Ayurveda Insights on Garbhopaghatakarabhava: A Review of Feto-Fatal Factors

Introduction

Pregnancy, or garbhini avastha, is a cherished and significant phase in a woman’s life, eagerly awaited by many. Despite being a time filled with incredible experiences, memories, emotions, and some anxieties, it is not always smooth sailing. Unlike the rapid transformation of a caterpillar into a butterfly, pregnancy is a long and sacrificial journey, akin to a nine-month-long ceremonial ritual (yajna). Every aspect of this journey, from prenatal care to the careful observation of bodily changes, demands attention and thoughtful selection, akin to offering sacred offerings (ahuti). Negligence has no place here, as one patiently awaits the body’s transformations.

However, this amazing process of creation can sometimes turn sorrowful if pregnancy does not progress to full term, leading to the premature demise of the fetus. In modern medical terminology, such termination of pregnancy before 20 weeks or when the fetus weighs less than 500 grams is termed abortion, often referred to as miscarriage or early pregnancy loss. Alternatively, if labor begins after 20 weeks but before the full term, it is known as preterm labor, where the survival chances for the delivered baby are significantly reduced.

According to Acarya Caraka, the factors crucial for the development and growth of the fetus include shukra (sperm), shonita (ovum), jeeva (atma or soul), and garbhashaya (uterus), serving as the vital field (kshetra) for implantation. In Ayurvedic texts, termination of pregnancy, preterm labor, and other complications associated with pregnancy collectively fall under Garbhopahatakarabhava, which refers to factors known to be fatal to pregnancy or to cause deformities in the fetus. Ayurvedic classics strictly caution against these factors, emphasizing their avoidance by pregnant women. The enumeration of such factors is meticulously detailed, covering a wide spectrum of categories that could potentially harm pregnancy.

Garbhopahatakarabhava:
The term consists of three fragments:

1. Garbha – Pregnancy
2. Upaghatakara – Damaging
3. Bhavas – Factors

The factors that have deleterious, disastrous, or fatal effects on the fetus are termed as garbhopaghakara bhava, or Feto-Fatal Factors.

Ayurveda Acarya have defined these factors in detail, covering a vast spectrum from the termination of pregnancy to the development of pathological anomalies in the fetus. Thus, fetal damage results in two forms:

• (a) Termination of Pregnancy – Garbhopaghata
• (b) Development of Anomalies

This termination of pregnancy is further divided into two stages depending upon the period of gestation:

“ācaturthāt tato māsāt prasraved garbhavicyutih |
tatah sthiraśarīrasya pātah pañcamaṣaṣṭhayoḥ || Su.Ni.8/10 ||”

1. Garbhasrava: In this stage, fetal age at the time of expulsion is up to four months, during which the constitution of the conceptus remains in a liquid state.
2. Garbhapata: In this stage, the expelled fetus is aged from the 4th to the 6th month, by which time fetal parts attain a definite shape and a little stability. According to Bhoja (as quoted in Madhokosh commentary of Madhav Nidana [1]), the period of garbhasrava is up to three months. Various Ayurvedic classical texts elaborate on garbhopaghata.

Garbhopahatakarabhava according to Caraka Samhita
The concepts of garbhopahata and Garbhopahatakarabhava are introduced in Caraka Samhita. Acarya Caraka advises against several practices during pregnancy, including excessive sexual activity (vyavaya), vigorous exercise (vyayama), riding vehicles (yana avrohana), wearing red clothing, consuming sharp substances, alcohol (madya), and meat (mansa). He also recommends avoiding anything that could harm the senses and other potentially dangerous activities, as guided by experienced women [2, 3].

Garbhopahatakarabhava according to Sushrutasamhita

Acarya Sushruta, like Acarya Caraka, advises pregnant women to refrain completely from vyavay (sexual activity), vyayam (exercise), and atitarpan (excessive drinking) from the moment of conception onward [4]. He emphasizes the importance of maintaining cleanliness and avoiding atikarshan (severe malnourishment), diwaswapna (daytime napping), and ratrijagran (insomnia). It is crucial to avoid vega dharana (suppressing natural urges), snehana (oil massages), and raktamokshana (bloodletting) [4]. Additionally, pregnant women should avoid emotions such as grief (shoka), activities like riding vehicles (yanavrohan), feelings of fear (bhaya), and squatting (utkatukasana) [4]. Women should avoid contact with filth (malin) and individuals with physical deformities (hina vikrat gatra), and refrain from consuming dried (shushka), stale (paryushita), putrid (kuthita), and moist (klinna) foods, as well as unappealing (drudarsha) and foul-smelling (durgandha) substances [4]. Pregnant women should avoid activities that could harm the fetus, such as going out unnecessarily (bahinishkraman), visiting lonely places (shunyagara), haunted trees (chaitya), cremation grounds (shamshan), or taking shelter under trees (vriksha ashraya) [4]. They should also avoid behaviors that provoke anger (krodha), disgrace (asanshaya), or loud speaking [4]. Overworking or excessively applying oil in massages (taila abhayanga) is not recommended [4].

Garbhopahatakarabhava according to Kashyapa Samhita
Acarya Kashyapa outlines unique precautions for pregnant women. He advises against looking directly at the rising Sun, setting Sun, eclipses, or specific celestial bodies like Rahu and the Moon (Shashi). He recommends that pregnant women move through the central part of their homes, perform religious rituals, and make offerings during solar or lunar eclipses to mitigate their effects on planetary influences. Additionally, they should avoid harboring hostility towards guests (atithi), offer alms to beggars rather than shooing them away, and perform rituals involving clarified butter (ghrita) for peace without using certain vessels or tying items with thin ropes. Loose clothing, trembling, excessive laughter, trauma, and prolonged heavy lifting should also be avoided. Kashyapa further advises against consuming garlic and using cold water during pregnancy [5].

Garbhopahatakarabhava according to Haritasamhita

According to Acarya Harita, the consumption of vidala anna (pulses), vidahi anna (spicy or pungent foods), guru (heavy), amla (sour), ushna kshira (hot milk), mratika (clay), surana, rasona (garlic), or palandu (onion) should be avoided during pregnancy. Additionally, he recommends avoiding vyavaya (coitus), vyayama (exercise), krodha (anger), rosha (grief), and chakramana (walking) [6].

Garbhopahatakarabhava according to Bhavprakasha

Acarya Bhavmishra continues the guidance of Acarya Sushruta, adding contraindications like sitting or sleeping in extremely soft and lofty places, visiting riverbanks, temples, or gardens, drinking rainwater, eating meat, and mingling with women whose children have died [7]. Acarya Caraka also documents various types of garbhopaghatakara bhava that contribute to fetal illness [7].

Garbhopahatakarabhava according to Yogratnakara

In Yogratnakara, pathya and apathya (beneficial and non-beneficial practices) are discussed for pregnant women, specifying that practices like sudation, emesis, consumption of kshara, and contaminated or stale food should be avoided [8].

Coitus during Menstruation and its Effects
Sexual activity is discouraged during menstruation in Sushrutasamhita, as conception during this time—though less likely—may lead to the child’s death in the womb, early death, or deformity [9].

Rajaswalacarya and its Effects on the Fetus

In Ayurveda, a prescribed regimen during rajahsrava kala (menstrual period) aims to protect the health of menstruating women. If conception occurs, following this regimen is believed to prevent potential health abnormalities in the offspring. Failure to observe these practices may negatively affect the fetus [10].

There are some specific etiological factors which don’t destroy but deform the fetus as following [11]:

Garbhopahatakara Bhava according to Contemporary Science

Various scientific studies on human pregnancy indicate that certain dietary choices and physical activities should be approached with caution. A meta-analysis conducted by Jin et al. highlighted that maternal caffeine intake during pregnancy is associated with risks such as low birth weight and childhood overweight and obesity in offspring [12]. Studies on drug abuse have similarly emphasized the detrimental effects on fetal health, particularly noting that nicotine, a primary component of tobacco, can adversely affect brain development and lead to long-term neurobehavioral changes in the fetus [13].

Regarding physical activities, precautions are advised. Jerky movements, especially when using vehicles, should be avoided during the first trimester and the final six weeks of pregnancy. Long-distance travel is ideally limited to the second trimester, with rail travel preferred over bus travel. Air travel up to 36 weeks of pregnancy is generally considered safe, though caution is advised for conditions such as placenta previa, preeclampsia, severe anemia, or sickle cell disease. Prolonged sitting, whether in a car or on an airplane, should be minimized due to the risk of venous stasis and thrombosis, and the seat belt should be positioned below the abdomen.

Sexual intercourse is generally unrestricted during pregnancy; however, prostaglandins and oxytocin released during intercourse may induce uterine contractions. Women at higher risk of miscarriage or preterm labor should avoid intercourse if they experience increased uterine activity [14].

Impaired fetal growth indicators, such as lower birth weight and smaller abdominal circumference, femur length, and estimated fetal weight measured at 30 and 36 weeks of gestation, are associated with prenatal alcohol exposure (PAE) [15].

Nutritional cravings and dietary habits early in pregnancy significantly impact fetal development. Adequate nutrition is critical for fetal growth, and specific cravings may signal particular nutrient needs. A balanced diet supports optimal fetal outcomes and reduces developmental concerns. Healthcare providers play a vital role in educating pregnant women about the importance of nutrition and guiding them toward healthy eating habits [16].

Categories of Garbhopaghatakara Bhava
The garbhopaghatakara bhava can be summarized under the following categories:

1. Fetal Factors (Related to Fetus)
   • Genetic or Bija dosha (abnormality in sperm & ovum)
   • Infection of the fetus
   • Other fetal diseases or anomalies, e.g., hydatidiform mole
2. Maternal Factors (Related to Mother)
   • Genetic or Bija dosha: Congenital abnormality in reproductive organs
   • Dietary Factors (Aharaja):
     • Related to food intake:

• Hot, pungent, and spicy (ushna, katu, tikshna)
• Heavy (guru) in quality or quantity
• Insufficient in quantity
• Putrefied, stale, and excessively dry
• Excessive consumption of meat

• Related to drinks:
  • Excessive intake of intoxicants and wines (madya)
  • Excessive intake of alcoholic drinks
  • Excessive loss of dhatus due to gastrointestinal disorders like diarrhea and vomiting

1. Lifestyle Factors (Viharaja)
   • Wearing red garments
   • Indulgence in harsh or violent activities
   • Sitting on high, irregular, or uncomfortable seats
   • Performing difficult or unsuitable exercises (e.g., long walks, racing, jumping, stair climbing)
   • Traveling in extremely jerky or uncomfortable conveyances
   • Frequently looking into deep wells, waterfalls, or from the roof of multistory buildings
   • Viewing unpleasant or ugly sights
   • Exposure to loud, unbearable, and horrible sounds
   • Prolonged exposure to the hot sun, hot weather, or fire
   • Suppression of natural urges for flatus, defecation, and urination
2. Traumatic Factors (Aghataja) [7]
   • Falling
   • Riding animals
   • Excessive intercourse (coitus is strictly contraindicated in the 1st and 3rd trimesters of pregnancy)
3. Kalaja Factors (Age & Ritu Kala)
   • Conception at a very young age (below 18) or in a woman above 35
   • Impregnation during the late secretory phase of the menstrual cycle
4. Psychogenic Factors [6]
   • Anger
   • Grief
   • Fear
   • Tension, etc.

All these factors can potentially harm the newly conceived fetus, similar to how a recently planted sapling without strong roots can be destroyed by heat or wind.

Mechanism of Garbhopaghata
Dosha vitiation due to various etiological factors is the primary cause of garbhopaghata. The garbhashaya (uterus) serves as the adhisthana (seat) of apana vayu. When vata dosha is vitiated in a pregnant woman, kupita vata promotes the detachment or descent of the growing fetus towards the cervix. If there is no nidana parivarjana (avoidance of causative factors) by the garbhini (pregnant woman), the condition can worsen due to the aggravation of vata and other doshas. This can lead to pain in the kukshi (abdomen) region and bleeding per vaginum. These conditions ultimately impair fetal growth and may lead to garbhopaghata (Figure 1).

Discussion

After reviewing numerous classical and contemporary sources, it becomes clear that an extensive array of factors—termed Feto-Fatal Factors—can disrupt or impair the normal development of a fetus. These factors were systematically described by ancient scholars with a scientific precision that remains relevant today. They encompass various aspects of daily life, from morning routines to bedtime practices, underscoring the importance of mindful living in today’s fast-paced environment.

Spontaneous abortion, a common cause of pregnancy loss before 20 weeks, is often attributed to genetic abnormalities, which are responsible for approximately half of all miscarriages. Ancient Ayurvedic literature classifies garbhopaghatakara bhava into fetal and maternal factors, with detailed categories of each. Fetal factors include genetic abnormalities, fetal infections, and developmental anomalies such as hydatidiform mole, all of which can severely impact fetal growth and health. Maternal factors encompass genetic predispositions, dietary influences (e.g., food choices, malnutrition), lifestyle-related risks (viharaja), trauma (aghataj), age-related conditions (kalaja), and psychogenic influences, each of which can independently or collectively alter fetal development.

From a contemporary medical perspective, various factors are recognized as significant risks. Excessive alcohol or drug consumption, infections, chronic illnesses, and environmental exposures remain prominent causes of adverse pregnancy outcomes. Structural abnormalities in the uterus and unmanaged conditions like diabetes, severe hypertension, lupus, kidney disease, thyroid disorders, and antiphospholipid syndrome can complicate maternal health and fetal development, increasing the likelihood of miscarriage or preterm labor. These modern risk factors resonate with the ancient Ayurvedic emphasis on avoiding harmful exposures and maintaining balance in mental, physical, and dietary habits.

This blend of ancient wisdom and contemporary medical knowledge provides a holistic framework for understanding the delicate nature of pregnancy. Ayurveda’s detailed guidelines on lifestyle, emotional well-being, and dietary restrictions emphasize the potential for prevention and improvement in pregnancy outcomes, urging a balance that is often challenged in modern life. The wisdom of garbhopaghatakara bhava offers insight into lifestyle modifications that can be adapted even today, promoting healthier pregnancies.

Conclusion

Regardless of the timing or cause, miscarriage—marked by the loss of pregnancy—remains a profoundly distressing and emotionally challenging event in a woman’s life, affecting her physical well-being, mental peace, and sometimes family dynamics. In our technologically advanced and fast-paced world, a mother’s emotions and sensitivities during pregnancy are just as delicate as they were in ancient Vedic times or centuries ago. While modern advancements have granted women new roles and opportunities, they have also introduced stressors and lifestyle changes that may challenge the harmony traditionally encouraged during pregnancy.

Revisiting ancient holistic lifestyles, which fostered balance and well-being for both mother and family, may offer valuable insights for modern practices. Integrating Ayurveda’s time-tested approaches with contemporary healthcare can bridge the gap between preventive care and medical intervention. Practices such as mindful nutrition, mental peace, and lifestyle adjustments can be as vital today as they were in ancient times, fostering resilience in maternal health and a harmonious family life.

In light of these findings, it is essential for healthcare providers, families, and society to recognize the wisdom embedded in both traditional and modern approaches. Embracing this combined perspective could not only reduce pregnancy complications but also contribute to the emotional and physical wellness of mothers. By understanding and respecting the intricate needs of pregnancy, we can help rejuvenate a supportive environment for both mother and child in our society.

Financial Support & Sponsorship: Nil
Conflicts of Interest: Nil

References:

1. Madhava Nidana, Mudhagarbhanidana, 64/2. Available from: http://niimh.nic.in/ebooks/madhavanidana/ (Accessed on 2/8/2024).
2. Carakasaṁhitā, Sutrasthana, Yajjapurusheeya, Chapter 25, Verse 40. Available from: http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 2/8/2024).
3. Caraka Saṁhitā, Shareerasthana, Mahatigarbhavakrantishareera, 4/18. Available from: http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 2/8/2024).
4. Suśruta Saṁhitā, Shareerasthana, Garbhinivyakaranashareera, 10/3. Available from: http://niimh.nic.in/ebooks/esushruta/ (Accessed on 2/8/2024).
5. Kashyapa Samhita, Sharirasthan, Chapter 5, Verse 16. Varanasi: Chaukhambha Sanskrit Sansthan; 2018.
6. Harita Samhita with Asha Commentary, Tritiyasthan, Chapter 49, Verses 6-9. Varanasi: Prachya Prakashan; 1985.
7. Mishra B. Bhavprakash, Chapter X, Verse Y. Bombay: Khemraj Shrikrishnadas Publication; 2000.
8. Yogaratnakara with Vidyotini Commentary by Vaidya Lakshmipati Shastri, Varanasi: Chaukhambha Prakashan; 2010.
9. Suśruta Saṁhitā, Shareerasthana, Shukrashonitashuddhishareera, 2/31. Available from: http://niimh.nic.in/ebooks/esushruta/ (Accessed on 2/8/2024).
10. Suśruta Saṁhitā, Shareerasthana, Shukrashonitashuddhishareera, 25/40. Available from: http://niimh.nic.in/ebooks/esushruta/ (Accessed on 2/8/2024).
11. Caraka Saṁhitā, Shareerasthana, Jatisutriyashareera, 8/21. Available from: http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 2/8/2024).
12. Jin F, Qiao C. Association of maternal caffeine intake during pregnancy with low birth weight, childhood overweight, and obesity: a meta-analysis of cohort studies. Int J Obes (Lond). 2021;45(2):279-87.
13. Ross EJ, Graham DL, Money KM, Stanwood GD. Developmental consequences of fetal exposure to drugs: what we know and what we still must learn. Neuropsychopharmacology. 2015;40(1):61-87.
14. Dutta DC, Konar H. DC Dutta’s Textbook of Obstetrics. 7th ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2014.
15. Pielage M, Smith D, Roberts E, et al. Alcohol exposure before and during pregnancy is associated with reduced fetal growth: the Safe Passage Study. BMC Med. 2023;21(1):318.
16. Jakiel G, Gabriel M, Pant A. The relationship between early pregnancy cravings, dietary intake, and fetal development. J Matern Fetal Neonatal Med. 2023;9(2).