Risks during pregnancy

This chapter aims to draw attention to potential risks and hazards which may occur during pregnancy. Complications occur in 20 to 25% of all pregnancies and may affect the mother, the unborn baby or both.

Follwing complications may occur:

  • Approx. 10% of pregnant women develop a disease during pregnancy. The most frequent is so-called diabetes of pregnancy, which occurs in five to ten per cent of all pregnancies. Thromboses and other diseases and problems are also common.
  • With some pregnancies - depending on familial tendencies - there is an increased probability that the growing baby will suffer deformities or other health problems.
  • In 20% of all pregnancies, miscarriages lead to an early and sad end of the pregnancy.
  • About ten per cent of all pregnant women will have a preterm baby.


In most cases, if symptoms are detected in good time, and/or a correct diagnosis is made quickly, a great deal can be done medically. For mothers-to-be, however, it is much more important that in the case of some of the complications and risks mentioned, they can do a great deal themselves to reduce the likelihood of risks occurring. This applies to preterm birth most of all.

Even if a number of the risk factors described below apply to a pregnant woman, there is still no reason to panic. You may have a somewhat increased risk of preterm birth in statistical terms, but it is generally more than 90% probable that your child will still be born healthy and at the right time. The positive thing here is that if you are aware of the risk factors and avoid/reduce them, you can increase this probability still further.

The most widespread risks in the course of a pregnancy are those below; some are subsequently described in more detail.

  • alcohol (see below for more details)
  • smoking (see below for more details)
  • illegal drugs (see below for more details)
  • chemicals and other hazardous substances (e.g. lead, copper, mercury, chloroform, carbon monoxide, pesticides, X-rays)
  • particular kinds of sport (especially sport involving hard knocks or rapid acceleration)
  • particular kinds of travel (e.g. because of the risks of infection in some holiday destinations, side effects of recommended/compulsory travel vaccinations, risk of thrombosis, especially on long-haul flights)
  • vaccinations (medical advice is indicated with regard to vaccinations which are prohibited or recommended during pregnancy)
  • age (risk of complications slightly higher below 18 and above 35, higher still from 40)
  • nutrition and weight (see details in separate section)
  • stress (physical and/or mental stress due to pressure of time, hectic working processes, conflict in professional/private life)
  • infectious diseases (e.g. listeriosis, toxoplasmosis, measles, vaginal infections, hepatitis B)
  • chronic diseases (e.g. diabetes, hypertension, rheumatism, thyroid disease, depression)
  • medication (medical supervision due to frequent contraindication in pregnancy)
  • previous pregnancies involving problems (e.g. complications, miscarriage, preterm birth)
  • family history, genetic factors (medical advice with regard to preventive care and possible genetic diagnostic tests)
  • parodontitis
  • illness of partner
  • multiple pregnancies (see details in separate section)


Drugs
For detailed information regarding the use of drugs during pregnancy please visit the website of the European Network Teratology Information Services www.entis-org.com

Alcohol
There is extensive scientific documentation to show how harmful alcohol is in pregnancy. It is most dangerous when the embryo is developing its organs,
so between the 15th and 60th day after fertilization.

Alcohol can lead to a whole series of diseases with severe consequences for the baby:

  • inadequate growth
  • inadequate weight
  • psychomotor disorders
  • hyperactivity
  • facial anomalies
  • deformities
  • disorders of the central nervous system
  • mental retardation


In Germany, some 1,700 children (0.25%) are born with severe consequences of maternal alcohol consumption. Large quantities of alcohol act like a strong toxin and damage the genotype, so the general recommendation is to avoid excesses even before becoming pregnant.

During pregnancy, alcohol should be given up completely if at all possible. A gynaecologist or other counselling clinics will help with alcohol problems.

Smoking
Like the consumption of alcohol and other drugs, smoking before and during pregnancy is associated with high risks for the unborn baby.

Smoking damages the developing baby in at least three ways:

  • Nicotine narrows the blood vessels. This reduces perfusion of the placenta and also causes the baby's blood pressure to rise.
  • The carbon monoxide in cigarette smoke reduces the oxygen content of the blood. As a result, the baby is practically always "short of breath".
  • The other constituents of the cigarette, such as lead and cadmium, are passed on to the child unfiltered. Cigarettes contain over 100 chemical substances, many of which are toxic and even damage the genotype.


Smoking before and during pregnancy can significantly increase the risks of the following diseases or complications:

  • infertility
  • menstruation problems
  • miscarriages
  • low birth weight
  • preterm birth
  • increased susceptibility of baby to illness
  • hyperactivity of the child
  • placenta praevia (placenta is positioned in lower part of uterus)
  • small growth
  • restricted ability to breastfeed


There is still disagreement about whether smoking also leads to deformities. There is much to suggest it, but study results are inconclusive. However, we do know precise details about the other complications. It is possible to measure how the risk rises with every cigarette smoked. We refer to a clear "dose/effect" relationship, in other words, the higher the dose, the more harmful the effect. The child's birth weight thus falls steadily as the quantity of cigarette smoke inhaled rises. Babies of smokers are 150–250 grammes lighter than those of non-smokers. The likelihood of a miscarriage occurring likewise increases and the rate of preterm births is more than double.

During pregnancy, smoking should be given up completely if at all possible. A gynaecologist or other counselling clinics will help with smoking problems.

The consequences of passive smoking are also measurable: pregnant women who do not smoke themselves but who are exposed to a lot of smoke from others at work or at home, likewise give birth to children of a lower birth weight. Passive smoking at work is already banned in some countries and in Germany, maternity legislation provides protection for a pregnant woman and her unborn child.

Illegal drugs
Illegal drugs are toxic and therefore harmful to both mother and child during pregnancy. A number of drugs are listed below by way of example:
 
Marijuana:
It is very hard to make clear statements about this. This is primarily because several drugs are usually taken rather than just one. Smoking a joint frequently exposes one to the harmful substances of tobacco. Alcohol is usually drunk in addition, or other illegal drugs are taken. Pregnant women who only smoke marijuana are very rare, or at least the numbers are so small that it is impossible to calculate a reliable statistical probability of health risks. This is true by analogy for isolated consideration of all other drugs. However, a current study from Great Britain shows that women who frequently use ecstasy have an increased risk of giving birth to a child with deformities. With all the uncertainty, the current state of research is unable to rule out average to heavy use of marijuana before and during the pregnancy leading to the following complications:

  • preterm birth
  • low weight gain for the mother
  • deformities
  • lower birth weight
  • developmental disorders in the child


Cocaine:
What was said for marijuana also applies to cocaine, though it is considerably more dangerous than marijuana. There are indications of links to:

  • preterm contractions
  • miscarriage
  • preterm amniorrhexis (waters breaking)
  • lower birth weight
  • reduced growth of the child
  • preterm birth
  • behavioural disorders in the child


Ecstasy:
Current studies from Great Britain indicate links between the consumption of ecstasy and deformities/preterm birth.

Heroin:
Heroin dependency in pregnant women is highly dangerous, because the risk of getting an infection from dirty syringes is extraordinarily high. As a consequence, mothers-to-be who are heroin addicts are generally given the substitute methadone. There are no results of studies into the consequences of heroin consumption on a child's health. The only certain fact is that the babies exhibit severe withdrawal symptoms after the birth. Unfortunately the same also applies to babies who develop under methadone.

Drugs should always be avoided during pregnancy because they are toxic and harm the unborn baby. Mothers-to-be who take drugs should try to get off them with specialist help. Counselling clinics can be found in the phone directory.


Special Thanks
EFCNI thanks BabyCare for kindly providing the information above.

For further information please visit the following websites:
BabyCare: www.baby-care.de
Erich Saling-Institute of Perinatal Medicine: www.saling-institut.de

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