CONDITIONS
Pregnancy
What is pregnancy?
The term “pregnancy” refers to the duration during which a foetus grows and develops within the womb or uterus of a woman. On average, the duration of pregnancy is around 40 weeks, which is slightly more than nine months, starting from the last menstrual period until the baby’s delivery.
A pregnancy is divided into three stages called trimesters: first trimester (week 0 to week 12), second trimester (week 13 to week 26), and third trimester (week 27 to week 40).
What are the common symptoms of pregnancy?
Each woman may experience different pregnancy symptoms at different times. It is important not to compare one’s pregnancy experience with others, as symptoms can vary greatly.
- Missed period: One of the most common early signs of pregnancy is a missed menstrual period. Once conception has occurred, the body produces hormones that inhibit ovulation and the shedding of the uterine lining. This results in the cessation of the menstrual cycle, and a woman will not experience another period until after giving birth. However, the absence of a period does not necessarily indicate pregnancy. Various factors such as stress, excessive exercise, dieting, hormone imbalances, and other circumstances can also lead to irregular periods.
- Nausea and vomiting: Often referred to as morning sickness, nausea and vomiting can occur at any time of the day and typically starts around the sixth week of pregnancy. It can begin as early as two weeks into a pregnancy.
- Breast changes: Pregnancy can cause breasts to become swollen, tender, or sore. Nipples may darken, and veins in the breasts may become more noticeable.
- Fatigue: Increased progesterone hormone levels can make pregnant women feel unusually tired and exhausted.
- Frequent urination: During pregnancy, the body’s blood supply increases. The kidneys filter the blood and eliminate the excess waste. This waste is expelled from the body as urine. The greater the amount of blood in the body, the higher the frequency of urination.
Less common symptoms include:
- Food aversions or cravings: Pregnant women may experience strong aversions to certain foods or cravings for others.
- Mood swings: Hormonal changes can affect mood, leading to heightened emotions, irritability, or mood swings.
- Bloating: Many women experience bloating early in pregnancy due to hormonal changes.
- Light spotting or implantation bleeding: Some women may notice light spotting or bleeding when the fertilized egg attaches to the lining of the uterus, usually around 10 to 14 days after conception.
- Headaches and dizziness: Hormonal changes and increased blood volume can cause headaches and feelings of dizziness or lightheadedness.
- Metallic taste: Some pregnant women report a metallic taste in their mouth.
- Acne or skin changes: The changes in skin during pregnancy are attributed to changes in hormones and increased blood volume. While some may enjoy a pregnancy glow and clearer complexion, others may experience more pimples.
- Back pain: Lower back pain can begin early in pregnancy and continue throughout.
- Changes in the sense of smell: A heightened sense of smell or aversion to certain smells is common during early pregnancy.
- Constipation: Increased progesterone can slow down the digestive system, leading to constipation.
What is a pregnancy test?
Pregnancy can be confirmed through the use of a pregnancy test, which can be conducted using either urine or blood samples. These tests detect the presence of the human chorionic gonadotropin hormone (hCG) produced by the placenta around ten days after fertilization. The hCG hormone levels in the body double approximately every two days during the first 60 days of pregnancy. The doctors often use blood test to diagnose pregnancy early or to confirm the results of an at-home pregnancy test. Blood tests are highly accurate and can detect pregnancy as early as the second week after conception.
Women have the option of conducting an at-home pregnancy test by testing a urine sample around two weeks after conception or around the time when a period is expected. Home pregnancy tests have improved in accuracy over the past decade, with most tests being 97% to 99% accurate when used correctly.
What are the foetal development stages during pregnancy?
Month 1 – Week 1-4
After fertilizing an egg and implanting it into the uterine lining, a sac grows around it. This becomes the amniotic sac, holding the amniotic fluid and cushioning the embryo. The placenta also forms during this month. This will bring nutrition and support to the baby from the mother.
Small limb buds appear, which will develop into arms and legs. The heart and lungs form, and by the 22nd day, the heart begins to beat. The neural tube develops, eventually transforming into the brain and spinal cord. By the end of the 4th week, the baby will be slightly smaller than a grain of rice. B vitamins are crucial in the baby’s development and the mother’s health during pregnancy. Vitamin B6 and Folic Acid (Vitamin B9) are especially important for early development, so make sure the right amounts of these are obtained.
Month 2 – Week 5-9
At two months pregnant, a baby’s face continues its development. The eyelids are formed. Buds, which will eventually be limbs, begin to develop. Organs such as the brain, sensory organs, and the digestive tract begin to take shape. The cartilage in the embryo begins to be replaced by bone. By the end of the second month, the baby is about 1 inch long. After about six weeks, the baby’s heartbeat can be detected with an ultrasound. Prenatal vitamins, DHA omega-3s, and fish oil play a crucial role in supporting the healthy development of the baby during pregnancy.
Month 3 – Week 10-14
By the end of the 3rd month, the baby is fully formed with all organs and extremities present, weighing about an ounce (28 grams) and measuring 4 inches long. The limbs, as well as the hands, feet, fingers, and toes, become well-developed. The fingernails and toenails begin to form while the external ears and teeth develop. Although reproductive organs have started to form, they cannot yet be determined on an ultrasound or sonogram.
Month 4 – Week 15-19
Hair, eyelids, eyelashes, and nails undergo significant development. The heartbeat becomes distinctly audible when using a Doppler instrument. The teeth increase in density, and the baby starts to stretch, yawn, and engage in other movements. The reproductive organs become visible on an ultrasound. The baby is now capable of stretching, sucking their thumb, yawning, and making incredibly adorable facial expressions. This is the month that their nervous system develops. Their reproductive system also develops fully. By the end of the 4th month, the baby is about 6-7 inches long and weighs 4-5 ounces (113-141 grams).
Month 5 – Week 20-24
This month, the baby may start to move. Hair growth continues on the baby’s head and body. The shoulders and back become covered with a thin hair called lanugo. A thick substance called vernix caseosa covers the skin to keep it protected from exposure to amniotic fluid. This layer will be shed before the baby is born. At the end of month 5, the baby is about 10 inches long and can weigh anywhere from 0.5 lbs – 1 pound (226 to 453 grams). If the baby is born prematurely after the 23rd week, it will be kept in the NICU for a better chance of survival.
Month 6 – Week 25-30
The skin is still translucent yet reddish and wrinkled. Their fingerprints and toeprints become well-developed. The baby’s eyelids become parted, and the eyes can be opened. The baby will respond to external stimuli such as sounds by increasing their pulse or moving. This is when one may experience the baby’s hiccups in jerk-like motions. At the end of month 6, the baby is about 12 inches long and can weigh close to 2 pounds (907 grams).
Month 7 – Week 26-29
During this month, a baby will continue to grow and develop the existing organs and systems. In addition, a layer of fat will begin to be stored. At this stage, hearing is fully developed. The baby will react to sound, pain, and light and often changes position. The amount of amniotic
fluid that cushions the baby begins to decrease as the baby grows larger. At the end of this month, the baby is about 14 inches long and can weigh between 2 – 4 pounds (907- 1814 grams). If born prematurely after week 27, the baby has a better chance of survival.
Month 8 – Week 30-34
During this month, the baby matures, accumulating fat stores and undergoing rapid brain development. The baby’s vision is developed at this stage, and they will start kicking more frequently. While most internal organs and systems are fully developed, the lungs still require additional time to mature. By the eighth month, the baby’s length can reach approximately 18 inches, and its weight can be close to 5 lbs (2267 grams).
Month 9 – Week 35-40+
The lungs become mature during this time in preparation for birth. Reflexes become more coordinated, allowing the baby to respond to sounds, blink, grasp, and turn their head. The baby may move less during the last few weeks and will move into a position for birth with the head down near the birth canal. The baby is now about 18-20 inches long and can weigh at least 7 lbs (3175 grams).
How much weight gain is recommended during pregnancy?
Various factors influence the appropriate weight gain during pregnancy, such as the individual’s weight before pregnancy and their body mass index (BMI). General guidelines for weight gain are:
Pre-pregnancy weight | Recommended weight gain |
Underweight (BMI below 18.5) | about 13 to 18 kg |
Healthy weight (BMI 18.5 to 24.9) | about 11 to 16 kg |
Overweight (BMI 25 to 29.9) | about 7 to 11 kg |
Obese (BMI 30 or more) | about 5 to 9 kg |
What are the vaccines given during pregnancy?
Three vaccinations are generally recommended for pregnant women in India. These vaccines comprise Tetanus Toxoid (TT), Tdap (Tetanus, Diphtheria, and Pertussis), and the Influenza vaccine.
- Tetanus Toxoid (TT): To prevent Tetanus, the national immunization schedule in India suggests the Tetanus Toxoid (TT) vaccine for pregnant women. It is advised to receive a minimum of two doses of TT injection during pregnancy, with a gap of at least 28 days between doses. Suppose the woman’s immunization status is unknown, or she has not been previously vaccinated. In that case, two doses should be administered before delivery, with the second dose completed four weeks prior to delivery.
- Tdap (Tetanus, Diphtheria, and Pertussis): The ideal time to administer the TDAP vaccine is between 27-36 weeks of pregnancy, which ensures higher levels of antibodies in the foetus. This vaccine plays a vital role in preventing Pertussis and its potential complications for both the mother and the newborn.
- Influenza Vaccine: World Health Organization and Centers for Disease Control and Prevention (CDC) strongly recommend Influenza vaccination during pregnancy. All pregnant women should receive the inactivated influenza vaccine. It is primarily recommended during the second and third trimesters but can also be given in the first trimester.
What is prenatal or antenatal care, and why is it important?
Women who suspect they might be pregnant should arrange an appointment with their gynaecologist/OB-GYN to initiate prenatal care. Prenatal visits typically involve a physical examination, weight monitoring, and providing a urine sample. Depending on the pregnancy stage, a gynaecologist/OB-GYN may conduct blood tests and imaging tests like ultrasound scans. These visits also include discussions about the mother’s health, the foetus’s health, and any concerns regarding the pregnancy.
Pre-pregnancy and prenatal care play a crucial role in preventing complications and educating women on essential measures to safeguard their babies and ensure a healthy pregnancy. Through regular prenatal care, women can:
- Minimize the risk of pregnancy complications: Managing pre-existing conditions such as high blood pressure and diabetes is vital in preventing severe complications and their repercussions.
- Decrease the likelihood of complications for the foetus and infant: Research has shown that tobacco smoke and alcohol consumption during pregnancy can heighten the risk of sudden infant death syndrome. Alcohol intake also raises the chances of foetal alcohol spectrum disorders, which can lead to various issues like abnormal facial features, microcephaly, poor coordination, memory deficits, intellectual disabilities, and problems with the heart, kidneys, or bones.
- Ensure the safety of medications taken: Certain medications, including specific acne treatments and dietary or herbal supplements, should be avoided during pregnancy as they can harm the foetus
What is a high-risk pregnancy?
A high-risk pregnancy is one that threatens the health or life of the mother or her foetus. It often requires specialized care from specially trained doctors.
Risk factors for a high-risk pregnancy can include:
- Existing health conditions, such as high blood pressure, diabetes, or being HIV-positive
- Overweight and obesity: Obesity increases the risk for high blood pressure, preeclampsia, gestational diabetes, stillbirth, neural tube defects, and caesarean delivery. Recent studies conducted by researchers at the National Institute of Child Health and Human Development (NICHD) have revealed that infants born to obese mothers have a 15% higher risk of heart problems at birth.
- Multiple births: The risk of complications is higher in women carrying more than one foetus (twins and higher-order multiples). Women with multiple pregnancies face a higher risk of experiencing complications like preeclampsia, premature labour, and preterm birth. It is worth noting that more than half of all twins and up to 93% of triplets are born before the completion of 37 weeks’ gestation.
What are warning symptoms and signs in pregnancy that need immediate attention?
- Severe pain in the abdomen
- Generalized weakness, easy fatigability, and breathlessness
- Vaginal bleeding in early pregnancy
- Excessive swelling in the legs
- Excessive nausea and vomiting
- Convulsions
- High fever
- Burning in the urination
Pregnancy experience varies from woman to woman. Common symptoms of early pregnancy include missed periods, breast soreness or tenderness, increased fatigue, and nausea (morning sickness). If a woman suspects she might be pregnant, consider taking an at-home pregnancy test. These tests are widely available at pharmacy stores and provide highly accurate results. In case of a positive outcome, it is advisable to contact a gynaecologist/OB-GYN. Early prenatal care is crucial for maintaining the health of both the mother and the foetus.
References
- Eunice Kennedy Shriver National Institute of Child Health and Human Development. Pregnancy. Available from: https://www.nichd.nih.gov/health/topics/pregnancy. Accessed on 17th May 2024
- Eunice Kennedy Shriver National Institute of Child Health and Human Development. What is prenatal care, and why is it important? Available from: https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care. Accessed on 17th May 2024
- Eunice Kennedy Shriver National Institute of Child Health and Human Development. What is a high-risk pregnancy? Available from: https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/high-risk. Accessed on 21st May 2024
- Cleveland Clinic. Am I pregnant? Available from: https://my.clevelandclinic.org/health/articles/9709-pregnancy-am-i-pregnant. Accessed on 17th May 2024
