International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571

Review Article

Health Ailments of Asian Women in

Dr. Debosree Ghosh1, Suvendu Ghosh2, Syed Benazir Firdaus1, Partha Sarathi Singha3

1Department of Physiology, 3Department of Chemistry, Government General Degree College, Kharagpur II, P.O Madpur, Dist - Paschim Medinipur, Pin: 721149, West Bengal, India 2Department of Physiology, Hooghly Mohsin College, P.O. - Chinsurah, Dist. - Hooghly, Pin-712 101, West Bengal, India

Corresponding Author: Dr. Debosree Ghosh

ABSTRACT

Pregnancy may be defined as a condition when a female conceives the fertilized ovum in her uterus and it matures and develops with time to a full grown baby. The average length of human gestation is 280 days, or 40 weeks, from the first day of the woman's last menstrual period. [1] During this period of time, the developing embryo derives all its necessary nutrition and requirements from the mother’s body. And the woman’s body undergoes several consecutive sequential physiological changes to adapt to the new situation of the growing foetus inside her womb. Though most of those changes are reversible yet some changes the mother has to carry for the rest of her life.

Key words: Pregnancy, ovum, embryo, foetus, womb

INTRODUCTION examining the causes of more than sixty Motherhood is considered as a thousand maternal deaths in hundred and blessing. The pleasure of giving birth to a fifteen countries. [2] It has been found that new one is immense but together with the pre-existing medical conditions such as journey of pregnancy comes several diabetes, HIV, malaria and obesity are physiological changes and health ailments responsible for at least one in four maternal of the woman who bears the baby in her deaths. Health impacts of such pre-existing womb. In earlier days, the highest rate of medical conditions can be aggravated by death of women in India was due to pregnancy. A quarter of such maternity and maternity related is accounted due to severe bleeding during complications. The most reported one being pregnancy and . [2] Studies reveal due to excessive bleeding accompanied by that poor access to healthcare and maternal lack of timely medical intervention. With mortality is disproportionately higher in development of science, advancements in rural populations of the poorer states of medical science and increased awareness, India. [3] the situation is better these days. Death rate Every woman’s health is different of pregnant women and death rate due to and so comes the issues of different health maternity related complications has ailments in individual mother. One of the significantly gone down around the world most known health problem that arrives including various Asian countries like India. with pregnancy is ‘’. A study conducted by WHO, published in Gestational diabetes in a condition when the the Lancet Global Health, involved level of glucose is higher than normal in

International Journal of Health Sciences & Research (www.ijhsr.org) 334 Vol.8; Issue: 6; June 2018 Debosree Ghosh et al. Health Ailments of Asian Women in Pregnancy pregnant women. [4] Normally the increased They become tender and proliferation of level of glucose goes down after baby is cells occur. Studies show that certain born. Unfortunately, gestational diabetes maternal characteristics i.e., maternal enhances the risk of developing type II weight and smoking habit etc., influence diabetes in mother as well the baby in later concentration of maternal hormone during stage of life. High level of glucose is not the first trimester pregnancy. [11] good for the normal development of the baby. [5,6] The other pronounced and Changes in Cardiovascular System significant health issue that can add to Certain cardiovascular changes complications of pregnancy is ‘Rh- occur in the mother during the first incombapiity’. [3] Some pregnancy is trimester. [12] Though the changes are not encountered with problems of infection. actually realised by the mother but are And other significant heath issue in clinically accessed. Plasma volume gets on pregnancy is increased or decreased level of increasing. [13] Little rise in plasma volume Thyroid Stimulating Hormone (TSH) and / occurs during the first trimester which is or thyroxine. For patients who are already followed by a progressive increase. Blood diabetic, should bring the level of blood volume in mother reaches peak level by glucose down to normal before conceiving around thirty four weeks of pregnancy after in order to avoid diabetes related which no further rise is observed. [14] complications in pregnancy. Thus it is Significant volume of blood is lost from the extremely important and significant to mother’s body during labor, delivery and maintain the level of blood glucose near postpartum. Normal delivery of baby or normal before and during pregnancy in delivery of baby by C-section surgery both order to ensure good health of both mother involves loss of significant volume of blood and baby. [7,8] Thus pregnancy is a from mother’s body. Though body tries to complicated journey of nine months for the meet up the loss and requirement of blood mother. by the body by increasing the volume of Mother’s health in the 1st trimester blood in mother’s body during the period of Physiological changes pregnancy yet often transfusion of blood First trimester refers to the first three becomes essential to save mother’s life months of pregnancy. The first trimester is during delivery and postpartum. Timely and considered to be the most critical phase of proper transfusion of blood is known to pregnancy. Level of hormones like significantly reduce maternal mortality. [15] progesterone and prolactin associated with Changes in Urinary System pregnancy and produced by placenta start Increased rate of urination is one of rising significantly. Adequate progesterone the marked changes in early pregnancy. In is essential for maintaining the pregnancy. the first trimester as a result of increased Luteal phase insufficiency is reported as one blood volume, the kidney starts filtering of the reasons for implantation failure and more blood, producing increased volume of has been found to be responsible for urine. Progesterone is also known to play . [9] Low level of progesterone some role in increasing urinary volume or any chromosomal abnormality in embryo during pregnancy. [16] The uterus begins to may lead to early and loss of grow in size and imposes pressure on the . [10] Doctors advice to have maximum urinary bladder and as a result of which precaution during this phase. The embryo mothers experience urge for frequent begins to derive nutrition from the mother’s urination from the beginning of her body and starts growing. Cells divide pregnancy days. But adequate fluid intake rapidly. The first trimester leads to several should be maintained by the mother for big changes in mother’s body. Hormones maintaining adequate volume of blood, induced changes occur in mammary glands. and in order to avoid

International Journal of Health Sciences & Research (www.ijhsr.org) 335 Vol.8; Issue: 6; June 2018 Debosree Ghosh et al. Health Ailments of Asian Women in Pregnancy dehydration and dehydration related other pregnancy. [22] If nausea, anorexia, vomiting complications during pregnancy days. becomes severe it may affect mother and Routine examination (RE) of urine is baby’s health adversely and so proper and initially advised by the doctor which if timely medical advice should be availed. yields doubtful results is followed by urine Pregnant women may experience a culture test in the first trimester. Urinary pathological condition termed as tract infection is not a very rare thing ‘’ which is observed in pregnant women specially in diagnosed when the pregnant woman gets working women who have to use public extremely sick due to severe dehydration toilets in their work places. Urinary tract which occurs due to vomiting during infections are always serious health issues pregnancy. In other words, ‘hyperemesis and should be diagnosed properly and gravidarum is a synonymous term for severe timely. [17] in pregnant women. [22-24] Changes in Respiratory System There are effective and safe medications A stuffy nose or a clogged nose is a available to treat morning sickness in very common experience reported by pregnant women but any kind of medication pregnant women in the first trimester. Also, should be availed during pregnancy only faster, deeper breathing and respiratory with doctor’s advice. Easily digestible foods discomfort are experienced by many should be consumed in order to avoid pregnant women during the first trimester of indigestion and other digestive disorders. [23] pregnancy and it remains throughout the Changes in Skin period of pregnancy. Tidal volume increases Progesterone surge in pregnant and this causes reduced Inspiratory reserve mother’s blood often causes acne during volume during the early months of early pregnancy. The skin issue continues in pregnancy. [18] The pregnancy hormone, some women throughout the entire period of progesterone is the key player in the story. pregnancy while in some other women the Progesterone changes the level of carbon skin problems goes away after first dioxide in blood and thus stimulates various trimester. [25] The area around he nipple and respiratory reflexes in the pregnant the areola becomes darker in colour due to woman’s body. Some women experience a progesterone induced accumulation of situation called pregnancy rhinitis. The nose melanin. During early pregnancy, small remains stuffy and is often accompanied by bumps appear on areola. They are termed as headache and rhinitis. [19] ‘Montgomery’s tubercles’. [26] Digestive Changes Musculoskeletal Changes Progesterone is produced in the Under the influence of the hormone pregnant mother’s body and the hormone relaxin, joints and ligaments of pregnant influences all physiological processes in the women loosens from the first trimester. This woman’s body. The most pronounced effect is actually an adaptive change in the is often experienced on the digestive system mother’s body for accommodating the of pregnant women. Progesterone decreases growing baby in the pelvic cavity and also the motility of the digestive tract and thus for giving birth. Though, the induces various types of digestive disorders. musculoskeletal changes are not much [20,21] The most common experience in the pronounced during the first trimester. [27] first trimester is nausea and vomiting. Mothers’ often experience back pain from Various digestive symptoms experienced the early days of pregnancy and the during early pregnancy are together termed condition worsens with progression of as ‘morning sickness’. Most women pregnancy. Medicines are not safe during experience morning sickness during first pregnancy and so doctors generally trimester but in some individuals the prescribe pain ointments and pain relief situation prevails throughout the period of sprays. Any old muscle pain or skeletal pain

International Journal of Health Sciences & Research (www.ijhsr.org) 336 Vol.8; Issue: 6; June 2018 Debosree Ghosh et al. Health Ailments of Asian Women in Pregnancy or injury may worsen during the period of size, the uterus also keeps expanding and as pregnancy. Pains due to arthiritis or sciatica a result, increasing pressure is exerted on are also observed to be worsened during the urinary bladder. Fluid supplementation pregnancy. [28] is to be continued in the form of Psychological changes consumption of enough fluid. The renal Pronounced hormonal changes occur blood flow increases and glomerular during pregnancy and it begins from the filtration rate (GFR) also increases. early days. Those hormones cause Increased renal blood flow causes an tremendous emotional changes in the increase in renal size of 1–1.5 cm. The renal pregnant mother. Excitement, anxiety, size reaches the maximal size by mid- happiness, worries various combined pregnancy, in the second trimester. emotions occupy the would be mother’s Mechanical compressive forces on the mind. The mother’s body begins undergoing ureters causes dilatation of the kidneys, several sequential changes from day one of pelvis and calyceal systems. All these conception. Along with those changes, the changes are brought about due to increased pregnant mother gets new experiences, level of progesterone in pregnant women’s becomes susceptible to emotional stress and blood. Progesterone, decreases ureteral tone, outburst. The woman becomes emotionally peristalsis and contraction pressure. [34] vulnerable and short tempered. [29,30] Changes in Respiratory System Mother’s health in the 2nd trimester Nasal congestion is experienced by Physiological changes most women in the second trimester of The fourth, fifth and sixth months of pregnancy. During normal pregnancy, pregnancy are termed together as the second demand for oxygen significantly rises. This trimester. The pregnant mother gets occurs due to increase in the rate of somewhat habituated and accustomed to her metabolism and increased oxygen altered physiological conditions. The body consumption. Respiratory crate doesn’t alter still continues undergoing changes. but tidal volume increases. There occurs an Changes in Cardiovascular System increase of 40-50% in minute ventilation. The mother feels her strong This hyperventilation causes an increase in heartbeats during the second trimester of arterial pO2 and decrease in pCO2 and a pregnancy. Excitement can cause decrease in level of serum bicarbonate in palpitations. In some women blood pressure pregnant mother’s blood. [35] Expiratory increases (in 6-8% women) and leads to reserve volume (ERV) decreases, functional hypertensive condition and require proper residual volume (FRV) decreases and medical interventions. Hypertension related inspiratory capacity (IC) increases during disorders have been found to be one of the the second trimester. Respiratory prime causes of pregnancy related maternal conductance decreases during pregnancy mortality. [31,32] Healthy lifestyle, keeping and respiratory resistance increases. [36] oneself away from stress and proper Digestive Changes balanced diet is extremely essential for Wernicke’s encephalopathy is maintaining good health of pregnant observed in some women during pregnancy women. Blood volume goes on increasing and Thiamine supplementation is important during the months of second trimester as in order to avoid the same. [37] As pregnancy well. Under the influence of the hormones, progresses, the uterus increases and reaches the blood vessels dilate and hypotension is a significant size by the second trimester as observed in most women in the middle of a result of which, a mechanical changes in second trimester. [33] the alimentary tract occurs. The stomach is Changes in Urinary System increasingly pushed upwards and gastric Urge for urination becomes more pressure increases. The tone of oesophageal frequent. As the baby goes on increasing in sphincter gets diminished and these factors

International Journal of Health Sciences & Research (www.ijhsr.org) 337 Vol.8; Issue: 6; June 2018 Debosree Ghosh et al. Health Ailments of Asian Women in Pregnancy lead to reflux, as well as nausea and promotes vascularisation and softening of vomiting. [38,39] Ostrogen and progesterone connective tissue. Often lesser sensitivity of levels changes significantly during the days hypermobile joints occurs. [44] Disturbances of pregnancy. Altered levels of these of the perception of position and movement hormones causes structural changes in the of joints and of the reflexes concerned with gastrointestinal tract. posture and gait. It is observed that during Changes in oestrogen and progesterone second trimester of pregnancy, a part of levels also influence the structural normal range of motion is not controlled alterations in the gastrointestinal tract and and this often leads to enhanced shear gastric muscle tone leading to gastric forces, pain and little trauma. Pain is dysrhythmia or gastroparesis. Though in reported to be experienced by mothers in most women, the morning sickness and various regions which include lumbar vomiting tendencies are relieved to some region, area above lumbar region, pain over extent during the second trimester. [40] the sacroiliac region etc. Pain is often Changes in Skin radiated to one or both legs and leg cramps As the baby grows within the are also experienced in some. [45] mother’s womb, mother not only gradually Psychological changes gains weight but also the uterus enlarges in Psychological disturbances, mood size within the pelvic cavity and causes swing and irritability all gets eased to some in the abdomen. With extent during the second trimester. Women increasing progesterone and other get much more accustomed to her changing pregnancy associated hormones like physiological changes. The sense of prolactin etc., cells of mammary gland movement of baby within the womb soothes proliferates and breast enlarges and this also the various mental and physical troubles causes stretch marks. Use of olive oil and with which the mother’s body continuously other hydrating agents may smoothen the fights. [29,30] skin and help to cope with stretch mark Mother’s health in the 3rd trimester formation. [41,42] Physiological changes Musculoskeletal Changes Pregnancy may also be accompanied Musculoskeletal changes are very by a subjective feeling of breathlessness prominent. Lordosis is observed in cervical without hypoxia. This is physiological and and lumbar vertebrae. Back ache is often is most common in the third trimester but observed and is increased during the second may start at any time during gestation. trimester. Weight of the growing baby adds Classically, the breathlessness is present at to the body weight of the mother and also rest or while talking and may paradoxically changes the centre of gravity. The line of improves during mild activity. gravity shifts forward and anterior. This Inspiratory reserve volume is alteration is adjusted by spontaneous reduced early in pregnancy, as a result of increased activation of gastrocnemius increased tidal volume, but increases in the muscle and soleus muscle. An active third trimester, as a result of reduced posterior displacement of the body, functional residual capacity. Total extension of hip joint, increase of the pulmonary and airways resistances tend to lumbosacral angle, increase in lumbar decrease in late pregnancy as a consequence curvature or a displacement of pelvis of hormonally induced relaxation of anteriorly and shoulder posteriorly occurs. tracheobronchial tree smooth muscles. Stretching of abdominal muscle occurs. [43] Pulmonary static and dynamic compliance, Ligamentous tensile strength is decreased as diffusing capacity and static lung recoil a result of which hypermobility of joints pressure do not change during pregnancy. occur. Connective tissue proliferates under [46] the influence of oestrogen and relaxin Changes in Cardiovascular System

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Fetal demands for nutrition and inspiratory reserve volume to normal is metabolism is an important compulsion for observed. Peak expiratory flow rate and cardiovascular adaptive changes during the FEV1 remains unaltered. [59,60] A feeling of days of conception. Although there is a breathlessness without hypoxia is a common sustained increase in blood volume till mid observation in this period. Respiratory rate pregnancy, a plateau in this rise is reported is higher so as prevent CO2 accumulation. by some studies [47,48] however others have Digestive Changes argued to a continued increase until By the third trimester of pregnancy, delivery. [49,50] Plasma volume increases at a mothers get somewhat accustomed to the greater proportion compared to red cell troubles with digestive system. Still in some mass demarking a tendency of physiological individuals the digestive problems prevail. anaemia. [51] Elevated blood volume in Frequent hunger cramps are experienced. concurrence with higher cardiac output Also, the growing baby starts to move leads to mild increase in left ventricular rapidly and frequently from the onset on dimension and wall thickness. [52] However third trimester in usual. Upward movement cardiac filling pressure is not higher than of the baby and growth of the uterus pushes postpartum. The raise in cardiac output is the stomach upwards and results in frequent however less than that compared to that of gastric reflux and heart burn. [38,39] second trimester. Unlike the elevated stroke Changes in Skin volume, the raised heart rate preferentially Physiological changes in the may be the cause for changes in the cardiac integumentary system in pregnant females output in this period of gestation. [53] are a manifest of hormonal alterations. Electrocardiographic studies showed Pruritic folliculitis visible on shoulders, decrease in PR interval could be due to upper back, arms, chest, and abdomen are shortening of A-V conductance with respect common in some females at in advanced to increase heart rate accompanied during stages. [61] Intrahepatic cholestasis of pregnancy. In addition, blood pressure fall is pregnancy (ICP) is usually visible in the last a common symptom in the first and second trimester. [62] Pruritic urticarial papules and trimester; third trimester shows a recovery plaques may also appear during this of the same to that of normal. [54] trimester. [63] Changes in Urinary System Changes in Musculoskeletal system Changes in cardiac output and blood Postural changes during pregnancy pressure during gestation is manifested to may be attributed to the gain in weight, some extent in renal function yielding to uterine expansion, shift of centre of mass, higher Glomerular Filtration Rate (GFR) skeletal changes, laxity of ligaments and and renal plasma flow associated with soft tissues as influenced by hormones hydroureter and hydronephrosis. [55] especially estrogen and relaxin. During third However specific changes occurring in third trimester a reduction in gait velocity is trimester include nocturia, reduction in visible compared to the other stages is serum anionic gap, [56] increased protein found. Maximal push pull forces of arms in excretion (about 180 to 200 mg/day), [57] standing and sitting posture is less and loss transient diabetes insipidus owed to of equilibrium with activities is quite increased vasopressinase activity [58] etc. common. In working ladies a complaint of Changes in Respiratory System postural fitness at work-station is seen Expansion of the uterine dimension especially in jobs at sitting posture that that may be a reason for diaphragmatic elevation may be attributable to trunk flexion in this indicating a decline in functional residual period. [64] Many women undergoing this capacity. However vital capacity remains period encounter morning stiffness of upper unaltered since chest diameter expands due and lower limb joints and pedal that to the upward pressure. Further recovery of may be an outcome of fluid accumulation

International Journal of Health Sciences & Research (www.ijhsr.org) 339 Vol.8; Issue: 6; June 2018 Debosree Ghosh et al. Health Ailments of Asian Women in Pregnancy and inadequate blood circulation. [65] adaptations in the women’s body. Most of Hormones of pregnancy may lead to the changes are temporary though some widening of linea alba leading to curving of remain forever for the rest of the life of the two bellies of the abdominal rectus muscle woman who completes the entire period of with a maximum of 50mm leading to gestation. Different types of physiological diastasis termed as diastasis recti. [66] During and psychological changes are experienced the period of pregnancy, the brain by the mother during the three different continuously receives feedback from the trimesters of pregnancy. Thus though skin, muscle and joints. The brain motherhood is a blessing, a new life is reconfigures its image of the changed body formed during the period, yet it is not a very and eventually, by the third trimester, the easy journey for the mother. Pregnancy also brain gets accustomed to the changing body has several health benefits for the mother. weight and posture. Weakening and [74] Proper awareness of the changes those overstretching of upper back muscle occurs. occur during pregnancy to be spread among Shortening of upper back flexors, pectoral women who are pregnant, women in muscles and shortening and tightening of reproductive age group. Awareness among hip flexor muscles also occur in the third men is equally important. Timely, regular trimester. and proper medical intervention is necessary Psychological Changes to maintain a healthy pregnancy and to Estrogen and progesterone level minimise pregnancy associated health peaks in this trimester. Placenta is the main ailments. Also a rich, balanced and proper source of progesterone and other hormones daily diet is important during the period of like leptins, estrogens, HCG, HPL etc. [67] gestation. More detailed studies need to be Leptin level elevates compared to second conducted on expecting mothers to access trimester thereby reducing appetite and their health status for implementing better generates satiety. 50-80% reduction in health care for pregnant mothers. Only insulin sensitivity is found. [68] Mean health mothers can give birth to healthy parathyroid related protein is also higher babies and healthy babies are the keys to a than other trimesters. [69] Placental and fetal beautiful tomorrow of mankind. Thus, it is release of corticosteroid binding globulin, utmost important to maintain and take good elevated corticotrophin releasing hormone care of mothers’ health, in every strata of leads to increased cortisol level. [68] the society, before, during and after Gravidity is associated with critical . neuro-muscular disturbances which may be due to maximal distension of uterus in this ACKNOWLEDGEMENT trimester. Vascular stasis may result in Dr. DG is in West Bengal Educational sensory changes in legs. Acroesthesia may Service (WBES) and acknowledges the be present. [70] Edema in the peripheral Department of Physiology, Govt. General Degree College, Kharagpur II, West Bengal, nerves may cause carpal tunnel syndrome. India. Dr. SG is in West Bengal Educational [71] Dorsolumbar lordosis may cause neural [72] Service (WBES) and acknowledges the pain. Other changes like food aversion Department of Physiology, Hooghly Mohsin due to increased olfactory sensitivity that College, Chinsurah, Hooghly, West Bengal, occurs during first trimester may be reduced India. Dr. SBF is in West Bengal Educational and the female may become hypoosmotic. Service (WBES) and acknowledges the [73] Department of Physiology, Govt. General Degree College, Kharagpur II West Bengal, CONCLUSION India. PSS is in West Bengal Educational Pregnancy is not a disease. It is a Service (WBES) and acknowledges the different physiological condition, marked Department of Chemistry, Govt. General Degree College, Kharagpur II, West Bengal, India. with several physiological changes and

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How to cite this article: Ghosh D, Ghosh S, Firdaus SB et al. Health ailments of asian women in pregnancy. Int J Health Sci Res. 2018; 8(6):334-343.

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International Journal of Health Sciences & Research (www.ijhsr.org) 343 Vol.8; Issue: 6; June 2018