Izinto zokusingqongileyo kunye ne-genetics zi noxanduva lweziphene zokuzalwa
Iziphene zokuzalwa zingathonya indlela abantwana abajonga ngayo abantwana, imisebenzi, okanye zombini. EUnited States, enye yeentsana ezingama-33 izalelwa ngesiphene sokuzalwa. Ezinye iziphoso zokuzalwa zibonakala ngokukhawuleza, ezifana nomlomo womlenze okanye intlungu. Ezinye iziphene zokuzalwa zidinga iimvavanyo ezizodwa zokuxilonga, ukufana nezifo zentliziyo.
Ukukhubazeka kokuzalwa kwenzeka xa umntwana ekhula kwisibeleko.
Ezinye iikhemikhali, amayeza kunye namachiza-abizwa ngokuba yi-teratogens-kunokunyusa ingozi yokuzalwa kwesiphene. Ngexesha leentsuku eziyi-14 zokuqala zokukhulelwa, i-teratogen ingabangela ukuba kubekho iiphene okanye kubangele ukukhulelwa kwesisu . Phakathi kweentsuku eziyi-15 no-60 zesigxina (ngexesha le-trimester yokuqala) umntwana ubangelwa yimiphumo ye-teratogens kunye neziphene ezinzima zokuzalwa zingabangela. Ngokukodwa, izitho eziphambili zikhula ngeli xesha. Kufuneka kuqatshelwe ukuba i-teratogens ayiyena kuphela imbangela yokukhubazeka kokuzalwa. I-Genetics idlala indima. Ukongezelela, zombini i-teratogens kunye ne-genetics ingabangela umonakalo kunye.
Akukho ndlela eqinisekileyo yomlilo yokuthintela iziphoso zokuzalwa, nangona kunjalo. Ekugqibeleni, iimeko zokusingqongileyo kunye nezofuzo zidibanisa ukuze kubangelwe ezi ngxaki. Ukugcina indlela yokuphila enempilo kunye neentlanganiso rhoqo kunye ne-OB-GYN ngaphambi nangesikhathi sokukhulelwa kunokukunceda ukuba unomntwana onempilo. Nangona kunjalo, kukho amanyathelo onokuyithatha ukuze unciphise umngcipheko wakho wokuba usana oluneziphene zokuzalwa.
# 1: Akukho Utywala ngexesha lokukhulelwa
Ukusetyenziswa kotywala kukubangela obuthathaka bokuzalwa ngexesha lokukhulelwa.
Ngokutsho kweCDC:
Akukho mali eyaziwayo yokusetyenziswa kotywala ngexesha lokukhulelwa okanye xa uzama ukukhulelwa. Akukho xesha elikhuselekileyo ngexesha lokukhulelwa ukusela. Zonke iintlobo zotywala ziyonobungozi, kubandakanya zonke iwayini kunye nobhiya. Xa umfazi okhulelweyo esela utywala, ngokunjalo umntwana wakhe.
Ukongezelela, isiqingatha sokukhulelwa konke e-United States asilungiselelwe. Ingathatha phakathi kweeveki ezine ukuya ezintandathu ngaphambi kokuba umfazi azi ukuba ukhulelwe. Ngeli thuba, utshwala bunokuphazamisa ukukhula komntwana.
Ukusetyenziswa kotywala ngexesha lokukhulelwa kungakhokelela ekutheni i-fetal alcohol syndrome (FAS). Ukungaqhelekanga okubonwayo kunye ne-FAS kubandakanya oku kulandelayo:
- umqobo wokukhula kwe-intrauterine (oko kukuthi, ukukhula kakubi kwintsana ebudeni)
- i-microcephaly (okt, intloko encinci nentuthuko yengqondo)
- Ubuso obuthathaka obuncinci ukuya kwi-middleface engaphantsi
- iimeko ezingafaniyo
- ukulungelelanisa
- ziphosakeleyo zenhliziyo
- ukukhubazeka kwengqondo
Iindlela ezichanekileyo apho utywala obangela i-FAS engaziwa. Siyazi ukuba utywala ngokukhawuleza uwela kwi-placenta kwindawo yokusabalalisa umntwana. Egazini lomntwana ongakazalwa, utywala ufikelela kwizinto ezinokulinganiswa nezo zifunyenwe kumama.
Nangona kunjalo, imfuyo ayinalo i-enzyme yotywala yedhydrogenase, eyenziwa yi-isibindi kwaye kufuneka iphule utshwala. Kunoko, iintsana zixhomekeke kuma-enzymes angama-placental kunye nabamama ukususa utywala. Ezi enzymes aziqhelani ngokukhawuleza njenge-alcohol dehydrogenase ekuxiliseni utywala; Ngako oko, utywala obuninzi luhlala kwindawo yokutshatyalaliswa komntwana.
Utywala lubangela umonakalo omkhulu kwinkqubo yesantya yomntwana. Akungonakalisi kuphela ukuphuhliswa kweeseli zesigulane kodwa kubulala (inkqubo ebizwa ngokuba yi-apoptosis).
# 2: Akukho ukutshaya ngexesha lokukhulelwa
Kungcono ukuyeka ukutshaya ngaphambi kokuba ukhulelwe; Nangona kunjalo, kumama olindelekileyo otshaya, akalokothi aphephe ukuyeka. Ngaphezu koko, abafazi abakhulelweyo kufuneka bahlale beshiya umsi wesandla.
Nazi ezinye iziphumo ezibi ukuba umntwana ozelwe ngumama otshaya ngexesha lokukhulelwa unokufumana:
- umda wokukhula kwamanzi
- umlomo
- i-cleft palate
- SIDS
- umsebenzi wokuqala
- ukwandisa ukunyuka (ukuthethelela)
- ukucaphuka
- ukwanda kweethambo zomzimba (hypertonicity)
- ukuthuthumela
I-Nicotine ibe ngaphezulu kweepesenti ezili-15 ezingakumbi kwigazi lomntwana ongaphantsi kwelo mama. Okubaluleke kakhulu ukuba umama ubhema, ukwanda komngcipheko wokukhula kwe-intrauterine. Ukongezelela koko, nabo batshaba iisigaretti ezili-10 okanye ezimbalwa ngosuku (ababhemayo abatshitshiweyo), bafake iintsana zabo kabini umngcipheko wokuba nesisindo esiphantsi sokuzalwa.
# 3: Akukho Marijuana okanye enye "iSitalato" Iziyobisi ngexesha lokukhulelwa
I-Marijuana yisona sidakamizwa esisetyenziswa ngokuqhelekileyo. Ngoku ngokusemthethweni kumazwe athile, anamaqondo amaninzi okukhulelwa ochaphazelekayo.
Ezinye iingcali zikholelwa ukuba inambuzane ayikho i-teratogenic kwaye ayibangeli iziphene zokuzalwa. Nangona kunjalo, i-CDC icebisa ngokubhekiselele kumfazi okhulelweyo ukutshaya okanye ukusebenzisa ezinye iziyobisi ezingekho mthethweni ngenxa yokuba ezi ziyobisi zingakhokelela ekunikezeni kwangaphambili, ubunzima bokuzalwa obuphantsi kunye neziphene zokuzalwa.
Ukongezelela, kukho inkxaso ngenkxaso phakathi kokusetyenziswa kweguni ngexesha lokukhulelwa kwaye kamva iingxaki ze-neurodevelopmental kumntwana, ezifana nokungahambisani nokunyanzeliswa kunye neengxaki ezingabonakaliyo.
Akukho nqanaba elikhuselekileyo lenambuzane enqunywe ngabasetyhini abaceba ukukhulelwa okanye abakhulelweyo. Ngaloo ndlela, kukulungele ukuba abesifazana bangabhisi okanye bachithe ezinye izidakamizwa ekukhulelwe okanye ngexesha lokukhulelwa. Ukuba udinga inambuzane kwimeko yezokwelapha, kukulungele ukuxoxa ngendlela enjalo ne-OB-GYN yakho.
# 4: Ukukhusela ukuthintela
Ezinye iintsholongwane ngexesha lokukhulelwa zingakhokelela ekuzalweni kokukhubazeka. Izifo ziyakuthintela ngokuthatha amanyathelo athile, kuquka ukuhlala kude nabantu abanezifo, ukuhlamba izandla, kunye nokupheka inyama. Ukongezelela, ezinye izitofu zikhusela umfazi kwiintsholongwane ezingakhokelela kwiziphene zokuzalwa.
Ngoku kutshanje, i-virus ye-Zika iye yafumana inkcenkcazo eninzi yokubangela iziphoso zokuzalwa kwiintsana ezithwele oomama abanesifo. Ezi ziphoso zokuzalwa ziquka i-microcephaly (intloko encinci) kunye neengqondo ezingaqhelekanga. Nangona kunjalo, ukudluliselwa kwegciwane leZika kwilizwekazi lase-United States lisaqhelekanga, kwaye ukusuleleka kwamanye amagciwane e-teratogenic kakhulu.
I-Cytomegalovirus (i-CMV) iyona nto ibangela kakhulu ukusuleleka kwiintsana. Ininzi yabasetyhini ine-antibodies ye-CMV. Ngokuqhelekileyo, usulelo olusisiseko lwe-CMV (ukusuleleka okokuqala ngqa) lukhokelela kumngcipheko we-CMV kwintsana (esele i-CMV yokuzalwa). Nangona kunjalo, ukuvuselelwa kwakhona kwe-CMV okanye ukusuleleka komama ngeendlela ezahlukeneyo kunokukhokelela ekuzalweni kwe-CMV.
Uninzi lwabantu abasulelekile nge-CMV alubonakali nentsholongwane kunye namava angenazo iimpawu. Umntu onomzimba omzimba unokugcina ukusuleleka kwi-CMV kwisheke. Nangona kunjalo, i-CMV ingabangela ukusuleleka kwentsholongwane kulabo abanamasosha omzimba athathaka. Ngaphezu koko, i-CMV inokufaka ingozi kumntwana kwaye ingakhokelela ekuzalweni kokukhubazeka.
Ininzi intsha ezalwa nosulelo lwe-CMV ziphilile. Malunga neyodwa yabantwana abahlanu abazalwa nge-CMV isifo abagulayo xa bezalwa okanye baqhubeke nokuphuhlisa iingxaki zempilo zexesha elide. Ezinye iintsana zibonisa iimpawu zentsholongwane ye-CMV ngexesha lokuzalwa. Ubuncinane beintsana zibonakala ziphilile ekuzalweni kodwa ziza phambili zivelise iimpawu zentsholongwane, njengokulahlekelwa kwindlebe.
Nazi ezinye iziphumo ezinokubakho kokusuleleka kwe-CMV kwintsana:
- i-petechiae (okt, iindawo ezincinci ezibomvu okanye ezibomvu kwesikhumba esibangelwa i-capillaries ephukile)
- Ukwandiswa kwesibindi kunye nepen
- iingxaki zesibindi, umphunga kunye neengxaki
- jaundice
- microcephaly
- hepatitis
- ukuxhamla
- ubukhulu obuncinane ekuzalweni
- i-hemolytic anemia (i-bloodmmune disorder disorder)
- ukubalwa kwemali
- i-chorioretinitis (oko kukuthi, ukuvuvukala kwe-choroid kunye ne-retina) kunye nezinye iingxaki zamehlo
- iingxaki zamazinyo
- iingxaki zokuva
- imiba yengqondo
- ukukhubazeka kwengqondo
Kunzima ukuqikelela ukuba zeziphi iintsana eziza kuhlakulela usulelo olukhuselekileyo lwe-CMV, kwaye akukho nonyango yokusuleleka kwe-CMV ngexesha lokukhulelwa okuya kuthintela isifo kwintsana. I-CMV inokudluliselwa kumntu omnye ukuya kwelinye ngetyala, ukulala ngesondo, njalonjalo.
# 5: Gwema iMithi ethile yeMigqaliselo
Amachiza amaninzi aneempembelelo ezinokuchaphazela ukukhulelwa. Nangona kunjalo, izidakamizwa ezingama-30 kuphela ziyaziwa nge-teratogens, ezinokubangela iziphene zokuzalwa. Imiphumo ye-teratogenic inokwenzeka iquka oku kulandelayo:
- umda wokukhula kwamanzi
- ezimbi
- neetyatalty toxicities
- izidakamizwa zokuziphatha (oko kukuthi, iziphumo ezimbi zeziyobisi ezichaphazela ukusebenza kwemisebenzi yemihla ngemihla)
- ukufa komntwana
Kuze kube phakathi kwekhulu lemashumi mabini, oogqirha babekholelwa ukuba umntwana wayehlala kwindawo ekhuselekile eyahlukileyo kumama. Le ngcamango yokuba iintsholongwane zikhuselweyo kwiidakamizwa zonyango kunye nezinye izinto ezinobungozi ziye zahlahlela emva kokuba imiphumo ye-thalidomide ibangele intlekele enkulu kwiminyaka yama-1960. I-Thalidomide yayisetyenziselwa ukunyanga ukugula kwasekuseni kodwa kwaphumela ekubeni unobungozi obunzima bomzimba, ubunzima bomzimba, njalonjalo kwiintsana.
Ukususela ngoxinzelelo lwe-thalidomide, oogqirha baye bafika kwi-ginger ukuya kwimiyalelo yeziyobisi ngexesha lokukhulelwa ngenxa yokwesaba imiphumo ye-teratogenic. Ngethamsanqa, amaninzi amaninzi angasetyenziswanga ngexesha lokukhulelwa.
Nazi ezinye izidakamizwa ezaziwayo zi-teratogens:
- cyclophosphamide
- diethylstilboestrol
- warfarin
- lithium
- isotretinoin
- carbamazepine
- phenytoin
- tetracycline
- ACE inhibitors
# 6: Thatha i-Folate Supplements
Ifolate, okanye i-folic acid, uhlobo lwe-vitamin B. Ngexesha lokukhulelwa, isidingo sobungozi sanda phakathi kwamahlanu kunye neshumi ngenxa yokuba le vithamini idluliselwa kumntwana. Ukusilela kwintolongo kunokuba nzima ukuyijonga ngexesha lokukhulelwa, kunye nokuba nomfazi onondliwa kakuhle unokufumana. Inqaku, eluhlaza, imifuno enamagqabi iphezulu.
Ngenxa yokuba isiqingatha sokukhulelwa konke eUnited States kungenakucwangciswa kwaye ukungabi nantoni kunokuchaphazela umntwana emva kokuba-ngaphambi kokuba umama azi nokuba ukhulelwe-i-CDC icebisa ukuba bonke abafazi beminyaka yobudala (phakathi kwe-15 no-45) bafanele bathathe ama-microgram ngokulandelelana imihla ngemihla.
Ezi zinto zilandelayo zikhuphula iimfuno zentando kumama:
- ukutya okubi
- ukuhlala negazi
- amayeza anticonvulsant
- ukuncelisa
- sulelo
Ukusilela kwintolongo kunokukhokelela kwiziphoso ezinzulu zokuzalwa kuquka i-spina bifida kunye ne-anencephaly. Zombini kwezi meko ziyiziphene ze-neural. Nge-spina bifida, amathambo omgudu awenzi kakuhle ngokujikeleza intambo yomthambo. Ngentlungu, iingxenye zentloko kunye nengqondo aziyikuzifakela kakuhle.
Uphando lubonisa ukuba ukuxhaswa kwe-folic acid ngexesha lokukhulelwa kuqhubeka kwiiveki ezi-12 zokukhulelwa kunokunciphisa umngcipheko weziphene ze-neural ngamaphesenti angama-70.
# 7: Gcina impilo ephilileyo
Isifo sikashukela esingalawulwayo ngexesha lokukhulelwa kunye nokukhuluphala ngaphambi nangesikhathi sokukhulelwa kunokunyusa ingozi yokuzalwa kweziphene kunye nezinye izimo zempilo ezinzulu.
Ukuba isifo sikashukela asilawulwa kakuhle ngexesha lokukhulelwa, iishukela eziphezulu zegazi zinokuchaphazela zombini umntwana kunye nomama. Iintsana ezizalelwe oomama abanesifo sikashukela zikhulu kakhulu, kwaye zinamalungu amakhulu, okwenza inkqubo yokuzalwa ibe nzima nakakhulu. Ezi ntsana nazo zifumana ama-sugar sugar aphantsi emva kokuzalwa. Ngaphezu koko, iintsana ezizalwe koomama abanesifo sikashukela zengozini yokwanda kokuzalwa, kwaye iintsana zibangelwa ingozi yokukhulelwa kwesisu.
Nazi ezinye iimeko ezize zenziwa ngabantwana abazalelwe oomama abanesifo sikashukela:
- isikhumba esiluhlaza kunye nesibhakabhaka, isantya sentliziyo esheshayo nokuphefumula ngokukhawuleza (iimpawu zomphunga kunye nokungaphumeleli kwentliziyo)
- ukutya okubi
- ukunyaniseka
- ubuqhophololo
- ukuthuthumela
- jaundice
- ziphosakeleyo zenhliziyo
Abafazi abanesifo sikashukela kufuneka bazame ukufezekisa ubunzima obuphilileyo ngaphambi kokukhulelwa. Ngexesha lokukhulelwa, abasetyhini abanesifo sikashukela kufuneka basebenze ukunciphisa inzuzo yesisindo kunye nokuzivocavoca, ukujongana noshukela lwegazi, kunye nokuthatha amayeza njengoko kuchazwe ngugqirha.
Ngokufanayo, abesetyhini kufuneka bazame ukunciphisa umzimba ngaphambi kokukhulelwa ngokutya, ukuzivocavoca kunye nezinye iindlela zokuphila.
> Imithombo:
> Barbieri RL, Repke JT. Izifo zonyango ngexesha lokukhulelwa. Ku: Kasper D, Fauci A, Hauser S, uLongo D, Jameson J, Loscalzo J. eds. Imigaqo yeHarrison ye-Medicine yangaphakathi, i-19e eNew York, i-NY: i-McGraw-Hill; 2014.
> Chung, W. "I-Teratogens neMiphumo Yabo." I-University University Medical Centre. http://www.columbia.edu.
> Hoffbrand A. Megaloblastic Anemias. Ku: Kasper D, Fauci A, Hauser S, uLongo D, Jameson J, Loscalzo J. eds. Imigaqo yeHarrison ye-Medicine yangaphakathi, i-19e eNew York, i-NY: i-McGraw-Hill; 2014.
> Masters SB, Trevor AJ. Utywala. Ku: Katzung BG, Trevor AJ. eds. I-Basic & Clinical Pharmacology, 13e eNew York, NY: McGraw-Hill; 2015.
> Powrie RO, uRosene-Montella K. Ulawulo lweMithi. Ku: McKean SC, Ross JJ, Dressler DD, Scheurer DB. eds. Iimigaqo kunye nokuSebenza kweMithi yeZibhedlele, 2e eNew York, NY: McGraw-Hill.