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The War on Women’s Health, Part 3: Maternal Fetal Medicine

The War on Women’s Health

Part 3: Maternal Fetal Medicine

Planning for knowns while anticipating the unknowns.

By Truthmonk
October 30, 2012

Contraindications for pregnancy

Why unplanned pregnancies are bad


Women who are aware that a pregnancy would be high-risk may decide to delay getting pregnant. A high-risk pregnancy is one where there are potential complications that could affect the mother, baby, or both. Good medical practice requires high-risk pregnancies to be managed by a specialist to help ensure the best outcome for the mother and baby.

Risk come from a multitude of sources. Some conditions that can make a pregnancy high-risk include: the age of the mother,1 chronic diseases like cancer,2 – 13 infections and STDs,14 – 17, 21, 30 mental health medication,18, 31, 32 and recreational drug use including alcohol and tobacco,19, 20, 33environmentally imposed risks,22 – 24 inheritable genetic disorders.25 – 29

Contraindicated medical conditions that primarily affect (by medical dysfunction class):
Age related risks
1 Older mothers  
Chronic disease risks
2 Asthma
3 Thyroid Disease – hyperthyroidism (GravesÕ disease)
4 Thyroid Disease – hypothyroidism
5 Cancer
6 Epilepsy
7 Hypertension (High blood pressure)
8 Diabetes
9 Heart disease
10 Obesity
11 Anemia
12 Lupus
13 Kidney Disease
Infection risks
14 Congenital Rubella Syndrome
15 Varicella (chickenpox)
16 Sexually Transmitted Diseases
17 General infections
30 Viral hepatitis
Mental health risks
18 Schizophrenia 31 Severe depression
32 Bipolar Disorder
Recreational drug risks
19 Illicit drug use
20 Smoking
33 Alcohol (Fetal alcohol syndrome (FAS))
Environmental risks – Chemical Exposure
  22 Agrichemicals
23 Pesticides
Environmental risks – Radiation Exposure
  24 Radiation Exposure
Genetic disorder risks
  25 Down syndrome
26 Cystic fibrosis
27 TayÐSachs
28 Sickle-cell anaemia
29 Thalassemia
For the contraindicated medical conditions’s citations in the inforgraph, see the matching number in the sources.

Teratogenic Effects34

Many developing fetal systems are vulnerable to outside influences called teratogens, especially during the first 4 to 10 weeks after conception. The fetal neurological system can develop neural tube defects, spina bifida, and mental retardation. The cardiovascular system is susceptible to birth defects such as truncus arteriosus, atrial septal defects, and ventricular septal defects. The skeleton can develop with musculoskeletal anomalies and clubfoot. Myasthenia gravis and severe combined immune deficiency affect the immune system. Female fetuses can suffer from the masculinization of their external genitalia. Other fetus components that are susceptible to birth defects include: ears, eyes, teeth, upper lip, palate, upper & lower limbs, kidneys, and lungs.

Teratogens also produce effects on the fetus indirectly through the mother. Maternal teratogens effects include creating susceptibility to premature birth, intrauterine growth retardation (small for gestational age infants), and placental development interruptions.

Teratogens effects on fetal and maternal systems during pregnancy

Pregnancy35, 36

A woman may not be aware that she is pregnant.

The early signs of pregnancy are variable between women and even from pregnancy to pregnancy in the same woman. Adding to the confusion is that the early symptoms of pregnancy also resemble symptoms before and during menstruation. Even more confusing is some women have periodic bleeding during pregnancy mimicking their menstrual period.

While some women are so aware of their bodies, they seem to know from the start when they become pregnant, most don’t realize they are pregnant until they miss their menstrual period.

A woman’s menstrual period isn’t a sure fire way to determine if she is pregnant. For some women, an irregular period will make it difficult to recognized if an atypical event such as a pregnancy has occurred.

Irregular periods often occur during the first few years after menarche just when women start to explore their sexuality. Irregular periods usually occur just before memopause. Menstrual irregularities can be caused by diseases such as irritable bowel syndrome, tuberculosis, liver disease, and diabetes.

Even a missed menstrual period doesn’t necessary mean a pregnancy. Other causes for a missed period include: excessive weight loss or gain, eating disorders such as anorexia or bulimia, increased exercise, emotional stress, illness, travel, pelvic organ problems such as impeforate hymen, and polycrystic ovary syndrome, or Asherman’s syndrome. This is by no means an complete list.

A pregnancy test in the only reliably way to know for certain if a woman is pregnant.

Pregnancy test
This pregnancy test on the left shows a negative result because the results window has no pink line. The pink line in the control window shows that the test is working. The right pregnancy test shows a positive result because there is a pink line in the results window.

Photo from Photo from US Department of Health and Human Services

The only way a woman can avoid the birth defect dangers caused by teratogens is to know when she is pregnant. And the only way for a sexually active, fecund, non-pregnant or postpartum abstinence woman to be certain of not becoming pregnant is through the use of adequate family planning and modern contraceptives.

Only then can a woman take into account their personal and family situation and make appropriate medical decisions that are best for her and her baby’s health.

Other overlooked benefits of oral contraceptive pills37

According to the American College of Obstetrics and Gynecology (ACOG), oral contraceptive pills (OCPs) help relieve or reduce the symptoms of dysmenorrhea (menstrual pain), normalization of irregular periods, acne treatment, treatment of endometriosis caused pelvic pain, prevention of menstrual-related migraines, menorrhagia (excessive menstrual bleeding), bleeding due to uterine fibroids, hirsutism (excess hair growth), suppression of menstruation.

National data from the 2006–2008 National Survey of Family Growth shows 58% of women on the pill use it for some type of noncontraceptive reason. Noncontraceptive reasons are the only reason for 14% of the women on the pill. In addition more than one-third of the women, which use the pill for noncontraceptive reasons, have multiple non-birth control health benefit reasons.

Use of oral contraceptive pills

Life Changes

Or pregnancy is for life

During a woman’s pregnancy, some cells from the fetus traverse through the placenta into the maternal circulation (fetal microchimerism (FMc)) and some cells from the mother travel to the fetus (maternal microchimerism(MMc)).38

  A fraction of these immigrant cells will survive in their new host. This intermingling of foreign DNA or cells is called microchimerism (Mc).39  

“Fetal cells have been detected in the human maternal circulation as early as 4 weeks and 5 days post-conception” to “as long as 27 years after the birth of a male.”40

This exchange of cells is expected since the placenta rather than being an impassable gate, must act like a selective porous filter to allow the developing fetus to obtain nourishment etc. These immigrant cells “persist in their new host, circulating in the blood and even taking up residence in various tissues.”41

  During pregnancy, some cells from the fetus traverse through the placenta into the maternal circulation (FMc) and some cells from the mother travel to the fetus (MMc). A fraction of these immigrant cells will survive in their new host. This is called microchimerism.  

The immigrant maternal cells in the fetus can persist well into adult life.42 Another probable source of Mc in the fetus is from an older sibling or previous pregnancy of the mother.43

This means that every woman harbors foreign DNA derived from the fetuses of all her pregnancies and all fetuses harbor foreign DNA derived from their mothers and the fetuses of all her previous pregnancies. They may harbor this DNA for the remainder of their lives.

Various studies have implicated microchimerism in diseases such as systemic sclerosis (SSc), primary biliary cirrhosis (PBC), Sjögren’s syndrome, polymorphic eruption of pregnancy, myositis, and thyroid disease.39

Eighty percent of people with autoimmune diseases are women.44 Several autoimmune diseases affect women in their postpartum years. Fetus-maternal microchimerism is one hypotheses proposed to explain the gender difference.

Hashimoto’s thyroiditis is an autoimmune disease believed to be the most common cause of primary hypothyroidism. It is characterized by a range of symptoms including weight gain, depression, fatigue, mania, memory loss, panic attacks, and hair loss. Sjogren’s syndrome is an autoimmune disease. It has symptoms such as dry mouth and dry eyes. Other autoimmune diseases where fetal DNA was detected, sometimes decades after pregnancy, include progressive systemic sclerosis (PSS) and systemic lupus erythematosus.

Other diseases fetus-maternal microchimerism has been implicated in include steatosis, hepatitis C, primary biliary cirrhosis, and cardiovascular disease.43 Its role in several cancers has been the subject of investigation including thyroid cancer, cervical cancer, lung cancer and melanoma.

Its role in degenerative diseases such as Alzheimer’s disease is intriguing. It has been suggested that an abnormal accumulation of fetal origin microchimerism is responsible for the increase risk with increase number of pregnancies for Alzheimer’s disease and the five fold increased risk in mothers who gave birth to a child with down syndrome.

Fetus-maternal microchimerism derived cells have been found in bone marrow, thyroid, lungs, lymph node, skin, kidney, liver, heart, intestine, gallbladder, cervix, brain, blood, spleen, pancreas, and other tissues.

Yet there is some evidence that fetal-derived cells may provide some protection against breast cancer.45

Mc caused disease isn’t a one-way street. Chronic inflammatory disease in offspring has been linked to MMc.46 In neonatal lupus syndrome-congenital heart block (NLS-CHB), an acquired autoimmune disease, the hearts of patients have been found containing maternal myocardial cells.47 In juvenile dermatomyositis (JDM), a multisystem autoimmune disease, the presence of maternally derived chimeric cells was found and data indicates they have a direct role in the JDM disease process.48

  Various types of microchimerisms affect humans. The common mother-Mc and fetus-Mc and the organs/presumed cell types affected by them are shown.  

The foreign DNA derived from siblings from previous pregnancies that a child harbors could be to its benefit or detriment.43

The research into FMc and MMc, is still in its infancy. The jury is still out as to the relationship that FMc and MMc may play in disease. What can be said is pregnancies make permanent changes to a women’s body. Some of these changes are on a large scale. Some, like FMc and MMc, are small scale.

Next: The War on Women’s Health, Part 4 – Contraceptive Coverage Economics

Previous: The War on Women’s Health, Part 2 – Family Planning

Mayo Clinic Guide to a Healthy Pregnancy

Women looking for authoritative, accurate information from a reputable source will appreciate this pregnancy book from the world-class Mayo Clinic. Features include week-by-week updates on baby’s growth and month-by-month changes for mom, a 40-week pregnancy calendar, a symptoms guide, and a review of important pregnancy decisions. In this illustrated book you’ll also receive advice on how to get pregnant, meal planning, exercise, medication use and parenthood. Plus, you’ll find answers to difficult or embarrassing questions. Mayo Clinic Guide to a Healthy Pregnancy is an essential pregnancy resource for parents-to-be.

Pregnancy, Childbirth, and the Newborn (4th Edition): The Complete Guide

This comprehensive, authoritative “bible” provides expectant couples with abundant, valuable, research-based information about pregnancy, labor, birth, the postpartum period, and newborn care. The book has been redesigned so it’s more accessible and reader-friendly, with more photos, illustrations, and boxed features that allow for important information to be highlighted. Also included in the new design are fun and informative sidebars, such as “Fact or Fiction?” in which the authors present common misinformation and the facts. New to this edition is a website with additional maternity care information as well as helpful forms and worksheets.


Numbers 1 – 33 are also for the contraindicated medical conditions’s cited in the inforgraph.

1 ø | Trying to get pregnant: Pregnancy after 35 (Webpage) | March of Dimes Foundation | May 2009 | Accessed February 27, 2012 @ http://www.marchofdimes.com/pregnancy/trying_after35.html.
2 ø | NAEPP Working Group Report on Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment, Update 2004 | U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute: Bethesda, MD | NIH Publication No. 05-5236 | March 2005 | Available @ http://www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg/astpreg_full.pdf | Accessed February 27, 2012.
3,4 ø | Thyroid Disease and Pregnancy | American Thyroid Association | 2005 | Available @ http://www.thyroid.org/patients/brochures/Thyroid_Dis_Pregnancy_broch.pdf | Accessed February 27, 2012.
5 ø | Pregnancy and Cancer (Webpage) | American Society of Clinical Oncology | May 2011 | Accessed February 27, 2012 @ http://www.cancer.net/patient/Coping/Emotional+and+Physical+Matters/
6 Staff | Epilepsy and pregnancy: What you need to know (Webpage) | Mayo Clinic | July 30, 2011 | Accessed February 27, 2012 @ http://www.mayoclinic.com/health/pregnancy/PR00123.
7 ø | High Blood Pressure in Pregnancy (Webpage) | U.S. Department of Health & Human Services; National Institutes of Health; National Heart Lung and Blood Institute | Not dated | Accessed February 27, 2012 @ http://www.nhlbi.nih.gov/health/public/heart/hbp/hbp_preg.htm.
8 ø | Type 1 or Type 2 Diabetes and Pregnancy, Problems of Diabetes in Pregnancy (Webpage) | Centers for Disease Control and Prevention | Updated: June 7, 2010 | Accessed February 27, 2012 @ http://www.cdc.gov/NCBDDD/pregnancy_gateway/diabetes-types.html.
9 ø | Impact on Females | American Heart Association (Webpage) | Updated: Mon, 24 Jan 2011 | Accessed February 27, 2012 @ http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/
10 Rasmussen, Sonja A | Human Teratogens | Centers for Disease Control and Prevention | June 26, 2011 | Available @ http://www.teratology.org/pubs/2011_human_teratogens_update.pdf | Accessed February 27, 2012.
11 Keller, Scott | Anemia in Pregnancy (Webpage) | WebMD | Reviewed: January 08, 2012 | Accessed February 27, 2012 @ http://www.webmd.com/baby/anemia-in-pregnancy?page=2.
12 ø | Pregnancy and Lupus (Webpage) | Lupus Foundation of America | No date | Accessed March 9, 2012 @ http://www.lupus.org/webmodules/webarticlesnet/templates/new_donate.aspx?articleid=314&zoneid=6.
13 Krane, N Kevin; Feinfeld, Donald A; Talavera, Francisco; Legro, Richard S; Batuman, Vecihi | Renal Disease and Pregnancy, Pregnancy and Underlying Renal Disease (Webpage) | Medscape Reference | Updated: Mar 29, 2011 | Accessed February 27, 2012 @ http://emedicine.medscape.com/article/246123-overview#aw2aab6c15.
14 ø | Chapter 19 Rubella; Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book), 12th Edition | Centers for Disease Control and Prevention, Atlanta, GA | Updated: April 15, 2011 | Accessed February 27, 2012 @ http://www.cdc.gov/vaccines/pubs/pinkbook/rubella.html.
15 ø | Vaccines and Immunizations, Vaccines and Preventable Diseases: Varicella Vaccine – Q & As about Pregnancy | Centers for Disease Control and Prevention | Reviewed on June 1, 2009 | Accessed February 27, 2012 @ http://www.cdc.gov/vaccines/vpd-vac/varicella/vac-faqs-clinic-preg.htm.
16 ø | Sexually Transmitted Diseases (STDs), STDs & Pregnancy – CDC Fact Sheet | Centers for Disease Control and Prevention | Updated: February 27, 2012 | Accessed February 27, 2012 @ http://www.cdc.gov/std/pregnancy/STDFact-Pregnancy.htm.
17 ø | Pregnant Women Need a Flu Shot! (Webpage) | Centers for Disease Control and Prevention | Updated: February 27, 2012 | Accessed March 10, 2012 @ http://www.cdc.gov/Features/PregnancyAndFlu/.
18 Nilsson, E; Lichtenstein, P; Cnattingius, S; Murray, RM; Hultman, CM | Women with schizophrenia: pregnancy outcome and infant death among their offspring | Schizophrenia Research | Volume 58, Number 2-3, Pages 221 – 229 | December 1, 2002.
18 Jaffe, D.J., | Pregnancy pointers for women with Schizophrenia | Schizophrenia.com | No date | Accessed February 27, 2012 @ http://www.schizophrenia.com/schizoph/NBDpreg.html.
19 Nihira, Mikio A. | Health & Pregnancy: Drug Use and Pregnancy (Webpage) | WebMD | Reviewed: December 20, 2009 | Accessed February 27, 2012 @ http://www.webmd.com/baby/drug-use-and-pregnancy?page=2.
20 ø | Smoking during pregnancy (Webpage) | March of Dimes Foundation | April 2010 | Accessed February 27, 2012 @ http://www.marchofdimes.com/pregnancy/alcohol_smoking.html
21 ø | Pregnancy and Childbirth (Webpage) | Centers for Disease Control and Prevention | Reviewed: October 10, 2007 | Accessed February 27, 2012 @ http://www.cdc.gov/hiv/topics/perinatal/index.htm
22 Winchester, Paul D; Huskins, Jordan; Ying, Jun | Agrichemicals in surface water and birth defects in the United States | Acta Paediatrica | Volume 98, Number 4, Pages 664–669 | April 2009.
23 Sanborn, M.; Kerr, K.J.; Sanin, L.H.; Cole, D.C.; Bassil, K.L.; Vakil, C. | Non-cancer health effects of pesticides, Systematic review and implications for family doctors | Canadian Family Physician | Volume 53, Number 10, Pages 1712 – 1720 | October 2007.
24 ø | Emergency Preparedness and Response, Radiation and Pregnancy: A Fact Sheet for the Public | Centers for Disease Control and Prevention | Reviewed March 29, 2011 Accessed February 27, 2012 @ http://www.bt.cdc.gov/radiation/prenatal.asp.
25-29 ø | Frequently Asked Questions About Genetic Disorders (Webpage) | U. S. Department of Health and Human Services; National Institutes of Health; The National Human Genome Research Institute | Updated: February 27, 2012 | Accessed February 27, 2012 @ http://www.genome.gov/19016930.
30 ø | Protect Your Baby for Life, When a Pregnant Woman Has Hepatitis B | Centers for Disease Control and Prevention | Publication No. 22-0432 | October 2010 | Accessed February 27, 2012 @ http://www.cdc.gov/hepatitis/HBV/PDFs/HepBPerinatal-ProtectWhenPregnant.pdf.
31 Staff | Antidepressants: Safe during pregnancy? (Webpage) | Mayo Clinic | January 10, 2012 | Accessed February 27, 2012 @ http://www.mayoclinic.com/health/antidepressants/DN00007.
32 Chang, Louise | Bipolar Disorder in Pregnancy | WebMD | Reviewed: July 13, 2010 | Accessed February 27, 2012 @ http://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-in-pregnancy.
33 ø | Alcohol Use in Pregnancy (Webpage) | Centers for Disease Control and Prevention | Updated: October 6, 2010 | Accessed February 27, 2012 @ http://www.cdc.gov/ncbddd/fasd/alcohol-use.html.
34 Professordoktor | Chart of critical periods of humandevelopment (Weblog) | SciTechLab |20120612 | Accessed 20120618 @ http://scitechlab.wordpress.com/2012/06/12/chart-of-critical-periods-of-human-development/.
35 Chang, Louise (Reviewer) | Health & Pregnancy, Pregnancy Symptoms (Online) | WebMD | Reviewed on August 09, 2010 | Accessed April 29, 2012 @ http://www.webmd.com/baby/guide/pregnancy-am-i-pregnant.
36 ø | Women’s Health, Missed or Irregular Periods – Topic Overview (Online) | WebMD | Updated on /2, 09 1 | Accessed April 29, 2012 @ http://women.webmd.com/tc/missed-or-irregular-periods-topic-overview.
37 Jones, Rachel K. | Beyond Birth Control: The Overlooked Benefits Of Oral Contraceptive Pills | Guttmacher Institute, New York, NY, USA | November 2011.
38 Pritchard, Stephanie; Wick, Heather C.; Slonim, Donna K.; Johnson, Kirby L.; and Bianchi, Diana W | Comprehensive Analysis of Genes Expressed by Rare Microchimeric Fetal Cells in the Maternal Mouse Lung (Online) | Biology of Reproduction Papers in Press | 20120606 | Accessed 20120618 @ http://www.biolreprod.org/content/early/2012/06/01/biolreprod.112.101147.
39 Nelson, J Lee | Microchimerism in human health and disease | Autoimmunity | Volume 36, Number 1, Page 5-9 | February 2003. http://informahealthcare.com/doi/abs/10.1080/0891693031000067304
40 Bianchi, D W; Zickwolf, G K; Weil, G J; Sylvester, S; and DeMaria, M A | Male fetal progenitor cells persist in maternal blood for as long as 27 years postpartum | Proceedings of the National Academy of Sciences of the United States America | Volume 93, Number 2, Page 705 – 708 | 19960123.
41 Nelson, J. Lee | Your Cells Are My Cells | Scientific American | February 2008 | 20080117 | http://www.scientificamerican.com/article.cfm?id=your-cells-are-my-cells.
42 Nelson, J. Lee | Microchimerism (webpage) | No date | Accessed 20120619 @ http://www.microchimerism.org/.
43 Nelson, J. Lee | The otherness of self: microchimerism in health and disease | Trends in Immunology | TREIMM-939, Pages 7 (Not in print) | 20120523 | Accessed 20120622 @ http://www.ncbi.nlm.nih.gov/pubmed/22609148.
44 Knippen, Maureen A. | Microchimerism: Sharing Genes in Illness and in Health | ISRN Nursing | Volume 2011, ID 893819, Pages 4 | 20110523 | Accessed 20120622 @ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169192/.
45 Gadi, Vijayakrishna K.; Malone, Kathleen E.; Guthrie, Katherine A.; Porter, Peggy L. | Nelson, J. Lee | Case-Control Study of Fetal Microchimerism and Breast Cancer | PLoS ONE | Volume 3, Number 3, e1706 | 20080305 | Accessed 20120619 @ http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0001706.
46 Stevens, Anne M | Do maternal cells trigger or perpetuate autoimmune diseases in children? | Pediatric Rheumatology (Online journal) | Volume 5, Article ID 9 | 20070516 | Accessed 20120623 @ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892552/
47 Stevens, A. M.; Hermes, H. M.; Lambert, N. C.; Nelson, J. L.; Meroni, P. L.; and Cimaz, R. | Maternal and sibling microchimerism in twins and triplets discordant for neonatal lupus syndrome-congenital heart block | Rheumatology | Volume 44, Issue 2, Pages 187-191 | February 2005 | Accessed 20120623 @ http://rheumatology.oxfordjournals.org/content/44/2/187.short.
48 Reed, Ann M.; McNallan, Kelly; Wettstein, Peter; Vehe, Richard; and Ober, Carole | Does HLA-Dependent Chimerism Underlie the Pathogenesis of Juvenile Dermatomyositis? | The Journal of Immunology | Volume 172, Number 8, Pages 5041-5046 | 20040415 | Accessed 20120623 @ http://www.jimmunol.org/content/172/8/5041.abstract?ijkey=fbe3e730b4a2d4cd19087a084b8efef6c0cce2d0&keytype2=tf_ipsecsha


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