1

PREGNANCY
V.A.Voinov
I.P.Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russia.
Summer
In the course of pregnancy and fetal development influenced by many factors
including the disorder environment. Many toxic compounds have gonadotropic,
teratogenic and embryotoxic properties. No less fraught with danger and conventional
drugs taken during pregnancy. In all these cases, especially when it is impossible to
prevent them from entry into the body, measures are needed detoxification, including
preventive and even before pregnancy. This is best achieved by means of
plasmapheresis.
Keywords: toxicants, detoxification, plasmapheresis.
It is known that in cities with large industrial enterprises, especially the chemical
industry, the levels of perinatal mortality and morbidity is significantly higher than the
national average, being one of the causes of the decrease of population growth.
Environmentally dependent pathological processes are the cause of fertile decline, risk
of gestational complications, fetal malformations and miscarriages, reduce the
reproductive potential of the nation [Vdovenko I.A. et al. 2013]. It should be added to
this the dramatic reduction in the category of healthy children, which has not only
medical, social, demographic, but also economic importance.
Is not completely safe also the countryside, where feeling the effects of the use of
herbicides, insecticides and other chemicals. They are not insured also residents quite
affluent cities, taking in foods that are rich in these "additives", also includes the
hormones and antibiotics fed to livestock and remaining in meat and dairy products.
There is a clear link sanitary condition of water consumed with child and maternal
mortality [Cheng J.J. et al., 2012]. This is particularly acute raises questions of water
purification and recycling of toxic waste [Onishchenko G.G., 2013].
Among the harmful environmental factors there are a number of chemical
compounds known embryotoxic, teratogenic and gonadotropic action. In the first case it
is manifested impaired fetal growth (slowing down development, reduction in body
weight and size), the second the appearance of his deformities and birth defects, in
the third the defeat of the female or the male sex glands, which is one of the causes
of infertility.

2
Some of the material of the book "Pregnancy and toxicants" (1986) about the
harmful effects of certain industrial chemicals at the time listed below.

Organ toxicity of some industrial chemicals

Embryotoxicity
Dichlorobutadiene

Teratogenicity
Benblat

Gonadotropic
isoprene

-Hexachlorocyclohexane

Polichlorfenil

Tetraethyl lead

Vinyl chloride

Cyclophosphamide

Dichlorobutadiene

Kepone

Thpen

DDT

Dichlorizobutilen

Aldrin, dieldrin, endrin

Dimethylformamide

Chlorpren

Chloroethanol

Maneb

DDT

2, 3 - dichloropropene

Ethanol

-Hexachlorocyclohexane

Ethylene glycol

Chloridin

Aniline dye

Sodium arsenate

Axtraction naphtha
Hydrogen chloride
-methylstyrene
Carbon tetrachloride
Thpen
Chloroethanol
2, 3 - dichloropropene
Allyl chloride
Dimetilnitrozoamin
Oksimetilpirofosfamid
Pesticides (aldrin, dieldrin,
endrin, trichlorfon, ftalofos,
captan)

It should be borne in mind the delayed effects of toxic substances. Thus, for
example, butyl ester does not cause changes in the embryo, but revealed changes in

3
the functional state of births, as well as their subsequent offspring of the first and
second generations of the violation of their reproductive function [Konstantinova T.K.,
Antonenko T.A., 1976]. In addition, nitrites and nitrates help to reduce the viability of the
first days of postnatal life, and kepon and ethylenethiourea cause offspring persistent
dysfunction of the central nervous system [Tryphonas L., Khera K., 1976]. Some
pesticides (epoxilonazole) cause degeneration of the placenta with subsequent fetal
resorption [Rey Moreno MC et al., 2013]. In some region of France, these pesticides
and their metabolites were detected in the urine of 5.3% -39.7% of pregnant women
living in these areas [Chevrier C. et al., 2014].
The fetus may be affected by the consequences of the transferred immediately
before pregnancy or during the first trimester of her disease. For example, after rubella
about 20% of children may suffer from cataracts or congenital heart disease, 30-35% of
children have hearing disorders [McElhaney R.D. et al., 1999].
We should not forget that many of our life-saving drugs are also chemical agents
and impact on the body of the pregnant woman and the embryo is not always safe. First
we need to recall the terrible thalidomide catastrophe 50s when reception during
pregnancy widespread in those years and soothing analgesic drug thalidomide caused
the whole epidemic of children born with congenital deformities, expressed mainly in the
absence of (amelia) or hypoplasia (phocomelia) one two, and often all four limbs [Lenz
W., 1965].
However, the statistics and the later period is not optimistic. Thus, according to
H.L. Mafenson et al. (1974), in the United States about 7% of newborns had
abnormalities, and just over 15 million. Persons had different birth defects. Of these,
only 10-15% in the etiology of anomalies were found to genetic factors, and 3%
chromosomal abnormalities.
In our time, also as not all drugs are safe for pregnant and fetal organisms. So
there are widespread antidepressants imipramine and amitriptyline potentially
teratogenic, causing a cleft lip, cleft palate, cerebral herniation and hydrocephalus.
Tetracycline is capable of causing disturbances of enamel and tooth formation.
Meprobamate causes of mental retardation in children. Salicylates, and in particular,
well-known acetylsalicylic acid (aspirin), are also embryotoxic agents. Phenothiazines
may cause the development of neonatal jaundice. Streptomycin, taken late in
pregnancy may be the cause of hearing impairment up to complete deafness in
children. Phenylbutazone, oxyphenbutazone, tolbutamide are responsible for the

4
development

of

neonates

toxic

thrombocytopenia.

Embryotoxic

effects

have

benzodiazepines (diazepam, seduksen, Relanium, Valium). Diethylstilbestrol, takes

women during pregnancy can cause birth through girls 11-15 years the occurrence of
vaginal adenocarcinoma.
All this has forced J.M. Rao and R. Arulappu (1981) assume that:
-

Effects of the drug on the fetus does not always coincide with the wellknown pharmacological effect in the body of the mother;

Some drugs can have long-term effects on the fetus with the appearance of
disorder in the later stages of ontogeny;

No medicine is completely safe for the developing fetus.

However, the overwhelming desire of doctors to treat, and of pregnant women

themselves treatment causes one to register and take the other (including their own,
without consulting a doctor) a lot of drugs, each of which is far from indifferent to the
fetus. Intrigue them lies in the long-term effects, which are sometimes difficult to relate
to their admission episodes during the mother's pregnancy.
And in our time, when reading the histories in the departments of pathology of
pregnancy maternity hospitals in some cases it was possible to count up to 20 (!)
varieties of medicines designated pregnant for various indications. Most often, such a
number of medications prescribed for toxicosis and threatened abortion. However, in
most of these cases can and should be had not to introduce new chemicals, and
remove from the body of harmful and toxic metabolites.
Thus, only the therapeutic apheresis able to pull these pathological products of
exogenous origin, as incorporated in the course of employment in hazardous
occupations, and as a result of living in the contaminated territories.
In cases of infertility caused by gonadotropic substances, it is advisable to pair
treatment. If, however, there were indications of the possibility of getting embryotoxic
and teratogenic compounds, the efferent therapy should be carried out before the
women of gestation, it is known that as a bookmark major organs and systems, and
their development defects are formed in the first trimester of pregnancy. It should be
borne in mind that during the first 12 weeks, the trophoblast has not yet formed a
reliable barrier function, so it is in the first trimester of pregnancy are particularly
dangerous potential embryotoxic and teratogenic substances, including many drugs
[Chaika V.K., T. Demina T.N., 2004].

5
Comparative studies carried out by us in comparable climatic and demographic
conditions, but differing in the concentration of industrial cities of the Volga region,
showed that in ecologically unfavorable conditions, the frequency of preterm birth, late
toxicosis of pregnancy, perinatal mortality and morbidity in neonates prevailed twice.
Similarly, a factor of 2-3 had a higher incidence of respiratory diseases and upper
respiratory tract, allergies, as well as a group of often chronically ill children during the
first years of life [Voinov V.A. et al., 1993, 1994]
This indicates that in areas of environmental stress pregnant are under double
press of toxic products, such as endogenous (genuine) and exogenous origin. At the
same time, even in the absence of the actual toxicity pregnant eco-toxicosis creates the
same unfavorable conditions for maturation of the fetal. Say the same also found the
biochemical disorders of immune homeostasis and children and the general population
in these industrial centers.
In particular this applies to signs of exhaustion or suppression of the antioxidant
defense system, as well as immune deficiency. This is evidenced by the fact that
formed in utero inferiority immunity persists in later life. The second and subsequent
generations in such conditions become even less resilient, which is manifested in the
growth of the so-called cumulative morbidity incidence of children, traced in the same
place for the last 30 years, and it already can significantly change the demographic
situation in the future.
In a study of I.M.Morozova (1998) noted that only 7.5% of children with allergic
diathesis during pregnancy their mothers were physiological. More than half of these
pregnancies complicated by preeclampsia, to a lesser extent the threat of miscarriage.
Complicated pregnancy has adverse effects on the immune system of the fetus. These
children are born to mothers with preeclampsia. Immunogram on the 5th day of life was
characterized by a high content of CD4 and ratio CD4 / CD8. Children born to mothers
with threatened miscarriage, revealed a decrease of functional reserves of neutrophils
and an increase in serum IgG and IgA.
There is no doubt greater risk of poisoning and more pronounced severity of
intoxication during pregnancy for most expectant mother. In particular, experimental
studies have found that pregnancy complicated by chronic intoxication leads to more
serious violations of liver function than conventional toxic hepatitis [Taskaev I.I., 1979].
All these above facts underscore the urgency of preventive detoxification, both
before and during pregnancy in cases where we can expect the complicated its course

6
and fetal abnormalities. The special importance of these activities become indications
when an adverse outcome of current or previous pregnancy.
Currently holding a detoxification becomes more affordable, thanks to the
development of simple and safe methods of membrane plasmapheresis on Russian
Hemofenix devices, opening the possibility of their use in the most extensive network of
hospitals on a municipal level, including maternity hospitals.

Referenses
Chevrier C., Serrano T., Lecerf R. et al. Environmental determinants of the urinary
conventrations of herbicides during pregnancy : the PELAGIE mother-child cohort
(France) // Environ Int. 2014. Vol. 63, 11, - P 8.
Chaika V.K., Demina T.N. [Antiphospholipid syndrome]. / Donetsk: Nord-Press.
2004. 236 p. (Rus).
Konstantinova T.K., Antonenko T.A. [On the potential and real danger
embryotropic action of chemical compounds] / In: Main issues problems remote effects
of occupational poisons. Moscow. 1976. P. 104-108. (Rus).
Lenz W. Epidemiology of congenital malformations // Ann. N.Y. Acad. Sci. 1965.
Vol. 123. P. 228-236.
Mafenson H.L., Grunster J., Horowitz Q. Hasards of maternally administred
drugs // Clin. Toxicol. 1974. Vol. 7, 1. P. 59-68.
McElhaney R.D., Ringer M., DeHart D.J., Vasilenko P. Rubella immunity in cohort
of pregnant women // Infect. Control. Hosp. Epidemiol. 1999. Vol. 20, 1. P.
66.
Onishchenko G.G. [On sanitary and epidemiological state of the environment] //
Gig. Sanit. (Rus). 2013, 2. P. 4-10.
[Pregnancy and toxicants] / Ed. V.D.Novikova, E.M.Gorbachva. Novosibirsk:
Nauka, 1986 - 158 p. (Rus.).
Rao J.M., Arulappu R. Drug use in pregnancy: How to avoid problems // Drugs.
1981. Vol. 22. P. 409-414.
Rey Moreno M.C. Epoxiconazole-induced degeneration in rat and the effect of
estradiol supplementation // Birth. Defects Res. B. Dev. Reprod. Toxicol. 2013. Vol.
98, 3. P. 208-221.
Taskaev I.I., [Histochemical and histological changes in the liver of rats with
experimental intoxication and subsequent pregnancy]. // Arch. Anat. (Rus). 1979.
Vol. 76, 2. P. 49-54.
Tryphonas L., Khera K. Postnatal CNS to ethylenethiourea in rats // Toxicol. nd
Appl. Pharmacol. 1977. Vol. 41. 1. P. 143-144.
Vdovenko I.A., Cetko N.P., Konstantinova O.D. [Ecological problems of
reproductive health] // Gig. Sanit. (Rus). 2013, 4. P. 24-28.
Voinov V.A., Tyshetsky V.I. Rogov I.I., Shiryaeva K.F., et al. [Medico-ecological
problems of primary prevention of respiratory diseases in children] // in. Modern
aspects of health and environmental characteristics of nonspecific lung diseases. - St.
Petersburg, 1993 P. 82-85. (Rus.).

7
Voinov V.A., Kostyuchek D.F. Vetrov V.V. [Toxemia of pregnancy and preventive
methods of detoxification] // St. Petersburg vrach. Vedomosti (Rus.). 1994, 7. P.
67-68.
Voinov V.A. [Efferent therapy. Membrane plasmapheresis] / Moscow, 2010, 400 p.
Voinov V.A. [Efferent therapy in obstetrics and neonatology] / St. Petersburg: Ed.
State Medical University. 2013. 82 p. (Rus).