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Pathologies during pregnancy

Pathologies during pregnancy

Certain pathologies which may occur in both pregnant women and in newborns may be connected to nutritional deficiencies in the pre-conception period and during the pregnancy. This is why it is important to conduct a healthy lifestyle from which both the mother and the baby can benefit.

More specifically, an adequate nutritional plan represents a good starting point for an easy pregnancy: the diet is one of the environmental factors which may significantly influence the mother’s health and the development of the baby both during the pre-conception period (when the mother is still only thinking about having a baby!) and during the pregnancy.

The pre-conception period is the largest part of the period which is defined pre-conception and which includes 5 phases: the pre-conception phase, the conception, the implantation of the fecundated ovule in the mother’s uterus, the placentation (formation of the placenta and of the annexes which will contribute to the nutrition of the fetus), embryogenesis (formation and development of the embryo). This period, although brief if compared to the pregnancy as a whole, is fundamental for the future development of the fetus.

The lack of certain micro-nutritional elements, vitamins and minerals may lead to the development of the following pathologies.

Neural tube defects: spina bifida and anencephaly

Spina bifida is a congenital malformation of the spinal cord, of the nerves and of the connected structures (vertebrae, muscles, skin): several different levels of severity and of functional disability exist. Nonetheless, in typical cases, the pathology is characterized by a lesion in the bone marrow with a subsequent paralysis of the lower limbs, hydrocephalus, intestinal and urinary incontinency and reduced sensibility. The pathology occurs in the first month of the pregnancy and may be identified at birth. It is also possible to diagnose it before the baby is born if the disease is overt and highly recognizable. It may be more difficult to diagnose if the disease is concealed and hidden. It is often accompanied by malformations such as hydrocephalus (a build up of cerebrospinal fluid – liquor – in the brain ventricles which may be congenital or may develop because of a tumor, of an infection or of a hemorrhage) and Chiari malformations.

Chiari malformations are pathologies which occur in the rear cranium, where the cerebellum and the brainstem are normally situated. This condition is characterized by an “obstacle” in the nervous structures in the brain-spinal chord passage and by a small bone structure. The cerebellum and the brainstem are therefore dislocated through a small opening called foramen magnum into the spinal canal. Chiari malformations may be associated to many other pathologies including spina bifida (a severe congenital malformation of the spinal cord and of the bone marrow which is generally accompanied by hydrocephalus and may determine a severe level of disability with paralysis of the lower limbs and other disturbs which normally occur in the urinary tract; the deficiencies associated with spina bifida are definitive and are not curable), syringomyelia (a chronic disease of the bone marrow characterized by an infiltration of the cerebrospinal fluid into the marrow with a subsequent formation of a cystic cavity). These pathologies may provoke compressions and/or lesions to the nervous fibers of the bone marrow, spina bifida and hydrocephalus.

In Italy, spina bifida syndromes occur in 4-6 cases every 10.000 births (about 360 new cases per year). In Great Britain the ratio is of 8 cases every 1000 and in Japan 1 new case occurs every 1000 births.

Anencefaly is a very severe malformation which prevents the fetus from developing at all. It is caused by a lack in the development of the brain and of the cranium structure. It is the most common of the pathologies which prevent the fetus from reaching post-birth life.

Can these pathologies be prevented?

The causes of the pathologies are still uncertain, but it has been proven that a correct assumption of Folate (vitamin B9) on behalf of the mother prevents up to 75-90% of spina bifida cases. Since the neural tube closes 30 days after the conception (typically between the 17th and the 29th day), when the woman often doesn’t even know she’s pregnant yet, all women who program a pregnancy or simply are in a reproductive phase and do not use birth control measures should take folate daily (400 mcg/day) by means of their diet and of food supplements.

Pernicious anemia

Pernicious anemia (also known as megaloblastic anemia) is a form of anemia which is caused by a lack of vitamin B12, folate and iron. It is a severe form of anemia characterized by a gradual reduction of blood cells because the bone marrow cannot produce mature red globules. It may derive from a hereditary incapacity of the stomach to produce a chemical substance known as “intrinsic factor” which is necessary for the intestinal absorption of vitamin B12 which may also turn into Crohn’s disease or into the incapacity of celiac individuals to absorb nutritional elements because of an allergy to gluten.It may occur in both males and females. It rarely occurs in individuals under 30 but the predisposition towards this disease increases with age. Vegetarian are particularly prone to this kind of anemia because vitamin B12 is mainly found in animal proteins. Moreover, the elevated levels of folate in vegetarian diets may hide a lack of vitamin B12.

Can this pathology be prevented?

A supplement of iron, folate and vitamin B12 may be helpful in the prevention of anemia.

Pre-eclampsia

Pre-eclampsia is a clinical syndrome which occurs in the second half of the pregnancy and it is characterized by an increase in the blood vessel pressure (hypertension), loss of proteins with urine (proteinuria) and in a swelling of the lower limbs (edemas) of the mother.

Can this pathology be prevented?

According to numerous studies, this pathology is connected with elevated levels of homocysteine which may be reduced (if the cause of the hyperhomocysteinemia is due to an unbalanced diet) by means of a supplement of folate and of the other Group B vitamins during the second trimester of the pregnancy. This may significantly contribute to the prevention of this disturb which occurs in 5-8% of pregnant women.

Intrauterine growth retardation

We traditionally speak of growth retardation when fetal weight is equal to or lower than the tenth percentile for the gestation period. In this definition are also included constitutionally small fetuses, for instance those born from low height parents. With the term intrauterine growth retardation it's more precisely meant a slowered fetal growth compared to previous controls. Causes of retarded growth are various (both maternal and fetal) and in about half the cases there is not a well recognizible reason. The most frequent risk factor is actually giving birth to a child affected by growth retardation.

Premature birth

About 10-15% of pregnancies end before the 36th week rather than the 40th. This may be caused by pathologies derived from the mother, such as diabetes, gestosis, vaginal infections, fibromas or because of cervical incompetence, or causes derived from the fetus, such as premature membrane rupture, twins or placenta previa. The physician can promptly act on some of these pathologies and try to prolong the gestation period as much as possible.

Hyperhomocysteinemia

Some studies, both in vivo and in vitro, have proven that not only a lack in folate but also a lack in other vitamins (B12, B6, B2) and in other nutritional elements such as zinc and bethaine may cause hyperhomocysteinemia (an excessive concentration of homocysteine in the blood which influences the nervous system functions, the vascular system and the bone structure negatively, mainly through an increase in the production of free radicals and through the subsequent oxidative stress), which seems to be associated with:

  • neural tube defects (NTDs) and congenital heart defects (CHDs) connected to the lack of vitamin B12,
  • lesions of the placenta which may cause its detachment and abortions,
  • pre-eclampsia,
  • in-uterus death and recurring miscarriages – these may occur with damage to the chorion and decidual vessels which cause problems in the implantation of the embryon,
  • cerebral vessel thrombosis.

Can this pathology be prevented?

When the causes of hyperhomocysteinemia are due to an incorrect lifestyle (unbalanced diet, excessive abuse of tobacco and alcohol) and are not genetic or connected to the assumption of certain prescription drugs, they may be controlled and reduced through a correct diet and with the assumption of specific group B vitamins, zinc and bethaine.

Which women risk having this kind of pathologies?

  • Women who are undergoing therapies based on estro-progestin: it is common to find a reduced level of B12 and folic acid in these patients,
  • strictly vegetarian women (a lack of B12 and zinc is common),
  • women with close-ranged pregnancies,
  • women with multiple pregnancies,
  • adolescents.

There are many other pathologies which may occur in pregnant women and in their babies and not all of these are treatable, such as genetically based pathologies.

Based on the above, we can assume that it is possible to reduce the risk of being subject to some of these pathologies thanks to a correct nutritional plan and to a supplement of certain micronutrients such as the ones contained in Normocis 400, a food supplement developed by Inpha2000 based on scientific studies that support the need for these supplements. A correct diet before the conception and during the pregnancy favors fertility and the first stages of the pregnancy and it is also important for the development of the pregnancy itself; it represents an essential instrument for the satisfaction of the new energetic needs of the mother and it provides the fetus with all the nutrients it needs for its growth in order to become a healthy new born baby.

A balanced diet generally provides all these nutrients in adequate quantities. Nonetheless, for certain micronutrients - such as folate - a supplement is necessary during the pregnancy and in general it is necessary when our lifestyle does not respect the “rules” of a healthy and balanced diet. In these cases a supplement of minerals and vitamins is fundamental.

This is why Inpha2000 and the University of Milan -Italy- have created the booklet Nutrition during pregnancies which is full of information and good advice for soon-to-be mothers.

Bibliography

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