Pregnancy - What to expect during pregnancy

Definition

The period from conception to birth. After the egg is fertilized by a sperm and then implanted in the lining of the uterus, it develops into the placenta and embryo, and later into a fetus. Pregnancy usually lasts 40 weeks, beginning from the first day of the woman's last menstrual period, and is divided into three trimesters, each lasting three months.

Description

Pregnancy is a state in which a woman carries a fertilized egg inside her body. Due to technological advances, pregnancy is increasingly occurring among older women in the United States.

First month

At the end of the first month, the embryo is about a third of an inch long, and its head and trunk-plus the beginnings of arms and legs-have started to develop. The embryo receives nutrients and eliminates waste through the umbilical cord and placenta. By the end of the first month, the liver and digestive system begin to develop, and the heart starts to beat.

Second month

In this month, the heart starts to pump and the nervous system (including the brain and spinal cord) begins to develop. The 1 in (2.5 cm) long fetus has a complete cartilage skeleton, which is replaced by bone cells by month's end. Arms, legs and all of the major organs begin to appear. Facial features begin to form.

Third month

By now, the fetus has grown to 4 in (10 cm) and weighs a little more than an ounce (28 g). Now the major blood vessels and the roof of the mouth are almost completed, as the face starts to take on a more recognizably human appearance. Fingers and toes appear. All the major organs are now beginning to form; the kidneys are now functional and the four chambers of the heart are complete.

Fourth month

The fetus begins to kick and swallow, although most women still can't feel the baby move at this point. Now 4 oz (112 g), the fetus can hear and urinate, and has established sleep-wake cycles. All organs are now fully formed, although they will continue to grow for the next five months. The fetus has skin, eyebrows, and hair.

Fifth month

Now weighing up to a 1 lb (454 g) and measuring 8-12 in (20-30 cm), the fetus experiences rapid growth as its internal organs continue to grow. At this point, the mother may feel her baby move, and she can hear the heartbeat with a stethoscope.

Sixth month

Even though its lungs are not fully developed, a fetus born during this month can survive with intensive care. Weighing 1-1.5 lbs (454-681 g), the fetus is red, wrinkly, and covered with fine hair all over its body. The fetus will grow very fast during this month as its organs continue to develop.

Seventh month

There is a better chance that a fetus born during this month will survive. The fetus continues to grow rapidly, and may weigh as much as 3 lb (1.3 kg) by now. Now the fetus can suck its thumb and look around its watery womb with open eyes.

Eighth month

Growth continues but slows down as the baby begins to take up most of the room inside the uterus. Now weighing 4-5 lbs (1.8-2.3 kg) and measuring 16-18 in (40-45 cm) long, the fetus may at this time prepare for delivery next month by moving into the head-down position.

Ninth month

Adding 0.5 lb (227 g) a week as the due date approaches, the fetus drops lower into the mother's abdomen and prepares for the onset of labor, which may begin any time between the 37th and 42nd week of gestation. Most healthy babies will weigh 6-9 lb (2.7-4 kg) at birth, and will be about 20 in. long.

Causes and symptoms

The first sign of pregnancy is usually a missed menstrual period, although some women bleed in the beginning. A woman's breasts swell and may become tender as the mammary glands prepare for eventual breastfeeding. Nipples begin to enlarge and the veins over the surface of the breasts become more noticeable.

Nausea and vomiting are very common symptoms and are usually worse in the morning and during the first trimester of pregnancy. They are usually caused by hormonal changes, in particular, increased levels of progesterone. Women may feel worse when their stomach is empty, so it is a good idea to eat several small meals throughout the day, and to keep things like crackers on hand to eat even before getting out of bed in the morning.

Many women also feel extremely tired during the early weeks. Frequent urination is common, and there

may be a creamy white discharge from the vagina. Some women crave certain foods, and an extreme sensitivity to smell may worsen the nausea. Weight begins to increase.

In the second trimester (13-28 weeks) a woman begins to look noticeably pregnant and the enlarged uterus is easy to feel. The nipples get bigger and darker, skin may darken, and some women may feel flushed and warm. Appetite may increase. By the 22nd week, most women have felt the baby move. During the second trimester, nausea and vomiting often fade away, and the pregnant woman often feels much better and more energetic. Heart rate increases as does the volume of blood in the body.

By the third trimester (29-40 weeks), many women begin to experience a range of common symptoms. Stretch marks may develop on abdomen, breasts, and thighs, and a dark line may appear from the navel to pubic hair. A thin fluid may be expressed from the nipples. Many women feel hot, sweat easily and often find it hard to get comfortable. Kicks from an active baby may cause sharp pains, and lower backaches are common. More rest is needed as the woman copes with the added stress of extra weight. Braxton Hicks contractions may get stronger.

At about the 36th week in a first pregnancy (later in repeat pregnancies), the baby's head drops down low into the pelvis. This may relieve pressure on the upper abdomen and the lungs, allowing a woman to breathe more easily. However, the new position places more pressure on the bladder.

A healthy gain for most women is between 25 and 35 pounds. Women who are overweight should gain less; and women who are underweight should gain more. On average, pregnant women need an additional 300 calories a day. Generally, women will gain three to five pounds in the first three months, adding one to two pounds a week until the baby is born. An average, healthy full-term baby at birth weighs 7.5 lb (3.4 kg), and the placenta and fluid together weigh another 3.5 lb. The remaining weight that a woman gains during pregnancy is mostly due to water retention and fat stores. Her breasts, for instance, gain about 2 lb. in weight, and she gains another 4 lb due to the increased blood volume of pregnancy.

In addition to the typical, common symptoms of pregnancy, some women experience other problems that may be annoying, but which usually disappear after delivery. Constipation may develop as a result of food passing more slowly through the intestine. Hemorrhoids and heartburn are fairly common during late pregnancy. Gums may become more sensitive and bleed more easily; eyes may dry out, making contact lenses feel painful. Pica (a craving to eat substances other than food) may occur. Swollen ankles and varicose veins may be a problem in the second half of pregnancy, and chloasma may appear on the face.

Chloasma, also known as the "mask of pregnancy" or melasma, is caused by hormonal changes that result in blotches of pale brown skin appearing on the forehead, cheeks, and nose. These blotches may merge into one dark mask. It usually fades gradually after pregnancy, but it may become permanent or recur with subsequent pregnancies. Some women also find that the line running from the top to the bottom of their abdomen darkens. This is called the linea nigra.

While the above symptoms are all considered to be normal, there are some symptoms that could be a sign of a more dangerous underlying problem. A pregnant woman with any of the following signs should contact her doctor immediately:

abdominal pain
rupture of the amniotic sac or leaking of fluid from the vagina
bleeding from the vagina
no fetal movement for 24 hours (after the fifth month)
continuous headaches
marked, sudden swelling of eyelids, hands, or face during the last three months
dim or blurry vision during last three months
persistent vomiting

Diagnosis

Many women first discover they are pregnant after a positive home pregnancy test. Pregnancy urine tests check for the presence of human chorionic gonadotropin (hCG), which is produced by a placenta. The newest home tests can detect pregnancy on the day of the missed menstrual period.

Home pregnancy tests are more than 97% accurate if the result is positive, and about 80% accurate if the result is negative. If the result is negative and there is no menstrual period within another week, the pregnancy test should be repeated. While home pregnancy tests are very accurate, they are less accurate than a pregnancy test conducted at a lab. For this reason, women may want to consider having a second pregnancy test conducted at their doctor's office to be sure of the accuracy of the result.

Blood tests to determine pregnancy are usually used only when a very early diagnosis of pregnancy is needed. This more expensive test, which also looks for hCG, can produce a result within nine to 12 days after conception.

Once pregnancy has been confirmed, there are a range of screening tests that can be done to screen for birth defects, which affect about 3% of unborn children. Two tests are recommended for all pregnant women: alpha-fetoprotein (AFP) and the triple marker test.

Other tests are recommended for women at higher risk for having a child with a birth defect. This would include women over age 35, who had another child or a close relative with a birth defect, or who have been exposed to certain drugs or high levels of radiation. Women with any of these risk factors may want to consider amniocentesis, chorionic villus sampling (CVS) or ultrasound.

Other prenatal tests

There are a range of other prenatal tests that are routinely performed, including:

PAP test
gestational diabetes screening test at 24-28 weeks
tests for sexually transmitted diseases
urinalysis
blood tests for anemia or blood type
screening for immunity to various diseases, such as German measles

Treatment

Prenatal care is vitally important for the health of the unborn baby. A pregnant woman should be sure to eat a balanced, nutritious diet of frequent, small meals. Women should begin taking 400 mcg of folic acid several months before becoming pregnant, as folic acid has been shown to reduce the risk of spinal cord defects, such as spina bifida.

No medication (not even a nonprescription drug) should be taken except under medical supervision, since it could pass from the mother through the placenta to the developing baby. Some drugs, called teratogens, have been proven harmful to a fetus, but no drug should be considered completely safe (especially during early pregnancy). Drugs taken during the first three months of a pregnancy may interfere with the normal formation of the baby's organs, leading to birth defects. Drugs taken later on in pregnancy may slow the baby's growth rate, or they may damage specific fetal tissue (such as the developing teeth), or cause preterm birth.

To have the best chance of having a healthy baby, a pregnant woman should avoid:

smoking
alcohol
street drugs
large amounts of caffeine
artificial sweeteners

Nutrition

Women should begin following a healthy diet even before they become pregnant. This means cutting back on high-calorie, high-fat, high-sugar snacks, and increasing the amount of fruits, vegetables and whole grains in her diet. Once she becomes pregnant, she should make sure to get at least six to 11 servings of breads and other whole grains, three to five servings of vegetables, two to four servings of fruits, four to six servings of milk and milk products, three to four servings of meat and protein foods, and six to eight glasses of water. She should limit caffeine to no more than one soft drink or cup of coffee per day.

Prognosis

Pregnancy is a natural condition that usually causes little discomfort provided the woman takes care of herself and gets adequate prenatal care. Childbirth education classes for the woman and her partner help prepare the couple for labor and delivery.

Key terms

Alpha-fetoprotein — A substance produced by a fetus' liver that can be found in the amniotic fluid and in the mother's blood. Abnormally high levels of this substance suggests there may be defects in the fetal neural tube, a structure that will include the brain and spinal cord when completely developed. Abnormally low levels suggest the possibility of Down' syndrome.

Braxton Hicks' contractions — Short, fairly painless uterine contractions during pregnancy that may be mistaken for labor pains. They allow the uterus to grow and help circulate blood through the uterine blood vessels.

Chloasma — A skin discoloration common during pregnancy, also known as the "mask of pregnancy" or melasma, in which blotches of pale brown skin appear on the face. It is usually caused by hormonal changes. The blotches may appear in the forehead, cheeks, and nose, and may merge into one dark mask. It usually fades gradually after pregnancy, but it may become permanent or recur with subsequent pregnancies. Some women may also find that the line running from the top to the bottom of their abdomen darkens. This is called the linea nigra.

Embryo — An unborn child during the first eight weeks of development following conception (fertilization with sperm). For the rest of pregnancy, the embryo is known as a fetus.

Fetus — An unborn child from the end of the eights week after fertilization until birth.

Human chorionic gonadotropin (hCG) — A hormone produced by the placenta during pregnancy.

Placenta — The organ that develops in the uterus during pregnancy that links the blood supplies of the mother and baby.

Rhythm method — The oldest method of contraception with a very high failure rate, in which partners periodically refrain from having sex during ovulation. Ovulation is predicted on the basis of a woman's previous menstrual cycle.

Spina bifida — A congenital defect in which part of the vertebrae fail to develop completely, leaving a portion of the spinal cord exposed.

Prevention

There are many ways to avoid pregnancy. A woman has a choice of many methods of contraception which will prevent pregnancy, including (in order of least to most effective):