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'''Understanding congentital disorders in [Ayurveda]] and contemporary research'''  

'''Understanding congentital disorders in [[Ayurveda]] and contemporary research'''  

Congenital disorders are disabilities or malformations present at or before birth.  These are identified in prenatal life or at birth, or many years later. As per the World Health Organization, congenital anomalies are a leading cause of neonatal deaths. Every year an estimated 295 000 newborns die within 28 days of birth due to congenital anomalies. These can contribute to long-term disability, with significant impacts on individuals, families, healthcare systems, and societies.  

Congenital disorders are disabilities or malformations present at or before birth.  These are identified in prenatal life or at birth, or many years later. As per the World Health Organization, congenital anomalies are a leading cause of neonatal deaths. Every year an estimated 295 000 newborns die within 28 days of birth due to congenital anomalies. These can contribute to long-term disability, with significant impacts on individuals, families, healthcare systems, and societies.  

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==Congenital disorders as per [[Ayurveda]]==

==Congenital disorders as per [[Ayurveda]]==

In Ayurveda, the congenital disorders are considered incurable(asadhya) with poor prognosis. Similarly, some hereditary of familial (kulaja) ailments are also explained as incurable. E.g.:- Congenital or hereditary obstinate urinary diseases including diabetes (Jataja prameha) ( [Cha. Sa. [[Chikitsa Sthana]] 6/57]  

In [[Ayurveda]], the congenital disorders are considered incurable(asadhya) with poor prognosis. Similarly, some hereditary of familial (kulaja) ailments are also explained as incurable. E.g.:- Congenital or hereditary obstinate urinary diseases including diabetes (Jataja prameha) [Cha. Sa. [[Chikitsa Sthana]] 6/57]  

 

Ayurveda emphasizes on prevention of congenital  disorders through proper preconception, ante- natal and  intra partum care.  The causes for congenital disorders are explained in detail. These are helpful in taking necessary actions to avoid such risk factors and obtaining a healthy progeny.

Ayurveda emphasizes on prevention of congenital  disorders through proper preconception, ante- natal and  intra partum care.  The causes for congenital disorders are explained in detail. These are helpful in taking necessary actions to avoid such risk factors and obtaining a healthy progeny.

==Causes of Congenital Disorders==

==Causes of Congenital Disorders==

The causes of congenital disorders can be analyzed in view of physical, mental and spiritual dimensions.  

The causes of congenital disorders can be analyzed in view of physical, mental and spiritual dimensions.  

These causes can be broadly classified based on period:  

These causes can be broadly classified based on period:  

1) Preconception period

1) Preconception period

2) Antenatal period

2) Antenatal period

3) Intra-partum period

3) Intra-partum period

===Physical factors ===

===Physical factors ===

==== Genetic defects in parents====

==== Genetic defects in parents====

Abnormalities in gametes (beeja dosha)

'''Abnormalities in gametes (beeja dosha)'''

The concept of genetics is denoted with the terms ‘beeja’(seed or gametes), ‘beejabhaga’ (chromosomes) and beeja-bhagavayava (nucleic acids and genes). The maternal (matruja) and paternal (pitruja) factors are responsible for formation of the embryo. When any part of these three genetic materials is abnormal, it leads to deformity or mal-formation of organ or body part. [Cha. Sa. [[Sharira Sthana]] 3/17]  

 

====Role of reproductive physiology (shukra dhatu) of parents====

The concept of genetics is denoted with the terms ‘beeja’(seed or gametes), ‘beejabhaga’ (chromosomes) and beeja-bhagavayava (nucleic acids and genes). The maternal (matruja) and paternal (pitruja) factors are responsible for the formation of the embryo. When any part of these three genetic materials is abnormal, it leads to deformity or mal-formation of the organ or body part. [Cha. Sa. [[Sharira Sthana]] 3/17]  

The vitiation of reproductive elements [[shukra dhatu]] and its channels of transformation and transportation (shukravaha srotasa) results in deformities in progeny. [Cha. Sa. Sutra Sthana 28/28], [Cha. Sa. [[Chikitsa Sthana]] 2;8/34] The normal status of [[shukra dhatu]] at the time of conception is important for normal embryogenesis.   

====Role of reproductive physiology ([[shukra dhatu]]) of parents====

The vitiation of reproductive elements [[shukra dhatu]] and its channels of transformation and transportation (shukravaha srotasa) results in deformities in progeny. [Cha. Sa. [[Sutra Sthana]] 28/28], [Cha. Sa. [[Chikitsa Sthana]] 2;8/34] The normal status of [[shukra dhatu]] at the time of conception is important for normal embryogenesis.   

====Disorders of female reproductive system ====

====Disorders of female reproductive system ====

Optimum health of uterus/female reproductive tract (kshetra) is an essential factor for normal growth and development of the fetus.  

Optimum health of uterus/female reproductive tract (kshetra) is an essential factor for the normal growth and development of the fetus.  

==== Role of time factor (kala) ====

==== Role of time factor (kala) ====

Age of the parents at the time of conception is important. In Ayurvedic texts, the minimum age for normal and healthy conception is described as twenty five years for male and sixteen years for female. At this age, the individual attains complete psycho-sexual maturity to become responsible parents. [Su. Sa. Sutra Sthana 35/13] Young girls and  old women are not advised for conception. [Cha. Sa. [[Sharira Sthana]] 8/6] If the recommended age is not followed for conception, it can lead to intrauterine death of fetus, neonatal death, ill health and deformed body parts of  the child.[A. S. Sharira Sthana 1/5]

Age of the parents at the time of conception is important. In Ayurvedic texts, the minimum age for normal and healthy conception is described as twenty five years for male and sixteen years for female. At this age, the individual attains complete psycho-sexual maturity to become responsible parents. [Su. Sa. Sutra Sthana 35/13] Young girls and  old women are not advised for conception. [Cha. Sa. [[Sharira Sthana]] 8/6] If the recommended age is not followed for conception, it can lead to intrauterine death of fetus, neonatal death, ill health and deformed body parts of  the child.[A. S. Sharira Sthana 1/5]

Pregnancy in a very young age causes premature births. Aneuploidy (abnormal chromosome number) is the principal hereditary abnormality associated with age of either parent.  Advanced maternal age is associated with increased risks for miscarriage, chromosomal abnormalities, stillbirth, foetal growth restriction and preterm birth.  . Recent research shows that younger paternal age(< 20 years) could increase the risks of urogenital abnormalities and chromosome disorders in fetus. advanced paternal age (≥ 40 years) could increase the risks of cardiovascular abnormalities, facial deformities, urogenital abnormalities, and chromosome disorders in their offsprings. Growing evidences also indicate that the offspring of older fathers are prone to reduced fertility and an increased risk of birth defects, some cancers, and schizophrenia.  

 

Pregnancy at a very young age causes premature births. Aneuploidy (abnormal chromosome number) is the principal hereditary abnormality associated with age of either parent.  Advanced maternal age is associated with increased risks for miscarriage, chromosomal abnormalities, stillbirth, foetal growth restriction and preterm birth.Recent research shows that younger paternal age(< 20 years) could increase the risks of urogenital abnormalities and chromosome disorders in fetus. Advanced paternal age (≥ 40 years) could increase the risks of cardiovascular abnormalities, facial deformities, urogenital abnormalities, and chromosome disorders in their offspring. Growing evidences also indicate that the offspring of older fathers are prone to reduced fertility and an increased risk of birth defects, some cancers, and schizophrenia.  

===Psychological and behavioral factors===

===Psychological and behavioral factors===

Pleasant state of mind is the prime requirement for conception. [Cha. Sa. [[Sutra Sthana]] 25/40] The mental status of parents during coitus and conception is important. Coitus shall be avoided, when either of the partners is hungry, thirsty, or frightened, averse, sorrow-stricken, angry, distressed with relationship or not desiring for sex. These states during coitus adversely affect conception and health of progeny.  [Cha. Sa. [[Sharira Sthana]] 8/17] Studies show that preconception stress alters offspring development in a parental and fetal sex-specific manner. This is reflected in the metabolic and immune-related genes in the placenta as well as brain transcriptome.  

A pleasant state of mind is the prime requirement for conception. [Cha. Sa. [[Sutra Sthana]] 25/40] The mental status of parents during coitus and conception is important. Coitus shall be avoided, when either of the partners is hungry, thirsty, or frightened, averse, sorrow-stricken, angry, distressed with relationship, or not desiring for sex. These states during coitus adversely affect conception and health of progeny.  [Cha. Sa. [[Sharira Sthana]] 8/17] Studies show that preconception stress alters offspring development in a parental and fetal sex-specific manner. This is reflected in the metabolic and immune-related genes in the placenta as well as brain transcriptome.  

===Spiritual factors ===

===Spiritual factors ===

Sinful acts and atheistic attitude of parents [Su. Sa. Sharira Sthana 2/50-52],   deeds of previous life (atma –karma dosha) [Cha. Sa. [[Sharira Sthana]] 2/29] and unrighteousness(adharma) [Su. Sa. Sharira Sthana 3/36] can cause congenital disorders.  These factors are commonly considered as of ‘unknown origin’ in current medical practices.  

Sinful acts and atheistic attitude of parents [Su. Sa. Sharira Sthana 2/50-52], deeds of previous life ([[atma]] –karma dosha) [Cha. Sa. [[Sharira Sthana]] 2/29] and unrighteousness(adharma) [Su. Sa. Sharira Sthana 3/36] can cause congenital disorders.  These factors are commonly considered as of ‘unknown origin’ in current medical practices.  

==Factors related to antenatal period==

==Factors related to antenatal period==

Improper antenatal care and poor nutrition during pregnancy can lead to deformity in the fetus. [Cha. Sa. [[Sharira Sthana]] 4/30] The six factors responsible for embryogenesis play an important role in the causation of congenital disorders. These include maternal (matruja), paternal (pitruja), spiritual (atmaja), psychological (sattvaja), adaptations (satmyaja) and nutritional component (rasaja). Minor defects in these factors can cause congenital abnormalities in the fetus. Major defects cause abortion or intrauterine death of the fetus. [Cha. Sa. [[Sharira Sthana]] 4/28-29]

Improper antenatal care and poor nutrition during pregnancy can lead to deformity in the fetus. [Cha. Sa. [[Sharira Sthana]] 4/30] The six factors responsible for embryogenesis play an important role in the causation of congenital disorders. These include maternal (matruja), paternal (pitruja), spiritual ([[atma]]ja), psychological (sattvaja), adaptations ([[satmya]]ja) and nutritional component (rasaja). Minor defects in these factors can cause congenital abnormalities in the fetus. Major defects cause abortion or intrauterine death of the fetus. [Cha. Sa. [[Sharira Sthana]] 4/28-29]

===Role of [[panchamahabhuta]]===

===Role of [[panchamahabhuta]]===

The five fundamental elements (pancha mahabhuta) play basic functions during embryogenesis. Vayu performs function of cell division/multiplication (vibhajana); agni carries function of metabolism(pachana); jala carries function of moisture or fluid (kledana); prithvi carries function of compactness or formation of mass(samhanana); and akasha carries function of enlargement of size(vivardhana). If these functions are carried out in normal proportion, the body's normal structure (shareera) is formed. The defective proportion or functioning can adversely affect embryogenesis and result in congenital anamolies. [Su.Sa. Sharira Sthana 5/3] More specifically, [[vayu]] and [[akasha]] cause anatomical deformities in children. [Bhela Sa Sharira Sthana 3/15-16].

The five fundamental elements ([[pancha mahabhuta]]) play basic functions during embryogenesis. [[Vayu]] performs function of cell division/multiplication (vibhajana); [[agni]] carries function of metabolism(pachana); [[jala]] carries function of moisture or fluid (kledana); [[Prithvi]] carries function of compactness or formation of mass(samhanana); and [[akasha]] carries function of enlargement of size(vivardhana). If these functions are carried out in normal proportion, the body's normal structure (shareera) is formed. The defective proportion or functioning can adversely affect embryogenesis and result in congenital anamolies. [Su.Sa. Sharira Sthana 5/3] More specifically, [[vayu]] and [[akasha]] cause anatomical deformities in children. [Bhela Sa Sharira Sthana 3/15-16].

===Role of [[dosha]]===

===Role of [[dosha]]===

Vitiation of all three [[dosha]] during pregnancy can cause congenital disorders. [A. H. Sharira Sthana 1/6] [[Vata]] [[dosha]] plays key role as controller of all activities and anatomical shapes (akruti) of the embryo (garbha). [Cha. Sa. [[Sutra Sthana]] 12/8], [Su. Sa. Sharira Sthana 2/50-52]

Vitiation of all three [[dosha]] during pregnancy can cause congenital disorders. [A. H. Sharira Sthana 1/6] [[Vata]] [[dosha]] plays key role as controller of all activities and anatomical shapes (akruti) of the embryo (garbha). [Cha. Sa. [[Sutra Sthana]] 12/8], [Su. Sa. Sharira Sthana 2/50-52]

===Role of [[ dhatu]]===

===Role of [[ dhatu]]===

The structural and functional integrity of maternal reproductive organs especially uterus is having a great role in the growth and development of foetus. The quality of [[rasa dhatu]] of mother and its transportation to the fetus play a vital role.The placenta (apara) and umbilical cord (nabhi nadi) also play crucial role in the nourishment of fetus (garbha poshana). The disorder of these structural entities certainly affects the fetus and leads to some congenital deformities.

The structural and functional integrity of maternal reproductive organs especially the uterus is having a great role in the growth and development of the fetus. The quality of [[rasa dhatu]] of the mother and its transportation to the fetus plays a vital role.The placenta (apara) and umbilical cord (nabhi nadi) also play crucial role in the nourishment of fetus (garbha poshana). The disorder of these structural entities certainly affects the fetus and leads to some congenital deformities.

===Mental status of mother===

===Mental status of mother===

The mental status of the mother during pregnancy can influence fetal growth and development. The psychological and cognitive development of fetus depends on the psychological status of mother and the topics listened by the pregnant woman.[A.S. Sharira Sthana 1/66]  And also, the importance of maintaining the positive psychological status of mother while treating the fetal growth related ailments like intra uterine growth restriction is being emphasized.[A.H. sharira Sthana 2/20]

The mental status of the mother during pregnancy can influence fetal growth and development.The psychological and cognitive development of fetus depends on the psychological status of the mother and the topics listened to by the pregnant woman.[A.S. Sharira Sthana 1/66]  And also, the importance of maintaining the positive psychological status of mother while treating the fetal growth related ailments like intra uterine growth restriction is being emphasized.[A.H. sharira Sthana 2/20]

 

===Diet and lifestyle of the mother: ===

===Diet and lifestyle of the mother: ===

The harmful diet and lifestyle factors followed by mothers that can adversely affect progeny (garbhopaghatakara bhavas) are described below. [Cha. Sa. [[Sharira Sthana]] 8/21] More research studies are needed to find out exact genetic connections in the causes and their effects on progeny.  

The harmful diet and lifestyle factors followed by mothers that can adversely affect progeny (garbhopaghatakara bhavas) are described below. [Cha. Sa. [[Sharira Sthana]] 8/21] More research studies are needed to find out exact genetic connections in the causes and their effects on progeny.  

===Causes of premature birth or atrophy or emaciation of fetus: ===

===Causes of premature birth or atrophy or emaciation of fetus: ===

• Sitting in awkward positions, on uneven and hard seats  

* Sitting in awkward positions, on uneven and hard seats  

• Suppressing the urge to pass flatus, urine, and defecation

 

• Indulgence in intensive or extreme forms of physical activities

* Suppressing the urge to pass flatus, urine, and defecation

• Excessive consumption of pungent and hot food items or less quantity of food than needed  

 

* Indulgence in intensive or extreme forms of physical activities

 

* Excessive consumption of pungent and hot food items or less quantity of food than needed  

===Causes of miscarriage: ===

===Causes of miscarriage: ===

• Repeated trauma or injuries, looking down from heights (e.g., from mountain-tops or cliffs, deep wells, etc.)  

* Repeated trauma or injuries, looking down from heights (e.g., from mountain-tops or cliffs, deep wells, etc.)  

• Traveling long distances in excessively jerky carriages

 

• Prolong exposure to  loud and unpleasant noise

* Traveling long distances in excessively jerky carriages

 

* Prolong exposure to  loud and unpleasant noise

===Causes of mental retardation and psychiatric disorders in child:===

===Causes of mental retardation and psychiatric disorders in child:===

• Excess sleeping in open air or walking at night leads to the birth of a mentally challenged child  

* Excess sleeping in open air or walking at night leads to the birth of a mentally challenged child.

• Indulgence in too many quarrels and fights can lead to epilepsy in a child  

 

• Excess indulgence in coitus (or a nymphomaniac) leads to the birth of a truant with a passion for women

* Indulgence in too many quarrels and fights can lead to epilepsy in a child.

• Constant grief in pregnancy would give birth to a timid, or under-developed, or short-lived child.  

 

• A woman who always thinks ill of others gives birth to a delinquent or an anti-social child.  

* Excess indulgence in coitus (or a nymphomaniac) leads to the birth of a truant with a passion for women.

• A woman who is a thief will give birth to a lazy child who is wicked and inept

 

• An intolerant woman would give birth to a child who is of fierce, deceitful, and jealous nature.  

* Constant grief in pregnancy would give birth to a timid, or under-developed, or short-lived child.

* A woman who always thinks ill of others gives birth to a delinquent or an anti-social child.

* A woman who is a thief will give birth to a lazy child who is wicked and inept.

 

* An intolerant woman would give birth to a child who is of fierce, deceitful, and jealous nature.  

===Lifestyle-related causes:===  

===Lifestyle-related causes:===  

• A woman who sleeps for long hours would give birth to a dull and unwise child with poor digestive capacity  

* A woman who sleeps for long hours would give birth to a dull and unwise child with poor digestive capacity.

• A woman addicted to wines gives birth to a child who is ever-thirsty and fickle-minded

 

* A woman addicted to wines gives birth to a child who is ever-thirsty and fickle-minded.

===Dietary causes: ===

===Dietary causes: ===

• A woman who consumes flesh and meat of godha (iguana) would give birth to a child afflicted with stones or shanairmeha (a type of urinary disorder where dribbling is seen)

* A woman who consumes flesh and meat of godha (iguana) would give birth to a child afflicted with stones or shanairmeha (a type of urinary disorder where dribbling is seen)

• A woman who consumes pork frequently would give birth to a child with red eyes, rough body-hair, and prone to suffering from severe respiratory disorders.  

 

• A woman who used to consume fish excessively would give birth to a child with lagophthalmos and related eye disorders  

* A woman who consumes pork frequently would give birth to a child with red eyes, rough body-hair, and prone to suffering from severe respiratory disorders.

• A woman used to eating many sweets is prone to giving birth to a dumb or excessively obese child or a diabetic child.  

• A woman fond of sour food items is prone to giving birth to an offspring suffering from bleeding disorders or diseases of the skin and eyes.

* A woman who used to consume fish excessively would give birth to a child with lagophthalmos and related eye disorders  

• A woman who consumes more salt or salty food articles may give birth to a child with early onset of wrinkles, grey hair, or baldness.  

 

• A woman used to pungent substances in excess may give birth to a weak child, deficient in semen and impotent.

* A woman used to eating many sweets is prone to giving birth to a dumb or excessively obese child or a diabetic child.  

• A woman using bitter substances in excess may give birth to a child with emaciated, weak or undeveloped body.  

 

• A woman habituated to excessive use of astringents may give birth to a child with a blackish complexion, suffering from constipation and udavarta (misperistalsis).

* A woman fond of sour food items is prone to giving birth to an offspring suffering from bleeding disorders or diseases of the skin and eyes.

[Cha.Sa. Sharira Sthana 8/21]

 

The effect of diet taken by the mother vitiating particular [[dosha]] is described. [Ash Sa Sharira Sthana 2/54-56]

* A woman who consumes more salt or salty food articles may give birth to a child with early onset of wrinkles, grey hair, or baldness.  

 

* A woman used to pungent substances in excess may give birth to a weak child, deficient in semen and impotent.

 

* A woman using bitter substances in excess may give birth to a child with emaciated, weak or undeveloped body.  

 

* A woman habituated to excessive use of astringents may give birth to a child with a blackish complexion, suffering from constipation and udavarta (misperistalsis).

 

[Cha.Sa. Sharira Sthana 8/21]

 

The effect of diet taken by the mother vitiating particular [[dosha]] is described. [A. S. Sharira Sthana 2/54-56]

 

A systematic review shows that parental alcohol exposures are significantly associated with the risk of congenital heart diseases in offspring. This highlights the necessity of improving health awareness to prevent alcohol exposure during preconception and conception periods.  

A systematic review shows that parental alcohol exposures are significantly associated with the risk of congenital heart diseases in offspring. This highlights the necessity of improving health awareness to prevent alcohol exposure during preconception and conception periods.  

===Effect of maternal diseases upon the fetus===

===Effect of maternal diseases upon the fetus===