Hepatosis in pregnant women: causes, symptoms, danger, treatment and prevention

Pregnancy is a happy time in the life of every woman, but, unfortunately, it is often overshadowed by various diseases. These include hepatosis in pregnant women, the symptoms of which most often begin to appear in the third trimester. Just a few years ago, this disease was very rare in medical practice; only one out of 16,000 expectant mothers suffered from it. But recently, an increasing number of pregnant women are faced with this unpleasant disease. Hepatosis in pregnant women is a degenerative liver lesion, manifested in impaired bile formation and bile flow.

Causes of hepatosis in pregnant women

Doctors turned their attention to this disease relatively recently, so experts are still arguing about what causes its appearance. Most medical minds agree that hepatosis in pregnant women is caused by certain genetic characteristics or disorders and can be transmitted through the female line. These genetic abnormalities may not manifest themselves in any way throughout life. But sometimes pregnancy, which brings with it an increase in body weight, hormonal imbalances and an increased load on the body in general and on the liver in particular, gives impetus to the development of hepatosis. The liver is also very susceptible to the influence of pregnancy hormones. For example, estrogen.

The main factors that increase the risk of this disease include:

1. Incorrect intake of vitamins. Vitamins are always an additional burden on the liver. Many vitamin complexes contain increased amounts of various components, which cause liver dysfunction, so they need to be taken correctly, taking into account age, body weight, dosage and stage of pregnancy.
2. Dietary disorder. Overeating and eating salty, fried, smoked, fatty foods, as well as foods rich in chemical additives, overload the liver and impair its functioning.
3. Insufficient physical activity. If the expectant mother moves little, then little energy obtained from food is consumed, and the metabolism, which is already slowed down by pregnancy, slows down.

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Diagnosis of hepatosis and its signs

Hepatosis in pregnant women is a disease that is sometimes very difficult to diagnose. By this time, the uterus already occupies the entire abdominal cavity, which makes palpation of the liver impossible. This disease is often confused with gallstone disease, because their symptoms are very similar. The most common signs of hepatosis include:

• skin itching;
• yellowing of the skin and whites of the eyes, the appearance of vascular networks on the face and hands, redness of the palms (they seem to be covered with red spots from the inside);
• nausea, vomiting, abdominal discomfort, bitterness in the mouth, stool disorders, loss of appetite;
• pain in the right hypochondrium;
• lightening of stool and darkening of urine (from orange to dark brown);

When the bile duct is disrupted, a large amount of bile accumulates in the liver. Unable to escape, bile begins to break through into the lymphatic system, and from there into the general bloodstream. If you conduct a blood test, it will show an increase in the level of transaminases, alkaline phosphatase, bilirubin and cholesterol, a decrease in hemoglobin, as well as red blood cells and platelets. A urine test will reveal the presence of bile acids and increased secretion of urobilin.

When bile enters the bloodstream, it causes itching, which intensifies in the evening and at night. Most often, pregnant women with this disease consult a doctor with complaints of an acute and irresistible desire to scratch. It drives you crazy, disrupts sleep, leads to fatigue and irritation. As a rule, the arms, legs and stomach itch the most. Filling the liver with bile causes overstretching of its capsule, the surface of which has a large number of pain receptors. This causes constant dull pain in the right side.

If hepatosis is suspected, the doctor at the antenatal clinic should carefully examine the patient, try to palpate the liver area, prescribe extensive blood and urine tests, as well as an ultrasound examination of the liver, gall bladder and neighboring organs.

Causes of bitterness in the mouth during pregnancy

Bitterness in the mouth during pregnancy is an unpleasant symptom that approximately 80% of women experience. The reasons for the appearance of bitterness at different stages of pregnancy are different.

In the first trimester, a reconfiguration of all body systems occurs. For the normal course of pregnancy, a large number of hormones are produced, the action of which is aimed at preserving the newborn life. The hormone progesterone has the most powerful effect. It relaxes the walls of the uterus and reduces its contractions, thereby promoting the growth and development of the fetus.

The hormone acts in the same way on the digestive system. It relaxes the stomach muscles, slows down the digestion of food and the movement of feces through the intestines. Undigested food easily enters the esophagus, causing bitterness. Progesterone affects taste buds. Many women note that their usual food becomes tasteless. After eating, an unpleasant taste appears in the mouth.

In late pregnancy, the appearance of bitterness is associated with an increase in the size of the fetus. The growing uterus presses on the stomach, and its contents enter the esophagus. Most often, this condition is observed in the third trimester, when the uterus reaches a large size and puts strong pressure on the walls of the stomach. After childbirth, when the uterus descends, the bitterness disappears.

Painful attacks during hepatosis

In the most difficult cases of hepatosis, the patient sometimes experiences attacks characterized by severe pain in the right hypochondrium. Often the pain is felt in the abdomen, at the level of the navel and is mistaken for an exacerbation of gastritis. Such attacks may be accompanied by continuous and painful vomiting without relief, headache, tinnitus, rapid heartbeat, darkening of the eyes and shortness of breath. They are very similar to severe poisoning syndrome, only in this case the stool practically does not change, and the food eaten is vomited.

Most often, such attacks are caused by eating harmful foods (fried, spicy, fatty, alcohol) and begin 40-60 minutes after eating or by a sudden movement, for example, a quick turn, bend or fall. Painful attacks can last up to 20-40 minutes, they begin suddenly and recede just as sharply. Often after an attack, quite severe residual pain remains in the right hypochondrium for several days. A big mistake during such attacks is taking paracetamol, because it only aggravates the situation, negatively affecting liver activity. It is allowed to take antispasmodic drugs such as No-Shpa.

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Postpartum period

This period includes the lactation period. During the period of feeding a child, a woman also loses a huge amount of minerals, such as calcium, fluorine, phosphorus and many others. And again, the main source for “washing out” them is teeth. After the baby is born, it is important to continue remineralization of dental tissues. During the year, a nursing mother must undergo at least 4 procedures. After completing feeding, the impregnation of dental tissues with microelements can be reduced to 2 times a year by combining remineralization with professional hygiene and a routine dental examination.

Pregnancy and childbirth are the most wonderful period in the life of every woman. Our goal is to make it easy for you and your teeth remain strong and healthy! We are ready to help you with this.

The danger of hepatosis during pregnancy

The affected liver is not able to cleanse the body of harmful substances, which leads to intoxication of the mother and a deterioration in her well-being. Surprisingly, from the very first day after birth, the disease begins to quickly recede and soon leaves no trace behind. After 1-2 weeks, blood counts return to normal. Even if hepatosis recurs in several pregnancies in a row, it does not make any visible changes in the woman’s liver. However, this does not mean that this disease is harmless. It disrupts the metabolism between mother and fetus, thereby adversely affecting the child. It has been proven that hepatosis increases the likelihood of perinatal mortality by 5%, and in 35% of pregnancies occurring against the background of this disease, hypoxia, prematurity and delay in fetal development were observed.

Treatment of hepatosis in pregnant women

Treatment of hepatosis is complicated by the fact that almost all medications are contraindicated for pregnant women. Many medications can cause hypoxia and intrauterine growth retardation in the fetus, so the doctor must conduct a full examination of the patient and make sure the diagnosis is correct before deciding on a treatment method. It is very important to understand at what stage the disease is. In the mild stage, you can do without drug intervention by using a special diet. The expectant mother should exclude all heavy, fatty and high-calorie foods from her diet, and also stop taking vitamin complexes and other medications (if their withdrawal does not harm the pregnancy). Drugs designed to optimize liver function are also often prescribed (Hofitol, Essentiale Forte N and others). In many cases, diet is enough to remove toxins from the body and improve the patient's condition.

In more severe stages, the woman is sent to a hospital, where the issue of early delivery is decided. If there is no danger to the fetus, then labor can be delayed by purifying the blood using IVs. They are combined with taking large doses of the above-mentioned drugs and a strict diet. If this technique makes it possible to suppress the disease or at least keep it at the same level of development, and the condition of the fetus does not cause concern, then treatment is continued until 37-38 weeks, and childbirth is planned for this period. If the method does not give the desired result (or if the condition of the fetus worsens, hypoxia is clearly visible), consent to induced labor or Caesarean section is urgently signed. Often the child has a defensive reaction to the unfavorable situation created, and premature birth spontaneously begins. However, you should not rely only on nature. If serious indications arise, it is recommended to start the labor process in advance to minimize the risk of complications.

It is very important that a pregnant woman with severe hepatosis is under constant medical supervision. It is also necessary to carry out extensive blood tests every two days. It often happens that under the influence of IVs, blood counts suddenly drop significantly. Having decided that the disease has subsided, the doctor discharges the patient, and after a couple of days she is again admitted to the hospital with a sharp increase in transaminases.

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Bad breath, also known as halitosis, is defined as “unpleasant odors coming from the mouth or air-filled cavities such as the nose, sinuses, and throat.” In 90% of cases, the smell comes only from the oral cavity.

Is bad breath normal during pregnancy?

Bad breath is common during pregnancy and usually occurs as a result of changes occurring in the body. Halitosis is caused by volatile sulfur compounds, which are hydrogen sulfide and methyl mercaptan and are produced by bacteria in the mouth.

What Causes Bad Breath During Pregnancy?

Below are common causes that can cause the development of volatile sulfur compounds and ultimately bad breath during pregnancy.

• Hormonal changes: As a result of increased hormone levels in the body, the mouth becomes an ideal breeding ground for plaque. Increased amounts of estrogen and progesterone can worsen the gums' reaction to plaque and cause gingivitis, or gum inflammation. Swollen gums have pockets where food gets stuck and causes an unpleasant odor. Plaque can be reduced through good hygiene.
• Vomiting: Nausea and vomiting are familiar to 66% of pregnant women. Frequent vomiting leads to the creation of an acidic environment in the mouth and subsequent demineralization of the teeth. As a result, they are prone to food getting stuck and rotting, which can cause an unpleasant odor.
• Calcium deficiency: The baby in the womb absorbs calcium from calcium deposits in the mother's body. A lack of vitamin in a woman’s blood leads to the leaching of minerals from bones and teeth. As a result, teeth become weaker and susceptible to tooth decay.
• Dehydration: It is recommended to drink more water during pregnancy to compensate for fluid loss due to vomiting or excess urination. Drinking less water can cause dehydration and dry mouth, which can cause bad odor.
• Lifestyle changes: Pregnancy causes hunger pangs in many women. Frequent snacking and eating at night can cause bad breath. Moreover, due to specific tastes, during an interesting situation, many people prefer sweet or unhealthy foods.
• Slow digestion: Digestion is usually disrupted during pregnancy due to the enlargement of the uterus and hormonal changes, which can cause acid reflux. This in turn leads to demineralization of the enamel, the formation of craters in the teeth and subsequent deposition of food.
• Reduced salivation: Saliva has a self-cleaning effect on the teeth. It washes away food debris from the grooves of teeth and keeps your mouth clean. Some studies have proven that salivation decreases during pregnancy, which may increase the likelihood of bad breath.
• Food: Food containing strong flavored ingredients such as garlic, onion, coffee, etc. can also cause bad breath.
• Medical conditions: Respiratory, ear, nose and throat infections, diabetes, liver problems, gastrointestinal and endocrine diseases can also cause bad breath.

The above conditions can lead to a wide range of dental problems, which can ultimately cause bad breath. In most cases, this condition occurs mainly due to inflammation of the gums (known as gingivitis).

It is important to note that pregnancy itself has little effect on the occurrence of gingivitis or periodontitis. Most often, plaque is already present in the mouth, so women planning pregnancy are advised to brush their teeth regularly.

Associated symptoms of bad breath (halitosis)

Sometimes you may not realize that you have bad breath, but the accompanying signs will not go unnoticed, namely:

• red, swollen, and bleeding gums;
• dry mouth or decreased salivation;
• coated tongue;
• unpleasant metallic or bitter taste in the mouth.

How to avoid bad breath during pregnancy?

Treating bad breath does not always require medical intervention. Sometimes you can cope with simple methods:

• Brush your teeth twice a day.
• Floss your teeth daily to prevent food particles from getting stuck between your teeth.
• Clean your tongue as it protects bacteria that can cause bad breath.
• Use warm salt water or non-alcoholic mouthwash to rinse your mouth after meals.
• Avoid foods with strong odors or brush your teeth after eating such foods.
• Eat foods rich in fiber because it has a self-cleaning effect on soft plaque and also helps improve digestion.
• Drink plenty of water as this will help in preventing dry mouth and resulting bad breath.
• You can also use sugar-free gum to get rid of the odor. Chewing gum also increases salivation.
• Calcium supplements help maintain optimal calcium levels in the blood.
• Get regular dental checkups, which are usually recommended every six months.

When should you see a doctor?

Experts usually recommend a professional teeth cleaning and polishing session during the second trimester, even if there are no dental problems.

Do not delay going to the dentist if you have the following problems:

• bad breath;
• bleeding gums;
• any mobile (loose) teeth;
• sore teeth or gums;
• burning sensation in the mouth
• metallic taste in the mouth;
• food deposits between teeth and gums;
• discharge of pus from the gums;
• a shiny red lump on the gum that looks like a raspberry. This may indicate the presence of pyogenic granuloma, a gum infection that occurs in 5% of all pregnancies.

Diagnosis of bad breath

A dentist will help determine the cause of bad breath using the following methods:

• Sensory measurement: This method measures the air exhaled by the patient through the nose. This is the most common method for diagnosing halitosis.
• Gas chromatography: This is considered a very reliable way to diagnose halitosis. Gas chromatography is used to measure volatile sulfur compounds.
• Sulfide Monitoring: Sulfide monitoring is a relatively inexpensive way to measure volatile sulfur compounds. It detects the electrochemical reaction of sulfur-containing compounds in exhaled air on a sulfide monitoring device.
• Chemical Sensors: These sensors have a built-in probe that helps measure wax compounds from the tongue and gum pockets. This sensor generates an electrochemical voltage that is detected by an electronic device.
• Ban test: A strip consisting of benzoyl-DL-arginine-A-naphthylamide is used to detect microorganisms that cause bad breath.

A few more tests that may be performed by your dentist:

• quantitative assessment of β-galactosidase activity;
• saliva incubation test;
• ammonia monitoring;
• method for producing ninhydrin.

In most cases, malodor during pregnancy resolves with basic treatment protocols such as teeth polishing, and these tests may not be necessary.

Is it possible to remove bad breath during pregnancy using medical procedures?

The dentist may prescribe one of the following procedures;

• deep exfoliation and root planing to remove plaque on the teeth and under the gums;
• resin fillings for teeth that have worn down due to acid reflux or vomiting;
• curettage in case of large deposits of plaque under the gums;
• surgical or laser removal of purulent granuloma.

FAQ

1. Does pregnancy cause bad breath?

Pregnancy itself may not cause bad breath, but morning sickness, acid reflux, food cravings and frequent snacking typical of an interesting position can provoke an unpleasant odor.

2. Is bad breath a sign of pregnancy?

The sense of smell increases during pregnancy. As a result, a woman may become more sensitive to the existing aroma from her mouth. However, an unpleasant odor in itself cannot be considered a sign of pregnancy.

References:

1. Diana V. Messadi and Fariba S. Younai, Halitosis; Dermatologic Clinics Journal
2. Bahadır Ugur Aylikci and Hakan Colak, Halitosis: From diagnosis to management; Journal of Natural Science, Biology and Medicine
3. Albert Tangerman and Edwin G. Winkel, Volatile Sulfur Compounds as The Cause of Bad Breath: A Review; Journal of Phosphorus, Sulfur, and Silicon and the Related Elements
4. Mustafa Naseem et al., Oral health challenges in pregnant women: Recommendations for dental care professionals; The Saudi Journal for Dental Research
5. Supawadee Naorungroj, Jaranya Hunsrisakhun and Supitcha Talungchit, Oral hygiene status, self-reported oral malodor, oral hygiene practices, and oral health knowledge: A cross-sectional study in a group of Muslim Thai pregnant women; Journal of International Oral health
6. Min Wu, Shao-Wu Chen, and Shao-Yun Jiang, Relationship between Gingival Inflammation and Pregnancy; Mediators of Inflammation
7. Hemalatha VT et al, Dental Considerations in Pregnancy-A Critical Review on the Oral Care; Journal of Clinical and Diagnostic Research
8. Abdulrahman Almaghamsi, Mussa H. Almalki and Badurudeen Mahmood Buhary, Hypocalcemia in Pregnancy: A Clinical Review Update; Oman Medical Journal
9. Amruta A Karnik et al, Determination of salivary flow rate, pH, and dental caries during pregnancy: A study; Journal of Indian Academy of Oral Medicine and Radiology
10. E. Leslie Cameron, Pregnancy and olfaction: a review; Frontiers in Psychology

Prevention of hepatosis in pregnant women

Although hepatosis is considered the result of certain genetic characteristics, there are a number of recommendations to avoid it or delay its appearance for a longer period:

1. Dieting. If you have a tendency to overload the liver, then you must completely avoid everything fried, fatty, smoked, salty, spicy and sour. The diet should consist of fruits, vegetables (except potatoes, legumes, onions and garlic), low-fat dairy products, chicken breast meat, and low-fat fish. You should not eat chocolate and other cocoa-containing products, egg yolks, cheese, pastries (1-2 pieces of black bread per day are allowed).
2. Physical activity. Movement is life, so you need to move more. This speeds up metabolic processes in the body, eliminates congestion, and facilitates the functioning of the liver.
3. Refusal of oral hormonal contraceptives and antibacterial agents. They can cause great harm to the liver.
4. Take vitamins carefully or avoid them. If possible, you should try to get all the substances the body needs from food, and not from vitamin complexes.
5. Treatment of chronic gastrointestinal diseases.
6. The use of hepatoprotectors and choleretic drugs. If pregnancy is not planned yet, then it is enough to carry out preventive courses with these drugs, and if pregnancy has already occurred, then they must be taken according to a special schedule agreed with the attending physician.

Hepatosis in pregnant women is a very insidious disease. If you suspect you have signs of it, be sure to tell your doctor so that he can order a blood test and make or rule out a diagnosis.

How to fix it?

You can’t put up with the taste of bitterness in your mouth during pregnancy, this is a rather unpleasant problem. But it can be solved, the main thing is to know the ways. You can review your daily diet, purchase special medications, use folk wisdom, or also add more physical activity to your daily routine. Even a combination of all these methods may not always help, but at least it will reduce the symptoms and make your mouth less bitter during pregnancy.

Balanced diet

If you constantly have a bitter taste in your mouth during pregnancy, you should reconsider your menu. Perhaps the root of the problem lies precisely in an incorrectly selected diet, which is why internal organs do not function properly. If you have not yet given up smoked foods, spicy, fatty and any canned foods, then you should do so now.

It is advisable not to sit or lie down after eating; it is important to remain upright for a while; it is also not recommended to wash down food with drinks - this will only harm the digestion process. It wouldn't hurt to go for a walk and get some fresh air. If you lie down, or even just sit down, it turns out that the stomach and esophagus will be at the same level, the valve will open, and acidity, along with undigested food, will flow back from the stomach into the esophagus. It is also undesirable to overeat, so you will have to refuse feasts or restrain the desire to try everything that is on the table.

Diet

As has already been said, you cannot overeat; you need to learn to eat more often, but in smaller portions. They should be sufficient and consist of natural products, without pickles, smoked foods, spicy foods, etc.

Regarding drinking, do not overdo it, otherwise it will cause swelling. Also drink half an hour before meals, and in no case after it, wait at least twenty minutes.

Physical activity

Physical activity is considered a good remedy for bitterness in the mouth during pregnancy. This could be regular walks in the fresh air, swimming classes (for pregnant women), fitness and yoga. Wear clothes that do not restrict movement or put pressure on your stomach.

When you move, you activate all processes in the body, including digestion. This way you can reduce unpleasant taste sensations.

Medications

There is only one rule regarding any drug from a pharmacy - only with a doctor’s prescription. You cannot find out on your own which cause is causing the problem. If this is a disease, then the wrong selection of medications will only worsen the situation.

In addition, such medications are prescribed for a certain period of time, that is, they can only be taken for a limited period.

Folk remedies

This problem was, is and will be, but in ancient times women dealt with it in special ways. With some herbs it is better not to take risks and not take them, as they can pose a danger to the woman and baby. But there are recipes that are quite safe and effective:

• Take two hundred grams of carrots, sixty grams of parsley, one hundred and fifty grams of celery. Make juice from these ingredients and drink three times a day, maybe even half an hour before meals instead of water, this will improve digestion. Just prepare fresh juice every day, that is, you cannot make a portion today and drink it the next two days.
• Regular potato juice is quite capable of solving the problem.
• Buy calamus root at the pharmacy and chew it to get rid of the unpleasant taste.
• Water with a little baking soda also helps many people. This is due to the fact that soda and acidity in the stomach react and neutralize each other, however, you should be careful with this method, everyone knows that a large amount of soda can harm the body. But severe bitterness in the mouth during pregnancy can be eliminated in this way.