Pregnancy

This article focuses on human pregnancy. For pregnancy in mammals, see Pregnancy (mammals). For a broader view, see gestation. For the medicine of pregnancy, see obstetrics.

A pregnant woman near the end of her term

Pregnancy is the carrying of one or more embryos or fetuses by female mammals, including humans, inside their bodies. In a pregnancy, there can be multiple gestations (for example, in the case of twins, or triplets). Human pregnancy is the most studied of all mammalian pregnancies.

Childbirth usually occurs about 38 weeks from fertilization, i.e. approximately 40 weeks from the start of the last menstruation. Thus, pregnancy lasts about nine months, although the exact definition of the English word “pregnancy” is a subject of controversy. The medical term for a pregnant female human is genetalian, although this term is rarely used in common speech. The term embryo is used to describe the developing human during the initial weeks, and the term fetus is used from about two months of development until birth. A woman who is pregnant for the first time is known as a primigravida or "gravida 1", while a woman who has never been pregnant is known as "gravida 0". Similarly, the terms "para 0", "para 1" and so on are used for the number of times a woman has given birth.

In many societies' medical and legal definitions, human pregnancy is somewhat arbitrarily divided into three trimester periods, as a means to simplify reference to the different stages of fetal development. The first trimester period carries the highest risk of miscarriage (natural death of embryo or fetus). During the second trimester the development of the fetus can start to be monitored and diagnosed. The third trimester marks the beginning of viability, or the ability of the fetus to survive, with or without medical help, outside of the mother's womb.

See also Pregnancy terms and definitions

Determining the start of pregnancy and predicting date of birth

See also: Gestational age

Before pregnancy begins, a female oocyte (egg) must join, by spermatozoon in a process referred to in medicine as "fertilization", or commonly known as "conception" (though the definition of the English word "conception" is somewhat controversial). Fertilization occurs usually through the act of sexual intercourse, in which a man ejaculates inside a woman, thus releasing his sperm; however, the advent of artificial insemination has made it possible for women to become pregnant if pre-existing medical conditions from either the woman or the man make fertilization through sexual intercourse difficult, or if a woman chooses to become pregnant without a male partner, for any number of reasons. Though pregnancy begins at implantation, it is often convenient to date from the first day of a woman's Last Menstrual Period (LMP). This is used to calculate the Expected Date of Delivery (EDD).

Traditionally a human pregnancy is considered to last approximately 40 weeks (280 days) from the LMP, or 38 weeks (266 days) from the date of fertilization. The 38 weeks of gestation is 9 lunar months. In the more familiar Gregorian calendar, the 40 weeks dating from the LMP is equivalent to a little more than nine months and six days, and this forms the basis of Naegele's rule of approximating the EDD. A pregnancy is considered to have reached term between 37 and 43 weeks from the beginning of the last menstruation. Babies born before the 37 week mark are considered premature, while babies born after the 43 week mark are considered postmature.

Though these are the averages, the actual length of pregnancy depends on various factors. For example, the first pregnancy tends to last longer than subsequent pregnancies. Fewer than 10% of births occur on the due date; 50% of births are within a week of the due date, and almost 90% within two weeks. The due date is typically calculated as 40 weeks from the last menstrual period.

An accurate date of fertilization is important, because it is used in calculating the results of various prenatal tests (for example, in the triple test). A decision may be made to induce labour if a fetus is perceived to be overdue. Due dates are only a rough estimate, and the process of accurately dating a pregnancy is complicated by the fact that not all women have 28 day menstrual cycles, or ovulate on the 14th day following their last menstrual period. Approximately 3.6% of all women deliver on the due date predicted by LMP, and 4.7% give birth on the day predicted by sonograph.

The beginning of pregnancy may be detected in a number of ways, including various pregnancy tests which detect hormones generated by the newly-formed placenta. Clinical blood and urine tests can detect pregnancy soon after implantation, which is as early as 6-8 days after fertilization. Home pregnancy tests are personal urine tests, which normally cannot detect a pregnancy until at least 12-15 days after fertilization. Both clinical and home tests can only detect the state of pregnancy, and cannot detect its age.

In the post-implantation phase, the blastocyst secretes a hormone named human chorionic gonadotropin which in turn, stimulates the corpus luteum in the woman's ovary to continue producing progesterone. This acts to maintain the lining of the uterus so that the embryo will continue to be nourished. The glands in the lining of the uterus will swell in response to the blastocyst, and capillaries will be stimulated to grow in that region. This allows the blastocyst to receive vital nutrients from the woman. Pregnancy tests detect the presence of human chorionic gonadotropin. An early sonograph can determine the age of the pregnancy fairly accurately. In practice, doctors typically express the age of a pregnancy (i.e. an "age" for an embryo) in terms of "menstrual date" based on the first day of a woman's last menstrual period, as the woman reports it. Unless a woman's recent sexual activity has been limited, the exact date of fertilization is unknown. Absent symptoms such as morning sickness, often the only visible sign of a pregnancy is an interruption of her normal monthly menstruation cycle, (i.e. a "late period"). Hence, the "menstrual date" is simply a common educated estimate for the age of a fetus, which is an average of two weeks later than the first day of the woman's last menstrual period. (The margin of error is 0 to 30 days after last menstruation, hence a 14 day average.) The term "conception date" may sometimes be used when that date is more certain, though even medical professionals can be imprecise with their use of the two distinct terms. The due date can be calculated by using Naegele's rule.

Pregnancy symptoms

Symptoms of pregnancy may vary from woman to woman and even pregnancy to pregnancy. While not all will occur with every pregnancy and some symptoms are in fact rare, following is a list of some of the potential symptoms of pregnancy.

• Implantation, the female body begins to adjust to prenatal stage. There may be some twinge associated with implantation. (Generally 7-10 after fertilization.)
• Delayed or difference in menstruation.
• Minor vaginal bleeding (spotting).
• Swollen or tender breast, minor lactation in third trimester.
• Fatigue, also may experience sleeplessness.
• Nausea, sometimes accompanied by vomiting, esp. the first trimester, most likely to start at around 7 weeks. (morning sickness).
• Lower backaches, but few pregnant women had serious back pain.
• Headaches, some may reach migraine level in others.
• Long frequent hiccuping spells.
• Enlarged feet and hands, or expanded buttocks.
• Frequent urination, sometimes random "drips" of urine.
• Constipation, but a few encounter random defecation.
• Food cravings, or increased appetite.
• Rational fear of increasingly imposing burden.
• Heartburn or upset stomach, but rarely may accompany vomiting.
• Stomach/intestinal gas, may be frequently flatulent or belch.
• Difficulty in walking and balance, some may be put on bedrest.
• Difficulty with contact or vision prescriptions.

Symptoms of pregnancy do not allow for a pregnancy diagnosis because each of these symptoms has the potential to be explained by other reasons (e.g. missing a period because of stress).

Pregnancy does have a minor, but noticed psychological effect by hormonal changes and chemical reactions in some women, known as "mood swings" that are controlled. She may experience periods of enhanced content, excitement or fickleness, and melancholy, anxiety or angst, but it often depends on how the pregnant woman views herself and attitudes on her condition in various ways.

Terminology

There are likewise finer distinctions between the concepts of fertilization and the actual state of pregnancy, which starts with implantation. In a normal pregnancy, the fertilization of the egg usually will have occurred in the Fallopian tubes or in the uterus. (Often, an egg may become fertilized yet fail to become implanted in the uterus.) If the pregnancy is the result of in-vitro fertilization, the fertilization will have occurred in a Petri dish, after which pregnancy begins when one or more zygotes implant after being transferred by a physician into the woman's uterus.

In the context of political debates regarding a proper definition of life, the terminology of pregnancy can be confusing. Because precise assessment of a pregnancy as being at the "embryo" or "fetus" stage is usually undeterminable, the terms (though more clinically precise) are less commonly used than terms like "baby" or "child." The medically and politically neutral term which remains is simply "pregnancy," though this can be problematic as it only refers indirectly to the embryo or fetus. In the context of personal treatment, bedside manner generally dictates that doctors make sparse use of clinical language like "fetus" and "embryo," and instead simply refer to the developing child as a "baby", though this is not medically accurate.

Detection

The early stages of pregnancy are often discovered by using a pregnancy test. There is no possible way to detect pregnancy until the 22nd day after fertilization. In the post-implantation phase the blastocyst secretes a hormone named human chorionic gonadotropin which in turn, stimulates the corpus luteum in the woman's ovary to continue producing progesterone. This acts to maintain the lining of the uterus so that the embryo will continue to be nourished. The glands in the lining of the uterus will swell in response to the blastocyst, and capillaries will be stimulated to grow in that region. This allows the blastocyst to receive vital nutrients from the woman. Pregnancy tests detect the presence of human chorionic gonadotropin.

Timeline of a typical pregnancy

The term trimester redirects here. For the term trimester used in academic settings, see Academic term

Pregnancy is typically broken into three periods, or trimesters, each of about three months. While there are no hard and fast rules, these distinctions are useful in describing the changes that take place over time.

First trimester

Comparison of growth of the fetus between 26 weeks and 40 weeks gestation.

Traditionally, doctors have measured pregnancy from a number of convenient points, including the day of last menstruation, ovulation, fertilization, implantation and chemical detection. In medicine, pregnancy is often defined as beginning when the developing embryo becomes implanted into the endometrial lining of a woman's uterus. In some cases where complications may have arisen, the fertilized egg might implant itself in the fallopian tubes or the cervix, causing an ectopic pregnancy. Most pregnant women do not have any specific signs or symptoms of implantation, although it is not uncommon to experience light bleeding at implantation. Some women will also experience cramping during their first trimester. This is usually of no concern unless there is spotting or bleeding as well. The outer layers of the embryo grow and form a placenta, for the purpose of receiving essential nutrients through the uterine wall, or endometrium. The umbilical cord in a newborn child consists of the remnants of the connection to the placenta. The developing embryo undergoes tremendous growth and changes during the process of embryonic and fetal development.

Morning sickness afflicts about seventy percent of all pregnant women, typically only in the first trimester. Most miscarriages occur during this period.

A pregnant woman at 26 weeks.

Second trimester

Months 4 through 6 of the pregnancy are called the second trimester. Most women feel more energized in this period, and begin to put on weight as the symptoms of morning sickness subside and eventually fade away. Although the fetus begins moving and takes a recognizable human shape during the first trimester, it is not until the second trimester that movement of the fetus, often referred to as "quickening", can be felt. This typically happens by the fourth month. The placenta is now fully functioning and the fetus is making insulin and urinating. The teeth are now formed inside the fetus' gums and the reproductive organs can be recognized, and can distinguish the fetus as male or female.

Third trimester

Final weight gain takes place, and the fetus begins to move regularly. The mother's belly button will sometimes "pop" out due to her growing belly. This period of her pregnancy can be uncomfortable, causing symptoms like weak bladder control and back-ache. Movement of the fetus becomes stronger and more frequent and the fetus prepares for viability outside the womb through improved brain, eye, and muscle function. The mother can feel the baby "rolling" and it may cause pain or discomfort when the baby is in the mother's ribs.

It is during this time that a baby born prematurely may survive. The use of modern medical intensive care technology has greatly increased the probability of premature babies living, and has pushed back the boundary of viability to much earlier dates than would be possible without assistance. In spite of these developments, premature birth remains a major threat to the fetus, and may result in ill-health in later life, even if the baby survives.

Prenatal development and sonograph images

See also: Prenatal Development

Prenatal development is divided into two primary biological stages. The first is the embryonic stage, which lasts for about two months. At this point, the fetal stage begins. At the beginning of the fetal stage, the risk of miscarriage decreases sharply, all major structures including hands, feet, head, brain, and other organs are present, and they continue to grow and develop. When the fetal stage commences, a fetus is typically about 30 mm (1.2 inches) in length, and the heart can be seen beating via sonograph; the fetus bends the head, and also makes general movements and startles that involve the whole body. Brain stem activity has been detected 54 days after conception. Some fingerprint formation occurs from the beginning of the fetal stage.

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  Relative size in 1st Month (simplified illustration)
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  Relative size in 3rd Month (simplified illustration)
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  Relative size in 5th Month (simplified illustration)
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  Relative size in 9th Month (simplified illustration)

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  7 weeks
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  13 weeks
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  17 weeks
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  20 weeks

Food and nutrition during pregnancy

It is important for an expectant mother to eat a healthy diet. Unless she has a specific health problem (e.g., diabetes mellitus or edema) common sense nutritional advice should be followed: balancing carbohydrates, fat, and proteins; and eating a variety of foods, including dairy products and several fruits and vegetables, daily. A pregnant woman should consult her obstetrician for specific advice. Some specific nutritional needs for pregnancy include:

Folic acid (also called folate or Vitamin B9) is strongly needed at the start of pregnancy, and even before conception. Folic acid is needed for the closing of fetus' neural tube. It thus helps prevent spina bifida, a very serious birth defect. Folates (from folia, leaf) are abundant in spinach (fresh, frozen or canned), and are also found in green vegetables, salads, melon, and hummus. In the United States, most wheat products (flour, noodles) are supplemented with folic acid.

Calcium and iron are particularly needed by the rapidly growing fetus. Pregnant women should eat enough dairy products (for calcium) and red meat (for iron) if they are not vegetarian. Women are often prescribed iron pills, since many young women get slight anemia. Calcium is effective only if women also obtain enough Vitamin D. The best way to get vitamin D is to sunbathe each day for 10-15 min. Salmon and fatty fishes are also a good sources of vitamin D.

Fluoride helps to build strong teeth by changing the nature of calcium crystals: if water or salt does not contain fluoride, it is wise to take fluoride mini-pills at the end of pregnancy and during breast-feeding (but high doses are toxic). In many American cities, drinking water is supplemented with fluoride. Some pregnant women suffer edema, and are told not to eat (too much) salt.

Fat from salmon, trout, tuna, herring, sardine, and mackerel contain long-chain omega 3 (n-3) fatty acids that are needed to build neurone membranes. Thus fatty fish intake during pregnancy may provide nutrition for proper brain and retina development of the fetus. However, large fish such as tuna and swordfish may contain too much toxic mercury, and one should balance risks with benefits: fish two or three times a week seems to bring enough good fat, but not too much mercury.

Dangerous bacteria or parasites may contaminate foods, particularly listeria and toxoplasma, toxoplasmosis agent. To avoid those two hazards, hygiene rules should be strictly adhered to: carefully wash fruits and raw vegetables; over-cook remainders, meat and processed meat; avoid raw-milk cheeses (listeria); try to avoid contact with cat feces (toxoplasma); clean the fridge often with diluted chlorine (then rinse).

Medical aspects of pregnancy

Main article: Obstetrics

Diagnostic criteria are: In a woman who has regular menstrual cycles and is sexually active, a period delayed by a few days or weeks is suggestive of pregnancy; elevated B-hcG to around 100,000 mIU/mL by 10 weeks of gestation.

Prenatal medical care is of recognized value throughout the developed world. Various Vitamins or supplements are recognized as beneficial during pregnancy. Prenatal multivitamins as well as folic acid as well as the choline available from lecithin have either government approval or published studies supporting their use. Folic acid reduces birth defects. Prenatal Choline derivable from lecithin improves the performance of rats on mental tests throughout the rats entire life. [1] Omega 3 fatty acids support the mental and visual development of infants they are also beneficial postpartum. [2]

Birth

Main article: Childbirth

Childbirth is the process by which an infant is born. It is considered by many to be the beginning of a person's life, and age is defined relative to this event in most cultures.

A woman is considered to be in labour when she begins experiencing regular uterine contractions, accompanied by changes of her cervix — primarily effacement and dilation. While childbirth is widely experienced as painful, some women do report painless labours, while others find that concentrating on the birth helps to quicken labour and lessen the sensations. Most women are capable of having a normal birth but sometimes complications arise and a woman may need to undergo a caesarean section.

During the time immediately after birth, both baby and mother are hormonally cued to bond, the mother through the release of oxytocin,a hormone also released during breastfeeding.

Postnatal period

Main article: Postnatal

For topics following on from a successful pregnancy and birth, see:

• Breastfeeding
• Child development
• Postpartum depression

Medical disorders in pregnancy

Most potentially serious problems can be anticipated and treated effectively. However, problems sometimes develop suddenly and unexpectedly. Regular visits to a doctor or midwife during pregnancy make anticipation of problems possible and improve the chances of having a healthy baby.

Approximately 4 million births occur in the United States each year. A significant proportion of these are complicated by one or more medical disorders . A small percentage of pregnant women or new mothers have AIDS, cancer, heart disease, lung disease, physical disabilities, diabetes and pyschiatric disorders like depression.

Two decades ago, many medical disorders were contra-indications to pregnancy. Advances in obstetrics, neonatology, obstetric anesthesiology, midwifery and medicine have increased the expectation that pregnancy will result in an excellent outcome for both mother and fetus despite most of these conditions. Certain medications deemed unharmful to the fetus may be highly neccessary to the welfare and benefit of the mother, especially if she has an unborn child.

A rare but possibly under-diagnosed disorder in pregnancy is Hyperemesis gravidarum, a condition in which morning sickness is constant and extreme, resulting in dehydration and malnutrition, due to frequent vomiting.

Terms and definitions

Technical

• embryo - conceptus between time of fertilization to 10 weeks of gestation
• fetus - from 10 weeks of gestation to time of birth
• Ga Pw-x-y-z - a = number of pregnancies, w = number of term births, x = number of preterm births, y = number of miscarriages, z = number of living children; for example, G4P1-2-1-3 means the woman had a total of 4 pregnancies, of which 1 is of term, 2 are preterm, 1 miscarriage, and 3 total living children (1 term + 2 preterm).
• Gestational age - time from last menstrual period (LMP) up to present
• gravidity (G) - number of times a woman has been pregnant
• infant - time of birth to 1 year of age
• parity (P) - number of pregnancies with a birth beyond 20 weeks GA or an infant weighing more than 500 g
• preterm infant - delivered between 24-37 weeks
• previable infant - delivered prior to 24 weeks
• term infant - delivered between 37-42 weeks
• first trimester - up to 14 weeks of gestation
• second trimester - 14 to 28 weeks of gestation
• third trimester - 28th week to delivery
• viability - minimum age for fetus survival, ca. third trimester
• zygote - from fertilization until second cell division
• full term refers to the end of 36 weeks (nine months) from the first day of the mother's last menstrual period — the end of gestation. If a woman gives birth earlier than this, it is classed as a premature birth.

Euphemisms and colloquialisms

There are a number of euphemisms and colloquialisms for pregnancy, ranging from polite to crude, and even comical ("self-humor") terms/phrases originated from pregnant women themselves including: "Mother to be", "with child", "expecting", "up the duff", and "bun in the oven".

Regional customs

In Korea, China, and Vietnam, age is measured starting from conception to acknowledge that the baby exists within the mother’s body before it is born. Therefore, a newborn baby is considered to be one year old.

The ancient Mayan calendar of 276 days possibly originated from the human gestational cycle, or to indicate the world was created as slowly as a baby develops.

See also

• List of pregnancy-related topics

References

• Mittendorf R, Williams MA, Berkey CS, Cotter PF. The length of uncomplicated human gestation. Obstet Gynecol 1990;75:929-32. PMID 2342739.
• Nguyen T, Larsen T, Engholm G, Møller H (1999). "Evaluation of ultrasound-estimated date of delivery in 17,450 spontaneous singleton births: do we need to modify Naegele's rule?". Ultrasound Obstet Gynecol. 14 (1): 23–8. PMID 10461334.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Medical Disorders During Pregnancy. N Engl J Med 333:1737, 2002.
• Pregnancy Symptoms. American Pregnancy Association, 2005.

External links

• Fetal Development Photos and information
• Pregnancy Week to Week Information about every week of pregnancy
• Early pregnancy: Morning sickness, fatigue and other common symptoms, from MayoClinic.com
• Normal Pregnancy, Labor, And Delivery (Merck Manual)
• Pregnant Women's Rights
• Wagner, Marsden. Welcoming Baby, or Not: Are men, machines, and hospitals really necessary for a healthy childbirth? American Sexuality Magazine. Accessed 3-27-07.