of pregnancy. J. Obstet. Gynaecol. Can. 2016; 38(12): 1127-37.
Slizovsky, Grigoriy, MD, Associate Professor, Head. Department of Pediatric Surgical Diseases, Siberian State Medical University, Ministry of Health of Russia.
634021, Russia, Tomsk, Moscow highway, 2. Tel.: +79138280168. E-mail: [email protected]
Kuzhelivsky, Ivan I., Ph.D., Associate Professor of the Department of Pediatric Surgical Diseases, Siberian State Medical University, Ministry of Health of Russia.
634021, Russia, Tomsk, Moscow highway, 2. Tel.: +79627788702. E-mail: [email protected]
Shikunova, Yana V., Ph.D., Associate Professor of the Department of Pediatric Surgical Diseases, Siberian State Medical University, Ministry of Health of Russia.
634021, Russia, Tomsk, Moscow highway, 2. Tel.: +79138280168; [email protected]
Sigareva Yulia A., 6th year student of the medical faculty, Siberian State Medical University, Ministry of Health of Russia.
634021, Russia, Tomsk, Moscow highway, 2. Tel.: +79539225641. Email: [email protected]
For citations: Slizovsky G.V., Kuzhelivsky I.I., Shikunova Ya.V., Sigareva Yu.A. Experience in treating early toxicosis of pregnancy. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (10): 118-22. (in Russian)
Gastritis During Pregnancy
Prepared by Dr Lua Guan Way
Consultant Gastroenterologist and Hepatologist
Gleneagles Medini Hospital
1. What is Gastritis? And what are their symptoms?
Gastritis refers to a group of conditions that develop from the inflammation, irritation, or erosion of the protective lining of the stomach. It most commonly results from an infection by the same bacterium that triggers stomach ulcers.
Gastritis comes in either one of two forms, depending on the severity of the inflammation and the length of the incubation period. Acute gastritis and chronic gastritis share similar symptoms, namely loss of appetite, recurrent nausea and vomiting, indigestion, and a feeling of bloating particularly after a meal. However, the pain stemming from acute gastritis occurs more suddenly but is temporary, while chronic gastritis causes duller and longer-lasting pain. Left unchecked, both can lead to ulcers or an increased risk of stomach cancer.
Regardless, gastritis is not a huge worry with prompt and appropriate treatment.
2. What causes gastritis in the first place?
Your stomach lining secretes mucus to protect against damage by corrosive digestive juices. Gastritis occurs due to the inflammation of this layer of tissue. The primary source of the condition is a bacterial infection of Helicobacter pylori (H. pylori), which can cause ulcers and in severe cases, stomach cancer. It is usually passed from person-to-person contact but may be transmitted via contaminated food or beverages as well.
Other risk factors can also engender gastritis, including alcohol, drug, and tobacco abuse, routine use of anti-inflammatory medication, extreme stress, chronic vomiting, and old age.
3. What are the main causes (besides lifestyle) that may cause expecting mothers to experience extra discomfort following gastritis?
Women who already live with gastritis will suffer an aggravation of the disease during pregnancy. This is due to fluctuating hormone levels combined with the pressure that a growing foetus places on the body. In addition to the typical symptoms, expecting mothers may also experience heartburn, toxicosis accompanied by severe vomiting, stomach pain, flatulence, and diarrhoea.
4. When gastritis happens, are there any side effects on the pregnancy?
While a pregnant woman afflicted with gastritis may encounter exacerbated symptoms, there is no negative effect on the course of pregnancy and the development of the child.
5. What different sort of gastritis problems would occur with expecting mothers? Are any of these to be taken more seriously over the other?
Heartburn, vomiting, stomach pain, flatulence, and diarrhoea pose minor inconveniences during pregnancy but could indicate serious health issues depending on the severity and frequency. Use self-help measures and home remedies to relieve negligible irritation. Visit your specialist should the problems persist.
6. Are there medications you would recommend expecting mothers to take for relieve of these discomforts?
Antacids containing aluminium, calcium, and magnesium were not found to be teratogenic in animal studies and are recommended as first-line treatment of heartburn and acid reflux during pregnancy. Over-the-counter antacids such as Gaviscon may help you cope with occasional heartburn symptoms. The doctor may also prescribe Histamine-2 blockers (such as ranitidine or cimetidine) or proton pump inhibitors (such as omeprazole) if your symptoms do not respond well to antacids. Although there is no evidence suggesting that these medication use is harmful during pregnancy, it is recommended that the drug only be used during pregnancy as needed, when no other options are available. If you are experiencing nausea and vomiting (especially during the early trimester), your doctor may prescribe you certain antiemetic medication, such as Metoclopramide (brand name Maxolon) and Domperidone (brand name Motilium). However, some women with the more severe form of pregnancy sickness, Hyperemesis Gravidarum, may require further hospitalisation and investigation.
7. Does the effect of gastritis heighten solely due to pregnancy?
No, it may be due to underlying pre-existing diseases, such as presence of Helicobacter pylori infection or peptic ulcer disease.
8. Besides medications, what can pregnant mothers do to ease gastritis discomforts?
Changes should be made to your dietary habits. Cut out foods that are spicy, fried, acidic, and high in fat content as these can cause gastritis flare-ups. Caffeinated drinks are also culprits, so swap your coffees and sodas with herbal teas and flavoured water. Certain dishes like red meat, pork, and refined foods may not elicit immediate reaction but could exacerbate pain in the long-term. Instead of having three big meals, space out about four to six reduced portions throughout the day. Your plate should consist of foods that are easy for your stomach to break down, for example low-fat dairy products, soup, porridge, as well as steamed or boiled lean meat and fish. Wash it all down with a fresh juice made out of fruits and vegetables.
Kate Middleton Is Pregnant And Suffering From Hyperemesis Gravidarum Again
No, you don’t need to be royalty to have hyperemesis gravidarum but your family may affect whether you get it. The 35-year old Kate Middleton, who is otherwise known as the Duchess of Cambridge, just announced that she is pregnant for the third time. She is probably somewhere between 8 and 12 weeks pregnant depending on what tabloid you read. Also, for the third straight pregnancy, she is suffering from hyperemesis gravidarum, which during her first pregnancy was severe enough to land her in the hospital.
To understand what hyperemesis gravidarum is, let’s break down the name into its parts. “Hyper” means a lot or severe just like hyperactive means you are really, really overly active. “Emesis” means vomiting, which means technically you can say “I drank far to much so now comes some emesis.” Gravid is a term for pregnant, frequently used in medical settings but rarely in social situations (you don’t commonly say, “hooray, I’m gravid”, “did you hear that she was gravid” or “are you gravid”). Combined the word means severe vomiting during pregnancy or very bad morning sickness.
Roughly 0.5% of all pregnancies in the U.S. result in hyperemesis gravidarum. Hyperemesis gravidarum is not your typical morning sickness. The vomiting is so frequent (usually more than 3-4 times a day) and severe that it can leave you dehydrated, deficient in important nutrients, and unable to maintain a healthy weight (losing more than 10 pounds). As with most cases of bad nausea and vomiting, the key is staying well-hydrated by drinking plenty of fluids and well-nourished by eating small and frequent meals. If you aren’t able to do this at home, you may need to visit a hospital to receive anti-nausea medications, intravenous fluids, and perhaps even feeding through a tube or an intravenous line. Over 59,000 pregnant women in the U.S. require hospitalization each year for hyperemesis gravidarum.
Here is an NBC Nightly News segment on the royal announcements:
If you do experience such unpleasant symptoms, can you blame your family? Before you say, yes, your family does make you nauseous and vomit, it’s not what your family says or does that may lead to this condition. As the Cleveland Clinic website explains, a potential culprit may be the rapidly rising levels of hormones such as HCG (human chorionic gonadotropin) and estrogen in your blood during pregnancy. However, the exact causes of hyperemesis gravidarum remain unclear, even though scientific studies have identified some possible risk factors (e.g., having had the condition in an earlier pregnancy, being overweight, carrying twins, triplets or more, or being pregnant for the first-time),
No, you may be able to point your finger at your family members because some evidence suggests that such severe morning sickness may run in families. A study from Norway published in the BMJ in 2010 found that women whose mothers suffered hyperemesis gravidarum were three times more likely to have the same problem during pregnancy, based on data from Norway’s national birth registry. Of course, such results don’t necessarily prove that this condition is inherited. But they are consistent with the findings from a study published two years earlier in the European Journal of Obstetrics & Gynecology and Reproductive Biology that analyzed the family histories of 1224 self-reported cases of hyperemesis gravidarum. Among these cases, 28% of the women had mothers who had experienced hyperemsis gravidarium. For those who had sisters who had been pregnant, 19% of their sisters suffered from hyperemesis gravidarum.
Besides not getting pregnant, is there anything that you can do to prevent the condition? Some have claimed that consuming Vitamin B6 supplements, zinc, or ginger, undergoing accupressure, or wearing pressure point wrist bands help. However, a recent Cochrane systematic review of existing scientific studies concluded that not enough quality scientific studies have been conducted to draw any strong conclusions. Other strategies are eating small and frequent meals of blander food and avoiding any food or medication that may cause nausea. Of course, when experiencing severe nausea and vomiting during pregnancy, don’t assume that it is hyperemesis gravidarum. Check with your doctor to rule out other possible causes such as food poisoning, infections, gallbladder disease, and pancreatitis.
Morning sickness tends to occur between the 6th and 14th weeks of pregnancy, although some continue to have symptoms until delivery. Additionally, morning sickness is often not confined to the morning. It is actually frequently “morning, noon, afternoon, evening, and really late at night sickness.” In fact, sickness may be a misnomer too, as a systematic review in Reproductive Toxicology determined that experiencing “morning sickness” may be associated with better pregnancy outcomes such as lower rates of miscarriages, birth defects, and premature births.
While the Duchess suffers through the symptoms, bookmakers have been accepting numerous bets on the child’s gender, birth date, and name. As Kate Samuelson reported for Time, there are equal bets on the child being male versus female, but Alice is the current name leader (8/1 odds) over Elizabeth (10/1 odds), James (12/1 odds), and Arthur (12/1 odds). While some are interpreting the bets on names as more people wanting or expecting a girl, keep in mind that Alice Cooper is male. Samuelson adds, without explaining the reason, that the odds of Donald as the name are 50/1. No word on where Barack or George W. rank on the list.
Pregnancy Toxemia in Ewes and Does – Metabolic Disorders
Ewes or does in the early stages (ie, are ambulatory, have a decreased appetite for grain, and are showing few nervous signs) can often be treated successfully with oral propylene glycol (60 mL, bid, for 3 days, or 100 mL/day). Adding oral calcium (12.5 g calcium lactate), oral potassium (7.5 g KCl), and insulin (0.4 IU/kg/day, SC) has increased survival rates. Oral commercial calf electrolyte solutions containing glucose may also be given by stomach tube at a dose of 3–4 L, qid, or drenched as a concentrated solution. It may also be prudent to induce parturition/abortion if the ewe or doe is also thin or fat and cannot manage fetal demands that late in pregnancy. This can be done by administering dexamethasone (20 mg, IV or IM). Parturition is expected within 24–72 hr, with most animals giving birth within 36 hr. Does may also benefit by the addition of prostaglandin F2α (dinoprost [10 mg, IM] or cloprostenol [75 mcg/45 kg body wt]). Contributing factors (eg, nutrition, housing, illness, other stressors) should be corrected for the group, and feeding management assessed (eg, adequate feeder space, feeding frequency, protection from adverse weather).
Treatment of advanced cases of pregnancy toxemia is frequently unrewarding. If a ewe or doe is already comatose, humane euthanasia is warranted, and treatment should focus on the rest of the flock. However, if the female is valuable and the owner wishes to pursue treatment despite the poor prognosis, then aggressive therapy should be directed against the ketoacidosis and hypoglycemia. Before starting this therapy, it should be determined whether the fetuses are alive (eg, real-time or Doppler ultrasonography). If the fetuses are alive and within 3 days of a calculated due date (gestation length 147 days), then an emergency cesarean section may be considered if economically viable. If the fetuses are dead or too premature to survive a cesarean section, it is less stressful to the ewe or doe to induce early parturition with dexamethasone (as above). Prophylactic antibiotics (usually procaine penicillin G at 20,000 IU/kg/day) are appropriate if the fetuses are thought to be dead.
Hypoglycemia can be treated by a single injection of 50% dextrose, 60–100 mL, IV, followed by balanced electrolyte solution with 5% dextrose. IV drips and lower dextrose levels in solution might cause less of a diuretic effect; however, this is often impractical in a field setting. Repeated boluses of IV glucose should be avoided, because they may result in a refractory insulin response. Insulin can be administered (20–40 IU protamine zinc insulin, IM, every other day). Calcium (50–100 mL of a commercial calcium gluconate or borogluconate solution, SC) can be given safely without serum biochemistry data. If serum biochemistry demonstrates hypocalcemia, ~50 mL of a commercial calcium solution can be given by slow IV injection while monitoring the heart. Oral potassium chloride (KCl) can be given as well, because serum potassium levels are often depressed. Use of flunixin meglumine at 2.5 mg/kg improved survival rate of ewes and their lambs, although the mechanism is unknown. Although aggressive therapy and intensive nursing care may be successful, it is not unusual to see case fatality rates >40%. Given the cost, it is prudent to share the guarded prognosis with owners before undertaking treatment.
A sample of late-gestation ewes or does can be tested for serum BHB levels to determine the extent of the risk in the rest of the flock. Generally, 10–20 animals in late gestation should be sampled (3%–20% of the pregnant flock). The risk of the flock can be determined based on the mean value of these results: normal (low risk) 0–0.7 mmol/L, moderate underfeeding (moderate risk) 0.8–1.6 mmol/L, and severe underfeeding (high risk) 1.7–3.0 mmol/L. Other diseases should be treated (eg, footrot). Females off feed should be separated from the group and hand fed, keeping in mind they should be able to see the group to feel comfortable.
Hyperthyroidism in Pregnancy. Medical information
Thyroid disease is the second most common endocrine disorder affecting women of reproductive age and when untreated during pregnancy is associated with an increased risk of miscarriage, placental abruption, hypertensive disorders and growth restriction. More common is relapse of previously controlled hyperthyroidism.
Pre-pregnancy hyperthyroidism counselling
This should be offered to all women. The main points about which to raise awareness are:
- General pregnancy and pre-conception advice to all women – eg, folic acid.
- Pre-conception patients may be offered definitive therapy – eg, ablation with radiotherapy (ideally, the patient should not conceive until six months later, once the levothyroxine dose has been optimised).
- Thyroid-stimulating hormone (TSH) levels should ideally be less than 2.5 mIU/L in those women taking levothyroxine prior to conception.
- Surgery is usually the therapy of choice in women planning to become pregnant.
- Following definitive therapy, levothyroxine dosage may need to be increased early in pregnancy (increased T4 requirement).
- If definitive therapy is not to be considered then the importance of adhering to medication must be stressed, as there is risk of multiple complications, both maternal and fetal.
- Propylthiouracil is less likely to cross the placenta than carbimazole and is usually considered the preferred antithyroid drug. The safest option is often to use propylthiouracil in early pregnancy, changing to carbimazole in the latter months.
- Close follow-up during pregnancy, with TSH receptor antibody (TRAb) status checked around 24-28 weeks to assess the risk of fetal and/or neonatal hyperthyroidism.
- There is a risk of disease worsening during the first trimester or in the early postpartum period; however, note that women may actually have better control of hyperthyroidism during pregnancy.
- Antithyroid medication is safe when breastfeeding.
Changes in thyroid physiology during pregnancy
- Thyroid gland enlargement.
- Increased gland vascularity.
These changes reverse postnatally.
- It occurs in around 2 per 1,000 pregnancies in the UK.
- The most common cause is Graves’ hyperthyroidism – overactivity resulting from the presence of TRAb.
- New-onset hyperthyroidism is estimated to occur in about 0.1-0.4% of pregnancies.
- This may rise to 1% if subclinical hyperthyroidism is included.
- Transient gestational hyperthyroidism may also occur – it has a 2-3% prevalence in Europe but is much higher in South Asians.
Causes of hyperthyroidism in pregnancy
- Graves’ disease.
- Transient gestational hyperthyroidism.
- Toxic multinodular goitre.
- Single toxic adenoma.
- Subacute thyroiditis.
- Iodine-induced hyperthyroidism.
- Struma ovarii.
- Thyrotrophin receptor activation.
Causes of relapse of previously controlled hyperthyroidism during pregnancy
- Increase in TRAb in the first trimester.
- High levels of human chorionic gonadotrophin (hCG) stimulating the thyroid gland.
- Impaired drug absorption through vomiting.
- Labour, infection and caesarean section may also worsen thyroid control.
Transient gestational hyperthyroidism
- Associated with hyperemesis gravidarum.
- Can arise from high levels of hCG which stimulate the TSH receptor.
- May occur in molar pregnancy.
- Patients are not usually thyrotoxic.
- Antithyroid drugs do not help.
- Resolves as hCG falls.
- Postpartum thyroiditis is defined as an abnormal TSH level within the first 12 months postpartum in the absence of a toxic thyroid nodule or thyrotoxin receptor antibodies.
- Women with a history of type 1 diabetes and women with thyroglobulin or thyroperoxidase autoantibodies are at increased risk of postpartum thyroiditis.
- A radioactive iodine uptake scan can help distinguish postpartum thyroiditis from Graves’ disease but is contra-indicated in breastfeeding women.
- Around a quarter of patients present with symptoms of hyperthyroidism, followed by hypothyroidism and then recovery; around one third present with hyperthyroidism; the remainder present with hypothyroidism
- The hyperthyroid phase of postpartum thyroiditis is caused by autoimmune destruction of the thyroid, resulting in release of stored thyroid hormone. This means that antithyroid medications are not typically beneficial and treatment is generally symptomatic, using beta-blockers.
- Women with a history of postpartum thyroiditis are at increased risk of permanent hypothyroidism and should be screened annually thereafter.
See the separate Hyperthyroidism article for signs and symptoms. However, in pregnancy the following warrant TFTs:
- Heat intolerance.
- Systolic murmur.
- Bowel disturbance.
- Failure to gain weight.
- Emotional upset.
Features of Graves’ disease may also be seen – for example:
- Eye signs.
- Weight loss.
- Pretibial myxoedema.
- Some of the symptoms may be due to pregnancy itself.
- If tachycardia is present then anaemia, arrhythmias and volume depletion might need to be considered.
- More rare causes such as phaeochromocytoma might also need to be considered.
- The differential diagnosis of Graves’ hyperthyroidism and transient self-limiting hyperthyroidism in early pregnancy can be difficult, especially since accurate measurement of serum thyroid hormones can be problematic.
- Serum TSH can exclude primary thyrotoxicosis. Confirm diagnosis with free T4 levels. If TSH is suppressed but free T4 levels are normal then, if not previously supplied, free T3 level is necessary (T3 toxicosis occurs in 5% of patients).
- Deterioration in the clinical features of Graves’ disease in the first trimester of pregnancy may occur due to stimulation of the thyroid both by hCG and thyrotropin receptor-stimulating antibodies. However, an improvement in Graves’ disease may occur in the second half of gestation due to the falling titre of thyroid-stimulating antibodies.
It is important to remember that the ranges of TSH, T3 and T4 are different in pregnancy.
TSH – levels are trimester-dependent
- Serum free T4 levels during pregnancy should be interpreted with caution
- Each laboratory should establish trimester-specific reference ranges for pregnant women if using a free T4 assay
- It is recommended that the non-pregnant total T4 range (5-12 μg/dL or 50-150 nmol/L) can be adapted in the second and third trimesters by multiplying this range by 1.5-fold.
- Alternatively, the free T4 index (‘adjusted T4’) can be a reliable assay during pregnancy.
TSH receptor antibody (TRAb)
This can cross the placenta, stimulating the fetal thyroid, so it is important to measure during pregnancy.
- Normal values <130% (by measuring thyroid-stimulating immunoglobulins) of basal activity.
- Risk of fetal or neonatal hyperthyroidism is increased when >500% activity is detected.
- Those women with high antibody concentrations in pregnancy, at diagnosis and at 22-26 weeks of gestation, will usually need to have fetal and neonatal monitoring of thyroid size and function undertaken.
Thyroid ultrasound scan can be requested but thyroid uptake scans are not recommended.
Poorly controlled hyperthyroidism during pregnancy is associated with the following:
Subclinical hyperthyroidism can be associated with gestational diabetes[8, 9]. Apart from this it has not been associated with any other adverse effects during pregnancy.
[10, 11, 12]
Hyperthyroidism during pregnancy can present as hyperemesis gravidarum or as thyroid storm – always check the TFTs. These women usually need urgent admission to hospital.
NB: hyperemesis gravidarum is associated with abnormal TFTs which improve once it settles.
Control is particularly important as the pregnancy progresses, especially in the third trimester. This is the result of suppression of the fetal pituitary thyroid axis from maternal transfer of thyroxine when hyperthyroidism is poorly controlled. Decide which of the following groups the patient belongs to:
Pregnant mothers with Graves’ hyperthyroidism already on treatment or completed treatment
- This includes those on medications or who have had radio-iodine or surgery.
- Measure TRAb in the first trimester.
- If TRAb levels are high then there is a need for close monitoring of the fetus, as neonatal hyperthyroidism may occur.
- Monitoring usually involves serial ultrasonography.
- TRAb should be re-measured in the third trimester.
- If TRAb remains high at 36 weeks then the neonate needs to have TFTs performed after birth and then repeated a few days later.
Pregnant mothers with a new diagnosis of hyperthyroidism
All pregnant women should be referred urgently for assessment of a new diagnosis.
Treatment of all cases of hyperthyroidism during pregnancy (new diagnoses or worsening of previously controlled hyperthyroidism)
- Antithyroid drugs are the first line for all.
- Radio-iodine is contra-indicated because of the risk that fetal hypothyroidism could be induced.
- Surgery is only where absolutely necessary and requires the patient to be rendered euthyroid with drugs to begin with.
- All cases should be discussed with a specialist.
- Adrenergic symptoms can be treated with short courses of beta-blockers – eg, propranolol. Use beyond a few weeks may adversely affect the fetus and is not advised.
- Propylthiouracil may cross the placenta less readily than carbimazole (which has, on rare occasions, been associated with teratogenic affects) and it is the first choice in pregnancy and breastfeeding. However, liver toxicity has been recently reported. Current opinion favours using propylthiouracil in early pregnancy and carbimazole in later months.
- In some countries, carbimazole may be the only choice available and the risks of not treating maternal hyperthyroidism will far outweigh those of potential teratogenicity.
- The aim is to keep the thyroid hormones in the upper third of the reference range. Once this is achieved then the dose of propylthiouracil is decreased to prevent effects on neonatal thyroid function (may produce neonatal hypothyroidism). A similar strategy is used in Graves’ disease presenting during pregnancy.
- Because maternal T4 crosses the placenta less well than antithyroid drugs, the block and replace regimen is contra-indicated in pregnancy.
- Medications need to continue into labour.
- As antithyroid drugs may cause neonatal hypothyroidism, a minimal dose required should be used and thyroid hormones should be kept within the upper third of the normal range.
- Graves’ disease tends to enter remission as pregnancy proceeds, so doses can usually be reduced or withdrawn in the third trimester.
- Monitoring usually involves the following:
- Measure TFTs every two weeks until the patient is on a stable medication dose and then weekly after 32-34 weeks of gestation in those with poorly controlled hyperthyroidism.
- Serial fetal ultrasonography (looking for intrauterine growth restriction, hydrops fetalis, advanced bone age, goitre, tachycardia and heart failure).
- Check TRAb at the end of the second trimester.
- Patients may continue to breastfeed, as the risk of propylthiouracil and carbimazole being secreted into breast milk is negligible. However, neonatal thyroid function should be checked regularly.
- Measure TFTs in both mother (six weeks and three months) and the neonate (six hours and again a few days later). The reason for rechecking TFTs a few days after birth is that the neonate will have metabolised any maternal antithyroid drugs by this time.
- Good thyroid control is associated with a normal pregnancy with good maternal and fetal health.
- Interestingly, while universal screening versus case finding for thyroid dysfunction has been shown to increase diagnosis and subsequent treatment, studies have not shown any clear differences for primary outcomes of pre-eclampsia or preterm birth or for secondary outcomes, including miscarriage and fetal or neonatal death.
90,000 When does early toxicosis begin and how to deal with it during pregnancy
Early toxicosis of pregnancy is a condition that causes a lot of suffering for a woman. Some feel the “catch” even before the delay, while for others it starts from 5-6 weeks. Obstetrician-gynecologist Galina Vladimirovna Ovsyannikova talks about the causes of toxicosis and how to alleviate it.
Symptoms of toxicosis
Food addictions change sharply, there is an increased sensitivity to odors, nausea, irritability, constantly wanting to sleep.
Less often, there is uncontrollable salivation, low-grade fever, vomiting.
Usually this condition takes a woman by surprise. She needs to continue to work, take care of her family, she has a lot of things planned. With this she goes to the doctor, already pretty tired and with a sad look. And we start to figure it out.
Firstly toxicosis does not torment everyone. Some simply eat everything and do not gain weight, or even lose weight, and this is their toxicosis.Such women are lucky. Although they also manage to worry about this, as they have heard enough “as it should be” from their friends.
Secondly the severity of toxicosis depends on the state of the nervous system, lifestyle and the “similarity” of the baby to the mother in terms of protein composition.
And more about that.
Toxicosis: why and for what?
- Nervous system. It has been noticed that toxicosis is most pronounced in anxious women, leaders, doctors, teachers, that is, people with increased nervous stress.And by the way, note that animals do not have such toxicosis as humans do. They do not take upon themselves “all the world’s responsibility” and therefore they do not feel sick or vomit. At most, females sleep a lot and retire to save energy.
- Lifestyle. If a woman enters pregnancy not in a resource state, tired, exhausted, slagged with poor nutrition and lack of water, and even after some illness, poisoning, herpetic manifestations, ARVI, then the body will try to “put the woman to bed” in order to sleep, rest, gain strength, eat different foods to replenish supplies.Everything is logical. This is a smart move in the fight for survival.
- Any person has a unique genetic code, which is laid down at the time of fertilization. And as much as it will be unlike the mother’s code, so toxicosis will be expressed. To make it clearer, there are people who are so similar in this code, protein composition, that their organs can be transplanted to each other and they will take root. Others, on the contrary, are not alike at all, and if, for example, a kidney is transplanted from such a person, then it will be rejected.Also here. If the child has inherited a similar genetic code, then the intoxication from getting his protein into the mother’s blood will be less. And vice versa. As pregnancy progresses and the placenta forms between the mother and the baby, a placental barrier forms. And toxicosis decreases: therefore, in most women, it goes away by the 12th week.
How to survive?
There are no recipes common to all: we are all different and each has its own cause of toxicosis. Still, there are rules that help most women:
- Get more rest and sleep.Sleep whenever possible and the body asks. A woman with severe toxicosis is almost always helped by sick days for 5.9 025
- Avoid long meal breaks. Eat light and high-calorie foods every 3 hours. Banana, date, dried fruit, sweet yogurt often help. It’s not scary if there is a roll or biscuits. All this is quickly digested, absorbed and gives you energy. But it is better to refrain from meat, fish, fatty and multicomponent dishes (for example, Olivier salad). This food is difficult to digest and assimilate.You will have to experiment with fiber. During pregnancy, constipation is often due to a relaxed – for the company with the uterus – intestines. In this case, coarse raw fruits and vegetables will trigger peristalsis and regulate stool, but in some, they cause gas and unpleasant colic in the stomach. So you have to try.
- Very often, nausea is especially pronounced in the morning, after sleep. This is due to the large hunger interval. To smooth out the sensation, try to have a light snack just before bed.If you get up at night to go to the bathroom, sip half a banana or a cracker along the way. And in the morning, waking up, not getting out of bed yet, eat yogurt, curd, bun. Lie down for another 20 minutes. Then get up, eat loose breakfast, and only then brush your teeth.
- The more dehydrated the body, the more intoxication. Start drinking warm, hot, good quality water in small sips. Necessarily between meals, not during. For taste, you can first add lemon or lime, you can buy mineral water in a glass at the pharmacy and drink it, preferably stirring and releasing gases from the bottle.But if you have not drunk water before, or drank very little of it, then you should not suddenly start drinking it in large quantities.
Medical treatment of early toxicosis also takes place, but only in severe forms!
And most importantly, remember, this state, although nasty, is temporary, absolutely safe for both you and the child. It will go away on its own very soon. And you will stop feeling weakened, sick pregnant, and you will feel your pregnancy as a big, important and very joyful “business.”
90,000 Toxicosis during pregnancy
One of the most common conditions in women,
expecting a child, in which there is nausea and urge to vomit, is
toxicosis. Toxicosis occurs due to harmful substances and the accumulation of toxins,
which are formed in the body of pregnant women.
Degrees of toxicosis
1. Nausea and urge to vomit appear no more than five times
per day. Weight loss is up to three kilograms.
2. Weight loss can be up to 4 kg in two weeks
toxicosis.Vomiting is observed up to ten times and leads to a decrease in arterial
3. Attacks of vomiting up to 25 times a day. Weight loss
is more than ten kilograms. The temperature may rise, become more frequent
When does toxicosis appear?
Doctors define some time frames for manifestation
- Early toxicosis manifests itself at 5-6 weeks
pregnancy. Early toxicosis usually ends by 13-14 weeks, but in each
case it is individually.
- Late toxicosis manifests itself in the latter
trimester of pregnancy. It is very dangerous if toxicosis appears in the middle
Signs of toxicosis
Initially the woman has:
- increased salivation,
- changes in taste buds,
- loss of appetite,
- weight loss.
Asthma and dermatosis appear less frequently during pregnancy.
The signs of toxicosis do not depend on who the woman is waiting for: a girl or a boy.
Symptoms of toxicosis can equally manifest themselves with a frozen
Pregnancy without toxicosis
Many women believe that toxicosis always accompanies
pregnancy and its absence raises concerns in them. Worry about it
the occasion is not worth it. The absence of toxicosis only means that a woman is absolutely
healthy.Her body was able to easily rebuild, cope with the stress and
prepared for bearing a child without disrupting the work of the general systems of the body.
Pregnant women who have escaped toxicosis are fine
feel, they can fully enjoy the unique state
Types of toxicosis
There are several types of toxicosis:
1. The earliest toxicosis can begin in a week
after fertilization.Vomiting and nausea may not appear, but appears
2. Early toxicosis. Appears in the first trimester
pregnancy. Usually women calmly go through this period, but if the signs
intensify, the doctor may prescribe drugs to reduce toxicosis and relieve
condition of a pregnant woman.
3. Late toxicosis. If pregnancy develops
normally, toxicosis does not appear again in the second trimester. But sometimes
toxicosis intensifies, a complication called gestosis occurs.A woman has
swelling, blood pressure rises. Treatment for this condition is prescribed
individually. Gestosis is not dangerous if a woman is observed by a doctor and will be in
4. Evening toxicosis. After a hard day, a big reception
food, the body gets tired, depleted and becomes susceptible to the effects
toxicosis. Evening toxicosis interferes with resting calmly. Ease the condition
can evening walks, fruit drink from fresh sour berries or freshly prepared
The main causes of toxicosis
There are several main causes of
hormonal system. The composition of hormones changes from the moment of fertilization,
this affects the well-being and health of the pregnant woman. The woman becomes
touchy, irritable, whiny, sense of smell is exacerbated, appears
nausea. For the body of the expectant mother, the embryo is a foreign body, and this
is reflected in her well-being.After a while, the level of hormones will come to
normal, the body will learn to calmly perceive the embryo, toxicosis recedes.
placenta. According to observations, signs of toxicosis disappear after
when the placenta is finished forming. The placenta begins to fulfill some
functions, including the retention of toxic substances. Until the end of this
process, the body itself tries to protect itself from intoxication with vomiting.
reaction.For many women, toxicosis is a kind of defense act.
There is nausea on coffee, cigarette smoke, eggs, meat. Due to the content in them
pathogenic microorganisms, they can be hazardous to health. And nausea
and the gag reflex protect the body from the ingress of hazardous substances into them.
diseases. It is advisable to go through
a complete examination to rule out the risk of infections. You also need to start
change. In the third trimester, toxicosis can occur due to nervous
the condition of the mother. Woman worried about the upcoming childbirth, health
baby, thereby provoking toxicosis. According to scientists, the nervous system
during pregnancy undergoes changes, and those centers are activated
the brain, which are responsible for the functioning of the gastrointestinal tract and
sense of smell.
Toxicosis manifests itself more often in women after 30-35 years.The risk increases if
pregnancy first. According to experts, the younger the mommy, the easier
she tolerates toxicosis. There are exceptions, though.
Heredity plays an important role. If mom suffered from toxicosis at 16
week, her daughter is at risk of developing the same condition with
probability of 70%.
pregnancy. The likelihood of manifestation of toxicosis in women, pregnant women
twins, more than women expecting one child.
How to relieve toxicosis?
All methods should be tested gradually, listening to
- Try eating a small piece of bread
some dried fruit or a cracker without getting out of bed in the morning. Then do
yourself mint tea with lemon and a small amount of sugar – this normalizes
- The onset of nausea can smooth sucking
slices of orange or lemon.
- Drink only those drinks that are suitable
for you. It could just be water, herbal teas.
- Eat fruit with plenty of
liquids: grapes, watermelon, melon. You can pamper yourself with ice cream.
- Use steamed food instead of spicy food.
fried food. For snacks, you can eat raw vegetables, fruits,
- You need to eat in small portions and often. IN
during the day, you can eat a banana, crouton, apple.
- After eating, do not go to rest.
- One of our grandmothers’ methods: a spoonful of honey when
the first manifestations of toxicosis.
- Aromatherapy helps: ginger oil is needed
rub between palms and inhale. Peppermint oil also helps.
And most importantly, the psychological attitude: repeat that with
you and your child will be fine and you are not afraid of toxicosis!
Early toxicosis in pregnant women – Leleka maternity hospital
Everyone has heard that pregnant women feel sick in the morning.Nausea, vomiting and other unpleasant symptoms are signs of early pregnancy toxicosis.
Causes of toxicosis in pregnant women
Oddly enough, evidence-based medicine still has no consensus regarding the causes of toxicosis. It is known for sure that after the appearance of the ovum in a woman’s body, the hormonal background begins to change, and the state of the nervous system also changes. These are two interrelated processes.
Unfortunately, these changes often affect other body systems.First of all, the digestive system suffers, and indigestion is fraught with negative consequences for the whole organism. Morning sickness, salivation, vomiting, rejection of certain foods can be so strong that a woman loses weight, suffers from vitamin deficiency, impaired immunity, and simply feeling unwell. With a moderate and severe stage of toxicosis, an uneven heart rate, changes in blood pressure, acetone in the urine can be observed. With severe toxicosis in pregnant women, a disorder of the water-salt balance in the body and the threat of spontaneous abortion is possible.
In addition, with toxicosis, chronic diseases are often exacerbated, especially of the gastrointestinal tract: ulcers, gastritis, duodenitis. Women who have undergone inflammatory diseases of the genital organs and multiple abortions are also at risk. In general, 50-60% of women suffer from toxicosis of pregnant women, but only in 8-10% of cases toxicosis acquires dangerous forms. With severe toxicosis, spontaneous abortion is often. However, if this does not happen, the main manifestations of toxicosis disappear by about 11-12 weeks.
How to avoid toxicosis: recommendations of doctors
There is no method that would 100% protect the expectant mother from pregnancy toxicosis. However, there are preventive measures that can help alleviate a woman’s condition.
1. Preventive treatment
In case of planned pregnancy, a woman is recommended to undergo treatment for her existing chronic diseases. To do this, you need to undergo a comprehensive medical examination. The risk of developing severe toxicosis in the presence of chronic gastrointestinal problems is significantly higher.
2. Balanced diet
Already during pregnancy, a woman can remove the manifestations of toxicosis through a balanced diet. Food products should be as natural as possible, easily digestible. In addition, it is worth limiting the size of a single serving: it is better to switch to fractional meals and eat more often, but in smaller portions.
In case of toxicosis it is recommended to exclude:
- fatty foods, especially buttercream cakes and pastries and fatty meat products such as bacon and bacon;
- salted and smoked products;
- semi-finished products – industrial dumplings and dumplings;
- alcohol, sweet carbonated drinks, industrial fruit juices;
- fruits and vegetables with a pungent taste and smell – strawberries, tomatoes, apricots, cherries;
- coffee and tea.
However, it should be remembered that any diet must be adjusted to the person, so these recommendations are not mandatory.
Stress and anxiety can increase the effects of toxicosis. Under the influence of hormones, the psyche of a pregnant woman becomes especially vulnerable, and even a little anxiety can become a reason for stress. Therefore, in case of toxicosis, it is advised to limit communication with strangers, avoid places where aggressive people congregate – state clinics, centers of communal services – and, if possible, go on maternity leave from work.
4. Healthy lifestyle
Regular walks in the fresh air, avoiding artificial stimulants – hard drinks, chocolate, popular TV shows, loud music – will benefit the mother and child and help reduce the manifestations of toxicosis.
It should be remembered that if all preventive measures are taken, and the condition of the pregnant woman does not improve, the symptoms of toxicosis intensify, a doctor’s consultation is necessary. Long-term toxicosis creates a background for the development of dangerous symptoms, for example, pyelonephritis, which threaten the life of both the child and the mother.
How to relieve the state of health in case of toxicosis?
Here are several alternative methods that do not contradict the recommendations of doctors, and help some women to relieve the state of health with severe toxicosis.
Lemon wedges. For bouts of nausea, you can suck on a small wedge of lemon. The sour taste provokes salivation, reduces nausea. Not recommended for citrus allergies.
Aromatherapy . Vapors of essential oils relax, relieve stress, soothe.
Healthy drink. Alkaline mineral waters and herbal teas are considered useful for early toxicosis. Mineral water should be allowed to stand open so that some of the gas evaporates. There are special hypoallergenic fees for pregnant women to brew for tea.
90,000 Toxicosis during pregnancy – what doctors advise – ISIDA Clinic Kiev, Ukraine
31 January 2019
Toxicosis during pregnancy is perceived by many women as inevitable: this is the body’s reaction to the really serious processes that take place in it in the first weeks and months of pregnancy.And all that remains to be done is to patiently wait for the end of this difficult period. This setting is not entirely correct .
Toxicosis requires the attention of a doctor
The first trimester of pregnancy is the most important, it is at this time that all internal systems and organs are laid in the baby. Therefore, any health problems in the mother are not a very good foundation for such an important “construction”.
In addition, behind the external manifestations of toxicosis – nausea and vomiting – more serious problems can be hidden, in overwhelming cases – obvious, sometimes – hidden, detected only with the help of laboratory tests.This can be, for example, various skin lesions, convulsions, in the most severe cases – jaundice of pregnant women, bronchial asthma of pregnant women, disorders of water-salt balance, metabolism, etc.
Therefore, close medical supervision of the condition of the expectant mother, who is experiencing toxicosis in the first trimester of pregnancy, is necessary. This is the most important rule, which cannot be neglected in any case.
Why does toxicosis occur in the first trimester
The only absolutely proven hypothesis about the causes of toxicosis does not exist.The most common are:
Early toxicosis is a reaction of the immune system. The human immune system reacts to the appearance of a foreign protein (embryo) by activating its forces and producing a fairly large number of antibodies. In response to these antibodies, nausea and vomiting occurs. “Accustomed” to the existence of a new life within itself, the body turns off the production of antibodies and toxicosis disappears.
Hormones cause toxicosis. Scientists – supporters of this theory of the onset of toxicosis – explain the attacks of nausea by the appearance in the body of a new, strongest organ – the placenta, which produces the hormone hCG.It is this hormone that causes an attack of vomiting. This theory is supported by the fact that the peak of the hCG hormone in the blood of a pregnant woman often coincides with the onset of vomiting. In addition, at the time of an attack of toxicosis, a decrease in corticosteroids in the adrenal cortex is often recorded.
Nerve reflex theory has the largest number of supporters among scientists. According to this theory, during pregnancy in a woman, the more ancient, subcortical parts of the brain are activated. It is there that the centers responsible for protective reflexes are located – the vomiting center, the centers of smell, salivary glands, stomach, etc.e. Activation of these centers leads to vomiting.
As you can see, all the causes of toxicosis in the early stages of pregnancy are due to natural, natural causes for a woman’s position. Why, then, do some women have toxicosis, while others do not? Everything is explained by the general state of health: in the presence of chronic diseases of the gastrointestinal tract, liver, thyroid gland, after induced abortions and against the background of bad habits, the occurrence of toxicosis is more likely.
What to do?
In case of toxicosis, the doctor observing your pregnancy will give a referral for a urine test, which can be used to determine the severity of toxicosis and dehydration of the body, biochemical and general blood tests.Depending on the test results and the degree of toxicosis (mild – vomiting no more than 5 times a day, severe – 10-20 times a day), the doctor will recommend a hospital stay or compliance with special rules at home.
How inpatient treatment will help
A hospital stay may be necessary, since with frequent vomiting, dehydration may occur, metabolism may be disturbed, a decrease in blood pressure, an increase in pulse rate, a decrease in urine output, and constipation may occur.If measures are not taken in time, a violation of water-salt, protein, carbohydrate and fat metabolism, acid-base and vitamin balance, the functions of the endocrine glands may develop. All this can negatively affect the development of the baby, because it is in the first trimester of pregnancy that all the main organs and systems of the baby are laid and formed.
Therefore, in no case should you refuse hospitalization if your doctor recommends it.
Treatment for mild toxicosis
A mild form of toxicosis (vomiting no more than 5 times a day) can be controlled using simple methods.
Diet is a very important factor. Avoid food that is too hot or cold – this will provoke an attack of vomiting. Eat often – at least 5-6 times a day, but in small portions. Trust your intuition – if you feel that pickles or exotic fruits are what you need, allow yourself to do so. But remember that your diet during the period of toxicosis should be balanced and your menu should be complete in terms of proteins, fats and carbohydrates.
Do not forget about the drinking regimen : many women suffering from toxicosis enjoy drinking tea with mint during this period – it not only quenches thirst, but also soothes.
Breakfast – in bed. If vomiting usually occurs in the morning, eat breakfast in bed without getting up. Lemon tea and a few crackers can help prevent nausea. If you feel that your newly awakened body is ready to take in a light and healthy breakfast, do it.
Avoid overwork, both physical and nervous. Sometimes attacks of nausea provoke fatigue, this is more often in the afternoon. A soothing tea can help relieve nervous tension.You can also take motherwort or valerian after consulting your doctor.
Early toxicosis usually disappears completely at about 12 weeks of gestation, less often it can last until the 16th week. Be patient and be extremely attentive to the nuances of your well-being – this is very important for the health of your baby.
Looking for a clinic that you can trust to monitor your pregnancy? Trust the specialists of the ISIDA clinic. Do you have any questions? We will be happy to answer them if you call the ISIDA clinic on 0800 60 80 80, +38 (044) 455 88 11.Or ask us your question and we will definitely answer it.
90,000 Why there is toxicosis during pregnancy and how to treat it
What is toxicosis
Morning nausea, vomiting, weakness, familiar to many expectant mothers, are called toxicosis of the first or second trimesters of pregnancy. Western doctors prefer another term – NVP (Nausea and Vomiting of Pregnancy; TRP – “nausea and vomiting of pregnant women”). And this has its own reason.
The word “toxicosis” comes from the Greek “poisonous”. This is how the body reacts to some kind of life-threatening poison. But there is nothing poisonous about nausea during pregnancy. Moreover: American doctors consider it to be one of the signs of normal fetal development.
Nausea and vomiting are common occurrences that, according to statistics, affect up to 70–80% of all pregnant women.
Yet sometimes toxicosis becomes dangerous.
When toxicosis during pregnancy is normal
Here are the main symptoms:
- Unpleasant sensations occur 2-6 weeks after conception.
- Lasts until about 12-14 weeks, gradually weakening.
- Most often, nausea occurs on an empty stomach, in the morning.
- At other times of the day the woman does not feel sick, that is, toxicosis practically does not affect the quality of her life.
When toxicosis can be dangerous
In rare cases, nausea and vomiting of the first or second trimester are acute, strong, almost constant. This condition is called hyperemesis gravidarum. It occurs in 0.3–2% of pregnant women.
Due to incessant nausea, a woman cannot eat, she loses weight, her body does not receive essential nutrients, which threatens the health, and even the life of both the expectant mother and her baby. There are often cases when an exhausted victim of toxicosis even decides to have an abortion – just to stop the torture.
Hyperemesis requires a mandatory consultation with a doctor. You may need treatment in a hospital, work with a psychotherapist and the involvement of social services that will help a woman get through a difficult period (this is important if a pregnant woman lives alone, and even more so alone raises older children).
There is another type of toxicosis – late. Late toxicosis (aka preeclampsia) occurs in the second half of pregnancy, usually after 28 weeks, and is considered a pathology. Its symptoms: severe edema, including internal organs, a sharp increase in blood pressure, convulsions. This condition is treated exclusively in a hospital or even intensive care unit, and this is another story.
Where does toxicosis come from during pregnancy
Scientists still do not know. They did not manage to find out exactly what factor triggers toxicosis.It is assumed that the cause of TRP is complex:
- Hormonal changes in the body in connection with pregnancy.
- Evolutionary adaptation. In ancient times, a woman who was sick stayed at home, by the fire in her own cave, which meant that she had less risk of being eaten before becoming a mother.
- Psychological moments. Pregnancy, even long-awaited and joyful, is still stressful. And nausea is a side effect.
Who has toxicosis more often
You are at risk if:
- this is your first pregnancy;
- you have experienced severe toxicosis in previous pregnancies;
- you are prone to motion sickness;
- you have migraines;
- You feel unwell while taking oral contraceptives containing estrogen;
- There are twins among your older children;
- you are obese (body mass index over 30).
There is also data from that women are at increased risk of toxicosis:
- without higher education; 90 025 90 024 household or part-time or telecommuters;
- with low income.
How to treat toxicosis during pregnancy
Unfortunately, since the causes of toxicosis are not yet clear, there is no specific treatment either. You can only try to overcome the unpleasant symptoms by making lifestyle changes.
This is what doctors recommend to do with toxicosis of the first or second trimesters of pregnancy:
- Get more rest. Fatigue can trigger or worsen nausea.
- Avoid food or odors that make you sick.
- In the morning, immediately after getting out of bed, eat a piece of toast or plain biscuits without additives. Do not start to be active on an empty stomach.
- Eat small meals more often. The ideal foods for TRD are foods that are high in carbohydrates and low in fat.For example, bread, rice, crackers, pasta.
- Drink plenty of water. Carry the bottle with you and sip a little throughout the day. Water can be replaced with dried fruit compote, rosehip decoction, citrus fresh juices.
- Include foods and drinks containing ginger in your diet: there is evidence that ginger can help reduce nausea and vomiting.
- Try acupuncture. There is some evidence that pressure on the wrist at a point 2–3 cm above the wrist crease, between two easily identifiable tendons, may relieve the symptoms of TRD.Press these points on both wrists for 5-10 minutes at least once a day. There are anti-nausea acupuncture bracelets on the market that use the same principle, but check with your doctor before purchasing.
If, despite changes in lifestyle, symptoms of toxicosis do not decrease, be sure to inform your gynecologist. Your healthcare provider will recommend antiemetic drugs that are safe for pregnant women.
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Toxicosis during pregnancy – Articles – Maternity hospitalVidnoe
What is “toxicosis”? Toxicosis of pregnant women (in medical practice – early gestosis) is one of the complications of pregnancy, which manifests itself in various disorders of the digestive system and impairment of all types of metabolism. Often added to this is “early” – because such manifestations, which give us a lot of inconvenience, are found only in the first half of pregnancy. Usually, they debut at 6-7 weeks of pregnancy, when the embryo begins to actively produce substances that change the work of the entire maternal body, and end by 12 weeks, coinciding with the completion of placentation.
Reasons for the development of toxicosis.
Psychogenic – it is believed that early toxicosis occurs in women for whom pregnancy has become somewhat unexpected news. Whether pleasant or not, the main thing is unexpected. Maybe you are glad that your baby will be born soon, but planned to do it a little later. The doubts and worries that constantly tear you apart lead to the excitation of certain parts of the brain, in the neighborhood of which are the vomiting center, vascular and respiratory.Well, there is no need to explain what such constant activation leads to.
Immunological – supporters of this theory explain the manifestations of toxicosis by the reaction of the maternal body’s resistance to foreign papa’s particles. After all, our baby, of course, is native, but half (of course, father’s half) is genetically alien.
Hormonal – at the beginning of pregnancy, the level of chorionic gonadotropin (hCG) increases significantly – this is one of the main hormones of pregnancy.The main manifestations of toxicosis can be associated with its action. As proof of this, we can say that with multiple pregnancies, when a much larger amount of hCG is released, vomiting of pregnant women occurs especially often. Also, the placental lactogen is called responsible for the onset of toxicosis (it is produced in the tissues of the placenta precursor – chorion, and then in the placenta itself). This hormone controls the synthesis of proteins that go into the formation and growth of the baby. At the same time, in the mother, the same process is inhibited, leading to the accumulation of used amino acids.Their excess can cause weakness, nausea, vomiting, headaches.
Various inflammatory diseases of the genital organs and chronic intoxication predispose to toxicosis. And if before the onset of pregnancy you had diseases of the gastrointestinal tract, liver, then you have a very great chance to experience all the “joys” of toxicosis.
It is completely objective that we owe such not the best memories of our pregnancy to the frantic pace of modern life with chronic stress, improper diet and an unhealthy lifestyle.This means that by changing the lifestyle, normalizing the digestive system, getting rid of bad habits when planning pregnancy, we can prevent or significantly reduce the manifestations of toxicosis in the first half of pregnancy.
How toxicosis can manifest itself.
There are several options for the course of toxicosis in pregnant women. Most often, toxicosis means only vomiting of pregnant women. Of course, it accounts for more than 90%, but sometimes the reaction of the mother’s body to pregnancy takes on other rare forms.These include: tetany of pregnant women (manifested by convulsions), dermatoses (various skin lesions), osteomalacia (softening of the bones), bronchial asthma of pregnant women, hepatosis (liver damage with jaundice). Toxicosis is often manifested by salivation – alone or together with vomiting.
Vomiting of pregnant women.
With the onset of pregnancy, your body begins to adapt to the new conditions of coexistence with your baby. Quite often, this “crisis of change” is accompanied by nausea, vomiting, and weakness.Many women report mood changes, tearfulness, or increased irritability. Once favorite things, foods, smells begin to irritate. Or, on the contrary, you suddenly want something unusual for yourself.
Moreover, up to 60% of cases of vomiting of a pregnant woman is regarded as a physiological sign of pregnancy. And only a little more than 10% of pregnant women with toxicosis need special treatment. It is important to understand that during physiological pregnancy, vomiting can be no more than 2-3 times a day, more often in the morning, on an empty stomach.Compliance with certain rules of behavior and nutrition, which will be discussed below, helps to reduce the manifestations of such “troubles” of pregnancy. This, however, does not affect the general condition of the woman. Otherwise, we can talk about the development of early toxicosis. This already requires medical intervention, and in some cases, hospitalization in a hospital for detoxification therapy.
Basic means of combating toxicosis.
Of course, your idea of a long-awaited pregnancy was more rosy.And here from somewhere came weakness, fatigue, irritability, and there is no life from constant nausea and vomiting. The main thing is not to despair, relax and follow all the doctor’s recommendations. No matter how obvious they seem to you – with toxicosis of pregnant women it “really works.”
And, first of all, let’s start by eliminating the psychological aspect. Allow yourself to be pregnant, with all your weaknesses. Do not be afraid of the changes taking place in your body and inner world.To combat toxicosis, you do not need to make every effort – you just need to learn to live with it – because in most cases this is a completely natural phenomenon at the beginning of pregnancy.
Next, we normalize daily regimen and nutrition. It is imperative for a pregnant woman to walk in the fresh air for at least 1-2 hours a day – oxygen enhances metabolic processes, preventing the accumulation of toxins. As “fresh air” you now need a full sleep, it is desirable that you have the opportunity to rest during the day – this is important for the normalization of the central nervous system.
Avoid all annoying and unpleasant moments, every pregnant woman has her own. Sick from smells – a handkerchief, perfumed by your favorite spirits, will come into service – your “pocket” companion. If one type of toothbrush starts vomiting in the morning – postpone this hygienic procedure until lunchtime – you will not bring much harm to your teeth in such a short time.
Now try to eat whatever you want – the main thing is that the food is easily digestible with a lot of vitamins.Of course, it is good if these are foods rich in protein (fish, meat, dairy products, cereals). But even if the thought of meat is unpleasant for you now, you do not need to eat through force, most likely, the outcome of such a meal will be the same. Your baby is still so small that he does not need a large reserve of building proteins – so adherence to a nutritionally and quantitatively complete diet can be postponed until a later time. The same rule applies to hard-to-swallow multivitamin tablets.
Waking up in the morning, allow yourself some time to soak up in bed – you can now, and you can put nuts or cookies on your bedside table in the evening. Someone in the fight against morning vomiting helps to eat, without getting out of bed, a spoonful of low-fat cottage cheese or half a boiled egg, after which, of course, you need to lie down.
Food must be liquid or semi-liquid, but not necessarily hot. You need to eat often up to 6-8 times a day in small portions, and after eating you need to lie down – so it is better absorbed.A late dinner, for example, a glass of kefir, will also not be superfluous – it prevents the accumulation of a large amount of gastric juice by the time of awakening.
You need to drink a lot, but preferably between meals, so as not to overload the stomach. Alkaline mineral water, juices, herbal teas are the best for this purpose – they can be brewed in a water bath or you can buy ready-made filter bags with mint, lemon balm, valerian, thyme.
During the day, you can relieve nausea with mint drops or chewing gum, as well as rinsing your mouth with lemon water, a decoction of mint, sage, chamomile.
To normalize the digestive system, you can use the following collection: 8 parts of wormwood, 2 parts of St. John’s wort, 2 parts of yarrow. Pour one tablespoon of the mixture with a glass of boiling water, insist on a water bath for 15 minutes and take 1/3 cup 3 times a day before meals.
Aromatherapy has proven to be good for combating toxicosis – essential oils of jasmine, rose, anise, lemon soothe nausea.
Perfectly relaxing head and collar massage.And if you involve your husband in this – there can be no better way to express solidarity in this “crisis moment” of pregnancy.
Effective during toxicosis is the effect on special antiemetic and metabolic points by acupuncture or acupressure. Acupuncture, of course, should only be carried out by a specialist, but acupressure techniques can be learned by yourself under the guidance of a doctor.
In any case, toxicosis is only a small temporary piece of your pregnancy, which will surely end soon.And the calmer, more optimistic, maybe to some extent even with humor, you react to it, the easier it will be to get through this “crisis” of your relationship with pregnancy. After all, the main thing is a new life emerging within you!
90,000 9-12 weeks of pregnancy
Ninth week for baby
During the ninth week, the weight of the fetus changes from 1 gram to 10 grams, the length is 30-45 mm. In the fetus, the back straightens and the embryonic tail disappears.The unborn child becomes completely like a small person. At this stage, the head is pressed to the chest, the neck is bent, the arms are also brought to the chest.
The development of the brain, which is quite intensive, is one of the main processes of this period. The cerebellum begins to function, the hemispheres acquire clear outlines. Since the cerebellum is responsible for coordinating movements, in the fetus they cease to be spontaneous and become clear and active, the fetus begins to feel the movement of its own body.
The heart rate at this stage is 120-150 beats per minute, two ventricles and two atria are formed in the heart. There is an emergence of a circulatory system of blood vessels, blood begins to flow through them. While the blood circulation in the upper part of the fetus is characterized by greater intensity than in the lower one. Therefore, the handles are more developed in comparison with the legs. The fingers are lengthened, and the membranes between them slowly disappear. By the end of the ninth week, the formation of the eyes ends, they are tightly covered with eyelids.Closing of the facial bones occurs, on the head it is already possible to distinguish the nose and nostrils, auricles and lobes, the upper lip. At this stage, the fetus becomes more and more like a human face.
Intensive development of internal organs leads to a rounding of the fetal tummy. The digestive organs and the liver develop, which is important because it is responsible for hematopoiesis (the formation of new blood cells). Thus, “fruit” blood appears.
At this stage in the life of the fetus, such an important event happens as the beginning of the synthesis of hormones, which include adrenaline.The intensive growth of the adrenal glands ensures this process. Also, the beginning of the synthesis of hormones is associated with the complication of the structure of the adrenal glands. All this helps the fetus to comfortably adapt to a variety of changes and extreme conditions. It is the presence of adrenaline in the body that allows it to withstand various stresses. The fetus acquires the ability to endure stress, since adrenaline regulates a special mode of “survival”.
Ninth week for the expectant mother
At this stage, the woman may still have drowsiness, fatigue, frequent mood swings and dizziness.The manifestations of toxicosis are able to reach their maximum. It is this period that is optimal in order to visit a gynecologist and register.
Baby’s tenth week
This week is important and significant, it is from this week that the fetal stage of development begins, and the future child is now officially called a fetus, not an embryo. All internal organs have already been laid, which in the future will only have to grow and develop. Experts rightly consider the tenth week to be the final one in the first critical period: from this time on, the likelihood of developing defects that may arise as a result of chemical factors of various natures is no longer so high.
The fetus at this time is freely located in the uterine cavity, without practically touching its walls. In the future baby, an intensive formation of the nervous system takes place, the transmission of impulses by the neuromuscular pathways is getting better. This process leads to intense movement. Such movements are reflex, they are active and are caused by contact with the walls of the uterus. The fetus is already making quite clear movements of the legs, head and arms. The woman is not yet able to feel fetal movements, but with ultrasound examination they are clearly visible.
At this time, the diaphragm is finally formed – a flat muscle, designed to separate the abdominal and chest cavities. Further development of the internal organs takes place.
The tenth week for the mother-to-be
The woman feels heightened anxiety, she retains emotional lability. All of this is a consequence of ongoing hormonal changes. The only thing should be understood that the restoration of balance will soon take place, which means the return of a stable good mood.
The situation is changing with the manifestations of toxicosis. Nausea begins to bother less and less, and vomiting, as a rule, stops altogether. Nausea mostly only in the morning. If the toxicosis completely disappears, an increased appetite may occur. At this time, it is important to monitor the diet and prevent a sharp increase in weight. It is necessary to exclude overeating and the use of high-calorie foods. For a woman in position, this is harmful and can cause shortness of breath, edema, deterioration of health.Excess weight is the reason for an increase in the load on all systems of the body, which already spends a lot of energy on the development of the fetus.
Women in the tenth week may notice a change in the abdomen. The cause may be overeating, as well as the redistribution of subcutaneous fat and muscle relaxation due to the influence of the pregnancy hormone progesterone.
The uterus during this period increases, but not so much as to affect the shape of the abdomen, it reaches the size of a large apple or grapefruit.Accordingly, pregnancy is still completely invisible to others.
Eleventh week for baby
The fetus continues to grow rapidly at the eleventh week. Outwardly, it looks like this: a fairly large head, small legs pressed to the tummy, a small torso and well-developed long arms. This uneven development is due to the fact that the bulk of the nutrients and the proportion of oxygen throughout the previous period was received by the upper part of the body, in which such vital organs as the heart and brain are located.
The fetus continues to form joints and bones, muscle growth. Not only large joints develop, but also small ones. In the jaws, the rudiments of teeth are formed, on the fingers – nails.
The movements of the unborn child are becoming more and more purposeful. Loud sounds and sudden movements begin to elicit a response from him. Grasping and sucking reflexes develop – this can be seen by the movement of fingers and lips. The formation of olfactory and gustatory receptors begins. If the amniotic fluid enters the nose or mouth, the fetus can taste it.
At this stage, the formation of the iris of the eyes also occurs, which after birth will determine their color. In newborns, in most cases, the eyes are blue or blue, brown are quite rare. The final color of the iris is formed by five months. It depends on the accumulated melanin pigment in the iris. Genetic inheritance determines the amount of a given pigment.
Eleventh week for a mother-to-be
At this time, in most cases, vomiting and nausea, as well as intolerance to certain odors disappear.Thus, a woman gets the opportunity to form a complete diet and start eating in a variety of ways, giving preference to various healthy products. It is advisable to eat freshly prepared food. If you follow a certain diet, you can avoid any problems at this time, the main of which is the problem with digestion. The relaxing hormone progesterone causes your intestinal muscles to become lazy, leading to bloating and constipation. If even strict adherence to the diet does not help to cope with the problems, it is necessary to contact a specialist who can prescribe safe medications.
In accordance with the growth of the fetus, the blood volume also increases. A woman, as a result of such changes, may experience increased sweating. Increased kidney function leads to more frequent urination. If there is no discomfort and pain with frequent urination, there is no reason to worry. Otherwise, you will also need to visit a specialist. Discomfort and pain can be symptoms of bladder inflammation, i.e. cystitis syndromes.
At a period of eleven weeks, the first prenatal screening is carried out, which is aimed at identifying malformations.An ultrasound and biochemical examination is performed. The first screening is aimed not only at identifying malformations. This examination allows you to find out the state of the chorion, the growth and degree of development of the fetus, the exact duration of pregnancy and other details.
Twelfth week for baby
The twelfth week ends the first trimester of pregnancy. By the end of this period, the length of the fetus is 90 mm, and its weight is approximately 20 g. At this time, many significant events take place in the life of the fetus.
He has an intensive development of the brain, the formation of connections between the spinal cord and the cerebral hemispheres. When you look at the structure of the brain, it resembles a smaller version of the brain of an adult. During all the first months, only red blood cells were in the fetal blood, but at the twelfth week, leukocytes, which are the body’s defenders and belong to the immune system, are added to them.
The digestive tract also develops. The liver, which at this stage is the most developed organ and occupies most of the abdominal cavity, begins to produce bile, and not only provide hematopoiesis, as it was before.It is from the twelfth week that the intestine is actively growing and begins to fit into loops, which can later be seen in an adult. The first peristaltic movements occur, that is, contraction of the intestinal muscles, which in the future should ensure the movement of food through it. The fetus, starting this week, swallows amniotic fluid, and they pass through the intestines. This happens until the very birth. Peristaltic waves are the training of the intestinal muscles.
In addition, the fetus undergoes rhythmic muscle movements, which are also training and imitate breathing.The glottis is tightly closed, so the amniotic fluid is not able to penetrate the respiratory system.
In the fetus, the kidneys begin to function, urine in them is collected in small portions and exits through the urethra, getting into the amniotic fluid.
At the twelfth week, the formation of the placenta is completed, which becomes able to function independently. The placenta is the most important organ for the fetus, through it not only the exchange of nutrients between the woman and the fetus takes place.The placenta is an effective protector against internal and external toxins.
Twelfth week for a mother-to-be
Twelve weeks are rightly considered the best in pregnancy. The woman’s well-being returns to normal due to the transfer of control of the process from the corpus luteum, which produced progesterone, which is the culprit of many troubles, to the placenta. All manifestations of toxicosis disappear, women become relaxed and calm.
The uterus at this stage has already enlarged enough and reached the edge of the pubis, but this cannot affect the shape of the abdomen.
As a rule, the first trimester is not accompanied by weight gain. If toxicosis manifests itself to a large extent, even weight loss is possible. If a woman’s appetite has not changed as a result of pregnancy, she should gain no more than 10% of the total weight during the entire pregnancy. Such an increase is usually 1-2 kg.
From the twelfth week, if the woman is doing well and there are no contraindications, it is recommended to start playing sports. In the earlier stages, they are not dangerous, but most often experts recommend that women take care of themselves after the end of the first trimester.
For the expectant mother, dancing, yoga, swimming, fitness classes, as well as any other type of activity that has been designed specifically for pregnant women, are perfect. Before starting training, be sure to consult a doctor. If you choose the right load, classes will have a positive effect on the course of not only pregnancy, but also childbirth. Also, sports at this stage will contribute to a faster recovery after childbirth.