Diseases

Pregnancy poisoning (gestosis) - causes, symptoms, therapy


The term pregnancy poisoning is actually obsolete today, but is still used colloquially for a number of diseases that can be attributed to an adaptation disorder of the body during pregnancy. The modern umbrella term for diseases of this type is medically correct gestosis. In addition to the morning sickness in the first third of pregnancy, this also includes pregnancy-related hypertension. It is estimated that such a disease affects around six to eight percent of all pregnant women. The diseases are diverse and there are no special diagnostic procedures yet, but here are some important details on the character and course of gestosis.

Definition

Strictly speaking, pregnancy poisoning is not actually poisoning. The term stems from outdated theories that certain chemical substances are released from the female metabolism during pregnancy, which can cause poisoning of women and children. However, today we know that this is not the case. Instead, it is assumed that gestosis is an adaptation disorder of the body during pregnancy. Depending on the severity, this adjustment disorder can trigger various health problems.

It is characteristic of gestoses that they almost always go hand in hand with increased blood pressure, the so-called gestational hypertension. Hypertension is therefore also a clear cardinal symptom of the disease. In this context, the term “high pregnancy pressure” would be technically more correct than pregnancy poisoning. In addition, symptoms such as nausea, the formation of edema and increased protein excretion in the urine, also called gestational proteinuria, can occur. Versatile pain symptoms are also conceivable, although these do not rule out a pronounced seizure. Because gestoses differ in severity mostly depending on the stage of pregnancy, they are divided into different forms in medicine -

Early gestures

With early gestosis, symptoms appear relatively harmless between the second and fourth month of pregnancy. These include:

  • Hyperemesis gravidarum (pregnancy vomiting): This is the classic pregnancy vomiting in the first trimester of pregnancy. In addition to vomiting, there may be an increased heart rate, low blood pressure and circulatory problems.
  • Hypersalivation (sialorrhea): In addition to uncontrollable vomiting, early pregnancy can also lead to increased salivation. This is not infrequently favored by various previous diseases of the mother, which affect the production of saliva due to the pregnancy-related body processes.

Late gestosis

They only appear after the fourth month of pregnancy. Characteristic of these gestoses is an increase in blood pressure, which is why they are also called hypertensive gestational diseases. Late sores are far more complicated and dangerous for the expectant mother and her unborn child. The main sub-forms are here:

  • HELLP syndrome: The name of this syndrome is made up of the English terms "haemolysis" for hemolytic anemia, "elevated liver" enzyme level for increased liver values ​​and "low platelet count" for a reduced number of platelets (platelets). The cardinal symptoms of the HELLP syndrome are already described. Pre-eclampsia is often associated with the syndrome. An estimated one to three women in 1,000 pregnant women are affected by HELLP syndrome.
  • Preeclampsia: This hypertensive disorder, which is estimated to affect three to five percent of all pregnant women, is associated with increased blood pressure and increased protein excretion in the urine. Water retention can also occur during pre-eclampsia. Because of these three characteristic symptoms, which can also be referred to as Edema (English for edema), Proteinuria (English for protein in the urine) and Hypertension or Hypertonia (English for high blood pressure), preeclampsia is sometimes referred to as EPH gestosis. A special form of pre-eclampsia is so-called graft pre-eclampsia or graft gestosis. Medicine speaks of this if a mother already had high blood pressure in the run-up to pregnancy and further symptoms of gestosis are associated with hypertension in the course of pregnancy. In addition, this form is considered the preliminary stage of eclampsia.
  • Eclampsia: About ten percent of all expectant mothers who previously suffered from pre-eclampsia develop an eclampsia in the further course. The disease is particularly complicated because, in addition to high blood pressure, edema and proteinuria, it can also cause epileptic seizures in the advanced stage, which usually occur shortly after birth in the mother. Eclampsia is therefore the most severe form of gestosis, because in the course of epileptic seizures, in the worst case, there is deep loss of consciousness, if not a coma, during pregnancy or childbirth. The epileptic seizures hold great risks for an unborn child, because during an attack the oxygen supply to the child in the womb is impaired, which can mean child death.

The causes of gestosis have not yet been conclusively clarified. However, there are various new research results that provide much more plausible explanations and theories for the development of the disease than the misleading term of pregnancy poisoning. A special reading tip for this is a study by the Department of Obstetrics and Gynecology at Bharati Vidyapeeth University Medical College in Pune, India in 2014. The research team responsible gave for the first time a comprehensive insight into the processes that take place before and during a gestosis in the female Abdomen and thus thinned the medical thicket around the causes of the disease at least a little.

An unknown interference signal in the placenta

Even if the reasons for the development of gestosis have so far been insufficiently researched, it has been found in the past that the disease originates in the placenta of the mother-to-be. Apparently, a hitherto unknown interference signal in the placenta is causing a disturbed adaptation of the maternal cardiovascular and metabolic system to the onset of pregnancy.

It is suspected that this interfering signal is either related to an incorrect implantation of the fertilized egg in the uterus, an impaired production of placental tissue or the development of birthmarks within the vessel walls. In any case, the signal causes massive malfunctions of the endothelial cells that line the inner layer of the vessel walls. With far-reaching consequences, because endothelial cells are responsible for a variety of tasks in the cardiovascular system, such as:

  • The production of important messenger substances that are needed to regulate blood pressure and to maintain the natural tension within the vascular muscles.
  • Regulation of the exchange of blood and tissue through the endothelium by acting as a barrier between the blood flow and the permeable outer layers of the blood vessels.
  • Another task of endothelial cells - angiogenesis - is particularly important with a view to the emergence of new life. This means the growth of blood vessels by sprouting or splitting existing blood vessels. Endothelial progenitor cells are also responsible for the formation of new vessels during embryonic development, so-called vasculogenesis.
  • The inhibition and activation of blood coagulation is also shaped by endothelial cells, which is why they are essential for the flow properties of the blood.
  • The endothelium is even actively involved in the fight against infection by delivering antibodies to the diseased tissue sections and triggering local inflammation as a defense reaction to infection.

It is not difficult to see that the functionally impaired function of multifunctional vascular wall cells in gestosis interferes sensitively with the symbiosis of the maternal and fetal blood circulation. A number of health problems arise from a disruption of the above-mentioned functions of endothelial cells, also called endothelial dysfunction.

Gestosis due to impaired blood circulation

If the endothelial cells can no longer perform their tasks due to malfunctions, this has extremely critical effects on the development of the placenta. For example, arterioles, the smallest unit of arterial vessels, can only grow insufficiently from the endometrium into the placenta, which has a decisive impact on the nutrient, oxygen and blood supply to the embryo. In addition, the disturbed blood circulation due to missing or incorrectly formed arterioles causes an increased increase in blood pressure in the womb. Likewise, the affected vessels are more sensitive to irritating stimuli and are therefore prone to vascular cramps, which can sometimes spread to the vascular muscles and their supplying nerves.

The cleaning of the blood in the placenta is also badly affected by endothelial dysfunction. Lipoproteins, in particular, which are responsible for the transport of water-insoluble fats in the blood, are only incompletely emptied due to the impaired blood circulation. This is why there is an increasing number of oxidation processes on the lipoproteins in the uterine vessels, which leads to strong oxidative stress, which leads to increased free radicals. These not only increase blood pressure, but also increase the risk of heart and vascular diseases. Overall, the following symptoms of an impaired blood circulation are associated with oxidative stress:

  • Hardening of the arteries (arteriosclerosis),
  • High blood pressure (hypertension),
  • Vascular spasms (vasospasm),
  • Vascular inflammation (vasculitis).

Caution: The values ​​of some substances that affect the vascular width have changed significantly, especially in pregnant women with preeclampsia. For example, the level of sFlt-1 (soluble fms-like tyrosine kinase 1) is significantly increased, while PIGF (placental growth factor) can be greatly reduced. The material imbalance not only affects blood pressure, it can also affect kidney circulation. This is one reason why kidney problems in patients with preeclampsia go far beyond the increased urge to urinate, which is typical of pregnancy.

Gestose - an autoimmune disease?

Against the background of vascular-related disorders, another dimension of the causes of the disease emerged in various studies. Recent research suggests that certain autoimmune processes also play a role in gestosis. Scientists found, among other things, that patients with preeclampsia have autoantibodies that adversely affect the angiotensin II receptors. Angiotensin II is a tissue hormone that, like endothelial cells, is needed to maintain blood pressure.

Russian scientists also noticed the increase in antivascular antibodies in pregnant women with gestosis in a study. Furthermore, a German-Norwegian-British joint study supports the theory of autoimmune processes as the cause of pre-eclampsia and suggests that an immunological incompatibility between mother and fetus, particularly in the case of vascular inflammation caused by arteriosclerosis, could be the reason for this form of gestosis.

A study from Salzburg, in turn, deals with the autoimmune disease type 1 diabetes as the cause of HELLP syndrome. According to the results of the study, the syndrome could be remedied in an experiment with a diabetes patient with appropriate therapy for the underlying disease. In addition, another study provided evidence that rheumatic autoimmune diseases favor preeclampsia.

Incidentally, the autoimmune theory for gestosis is not new. As early as 1998, the scientists Dekker and Sibai in the Netherlands observed that 50% of all women with preeclampsia had antibodies against endothelial cells (see here).

Plant and environment play a role

As is the case with many autoimmune diseases, which are triggered by environmental influences such as high levels of pollutants in the air, the gestosis also seems to worsen if something is wrong in the environment of the pregnant woman. Organochlorine pesticides in particular seem to trigger corresponding developmental disorders in the placenta. Researchers came to this conclusion after examining the placentas of 508 Kyrgyz women. 241 of these women lived in regions that are characterized by cotton cultivation and the high use of pesticides. 121 women lived in urban residential areas that were exposed to severe environmental pollution due to their proximity to industrial metropolitan areas, and 146 participants in the study came from pollutant-free mountain regions of Kyrgyzstan.

The result was clear. Organochlorine pesticides were found in a good 47 percent of all placentas, with women from polluted areas (especially those close to pesticide camps) making up the majority. The researchers observed not only increased pregnancy and birth complications such as stillbirth, low birth weight of the infant, infant infections and malformations, but also an increased prevalence of pre-eclampsia on contact with the pollutants.

A genetic component also appears to be involved in the described clinical picture. According to a study by Chesley and Cooper, the likelihood that the female family members of a woman with preeclampsia or eclampsia also develop corresponding pregnancy complications is extremely high. The sisters of the woman are most at risk here with a probability of 120 percent. The daughters' risk is somewhat lower at 88 percent, while the granddaughters are again much more at risk at 105 percent. The scientists carried out corresponding calculations using the Falconer method - a mathematical formula for determining genetic influences and environmental influences.

Other risk factors

Women who already had early gestosis are more likely to develop late gestosis later. The same applies to the occurrence of gestosis during a previous pregnancy. In addition, both young mothers under the age of 18 and women over the age of 40 have a significantly higher risk of the disease than women who become pregnant in the middle age. Likewise, first-time mothers tend to be more likely than second-mothers or third-mothers without a previous history. There is also an increased risk with multiple pregnancies.

In addition to the autoimmune diseases such as diabetes or rheumatism mentioned above, in the area of ​​risky underlying diseases, which increase the likelihood of developing gestosis

  • Obesity (overweight),
  • chronic high blood pressure,
  • Blood clotting disorders,
  • Multiple sclerosis,
  • Neuralgia,
  • Kidney disease
  • and to name the antiphospholipid syndrome.

The latter symptom is again an autoimmune disease that primarily affects women and is triggered by autoantibodies that target the body's own phospholipids. They are part of numerous body fluids, including the bile and the lung surfactant surfactant. In addition, phospholipids act as signaling molecules in the cells, which again raises the suspicion that the disease-related disorders in the endothelial cells are caused by autoimmune processes.

Symptoms of poisoning with pregnancy

The symptoms of gestosis are varied and differ according to the form of the disease. While more harmless general symptoms such as nausea, vomiting and increased salivation are noticeable in early mothers, all late mothers have high blood pressure due to pregnancy in common. In addition, as mentioned at the beginning, there is water retention (edema) in the tissue and protein excretion in the urine.

The increased blood pressure in particular has further effects in the advanced stage. For example, this severely strains the kidney's filtering work, which as a result not only excretes unfiltered protein, but also, due to the high pressure, only poorly reabsorb nutrients. This can lead to a nutrient deficiency in the pregnant woman, which is expressed, for example, in circulatory problems, headaches or visual disturbances. The liver suffers no less from the impaired blood circulation. Digestive problems and upper abdominal pain in particular indicate a disturbed liver function.

Neurological symptoms that arise due to vascular and nervous cramps include late onset and especially in the case of eclampsia especially headaches, impaired consciousness and vision (e.g. eye flickering), excessive reflexes and the seizures already indicated. A variety of pain symptoms in the abdominal area, such as stomach pain, intestinal or abdominal cramps, are possible and also extremely dangerous with regard to miscarriages caused by premature labor.

All in all, the following pregnancy problems can indicate gestosis:

  • High blood pressure,
  • Protein in urine,
  • small amount of urine,
  • A headache,
  • Seizures,
  • Liver dysfunction,
  • Renal dysfunction,
  • sudden, high weight gain,
  • Pain in the upper abdomen,
  • Visual disturbances,
  • Nausea and vomiting,
  • exaggerated reflexes,
  • Water retention (edema).

Attention: The combined appearance of symptoms such as upper abdominal pain, nausea, vomiting, visual disturbances, headache and restless reflexes indicate an eclampsia! Affected patients must go to the gynecologist immediately in order to prevent serious late complications such as seizures or comatose disorders!

Diagnosis

If you suspect pregnancy poisoning, you should see your gynecologist as soon as possible. In the course of a medical history, not only existing symptoms but also possible previous illnesses and family dispositions must be clarified. Since there are no separate diagnostic procedures to date, individual-specific tests are then carried out, which include blood pressure measurements, blood tests, urine tests and a weight check.

In gestose patients, the blood pressure should be measured several times a day, at intervals of six hours, in severe cases, if necessary, also every hour, so that deviations and sharp increases can be observed as well as possible. Proteinuria can primarily be determined in a urine test. It occurs when a patient excretes more than 300 mg of protein per liter of urine per day. In the blood test, the liver and kidney values ​​and the coagulation parameters are particularly important, for example by determining the number of blood platelets. In addition to the laboratory tests, the condition of the child is checked using a cardiotocography (CTG) and an ultrasound examination. The placenta function can also be assessed thanks to imaging measures.

Therapy

The course of pregnancy poisoning largely depends on the type of gestosis. With lighter forms, avoiding stress can lead to freedom from symptoms after just a few days. With heavier forms, on the other hand, drug treatment is usually necessary that at least lowers blood pressure. In the worst case, an early induction may be necessary. After birth, high blood pressure usually normalizes after three months at the latest with the help of medication. It should be noted that late treatment can be fatal to both mother and child if left untreated. So please take the medical instructions seriously and implement them carefully.

Avoiding stress

To keep blood pressure as low as possible, you should avoid everyday stress. Hustle and bustle is not good for an unborn child, which is why stress-free everyday planning and targeted relaxation training should be part of every pregnancy. Suitable courses are, for example, aqua aerobics for pregnant women, Qi Gong, singing bowl therapy and yoga. Breathing exercises that are important at the latest for the birth also help to create more peace and serenity.

For better relaxation, warm baths are recommended, which can also be helpful for light water retention. Take regular breaks between strenuous activities and do nothing hectic before going to bed. Speaking of sleep: healthy sleep hygiene is fundamentally important to keep blood pressure low.

Quitting smoking not only for blood pressure reasons, but also for the well-being of the unborn child goes without saying during pregnancy. Nicotine causes physical stress not only for the mother, but also for the child, since the already impaired metabolism between mother and placenta this has to deal with an unhealthy amount of toxins.

Nutritional measures

Pregnancy poisoning can only be prevented to a limited extent, but the reduction of excess weight is recommended in the run-up to pregnancy through a healthy diet. The right nutritional measures for gestosis can also prevent pregnancy. For example, drinks that raise blood pressure, such as coffee or cola, should be avoided and more nutrients such as L-arginine and selenium should be used. These not only reduce the risk of preeclampsia preventively, you can also alleviate the symptoms of an existing gestosis. The intake of folic acid is just as important, since the mineral has been proven to protect against arteriosclerosis, anemia and embryonic malformations.

In view of the high importance that folic acid has in embryonic development, pregnant women have an increased need anyway and have to consume a full 800 µg daily instead of the normal 600 µg. In the case of a gestosis, the need can sometimes be even higher. Fortunately, folic acid, selenium and L-arginine can often be found in the same foods, which are mainly provided by cereals, legumes, seafood and fish. Here is a small selection:

  • Red cabbage,
  • Beans,
  • Mushrooms,
  • Peas,
  • Peanuts,
  • Shrimp,
  • Oatmeal,
  • Cod,
  • Salmon,
  • Lenses,
  • Brown rice,
  • Oranges,
  • Brazil nuts,
  • Pine nuts,
  • Turkey breast,
  • Soybeans,
  • Sunflower seeds,
  • Asparagus,
  • Spinach,
  • Tomatoes,
  • Wheat bran.

One or two bites of lean veal or poultry liver can also be consumed during pregnancy with a view to adequate folate, selenium and arginine supply. Together with dairy products, the lean meats also provide important proteins, which, due to disease-related proteinuria, are in greater demand.

It also makes sense to use vascular protective unsaturated fatty acids instead of harmful saturated fatty acids. In addition to fish, these are mainly found in vegetable oils. The iodine intake that is important for pregnant women, on the other hand, is to be covered by dietary supplements rather than salt, since the latter is considered a blood pressure driver and is therefore completely unsuitable for patients with gestosis.

Naturopathy

Not all herbs that help against high blood pressure outside of pregnancy are also suitable for expectant mothers. Herbs of traditional Chinese medicine, such as

  • Chinese angelica,
  • Chinese asparagus root,
  • Bell wrought root
  • or schisandra berries

should not be taken here without explicit dosage instructions from a professional TCM customer. The herbs are used specifically for pregnancy-related blood pressure and blood formation disorders, but have dangerous side effects when overdosed.

Native herbal herbs, which are used as an ingredient in pregnancy teas by default, look much milder here. Which includes:

  • Anise,
  • Fenugreek,
  • Fennel,
  • Daisy,
  • Pomegranate,
  • Raspberry leaves,
  • Chamomile,
  • Garlic,
  • Lavender,
  • Parsley,
  • Rosemary,
  • sage

Of course, you should always enjoy it in moderation here, too, but general consumption is rather harmless. Herbs such as anise, fennel, garlic, rosemary or parsley can also be used as an ingredient in delicious dishes and offer a spicy food supplement during pregnancy.

Medication

If your blood pressure exceeds 150/100 mmHg, your gynecologist will take you to a clinic as a precaution if you have gestosis. In addition to the constant monitoring of the child and mother as well as the insertion of a bladder catheter to constantly check the protein excretion in the urine, the infusion of antihypertensive drugs is also necessary. Preparations such as nifedipine or dihydralazine are used for this. Beta blockers are also occasionally used. Aspirin may also be used to relieve pain. If severe seizures are feared, magnesium sulfate is added.

Initiation of childbirth

In very severe cases of pregnancy poisoning, the only way of treatment is to give birth prematurely. From the 37th week of pregnancy, this measure is usually not a problem. An introduction to earlier weeks of pregnancy should be discussed with the treating gynecologist. (ma)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Swell:

  • German Society for Gynecology and Obstetrics (DGGG): S2K guideline on hypertensive gestational diseases: diagnosis and therapy, as of March 2019, detailed view of guidelines
  • Rath, Werner / Gembruch, Ulrich / Schmidt, Stephan: Obstetrics and Perinatal Medicine: Prenatal Diagnostics - Diseases - Delivery, Thieme, 2nd edition, 2010
  • Professional association of gynecologists (BVF): https://www.frauenaerzte-im-netz.de (accessed: June 24, 2019), pregnancy diseases and complaints
  • Working group affected by gestosis: https: //präeklampsie-hellp.de (accessed: June 24, 2019), preeclampsia
  • Harvard Health Publishing: https://www.health.harvard.edu (accessed: June 24, 2019), Preeclampsia And Eclampsia
  • Mayo Clinic: https://www.mayoclinic.org (accessed: June 24, 2019), Preeclampsia
  • Merck & Co .: https://www.msdmanuals.com (accessed: June 24, 2019), Preeclampsia and Eclampsia
  • AMBOSS GmbH: https://www.amboss.com (accessed: June 24, 2019), hypertensive gestational diseases

ICD codes for this disease: O14ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.


Video: What Is Pre-eclampsia? (November 2021).