The pregnancy (technical terminology also gestation or pregnancy , Latin graviditas ) is the period in which a fertilized egg in the body of an expectant mother matures to a child. The normal course of human pregnancy from conception to birth lasts an average of 38 weeks, with a range of several weeks. During the first eight weeks after the egg is fertilized, the developing child is called an embryo . After the internal organs are formed (from the ninth week of development), the term fetus (also fetus ) is used.
The adjective pregnant ( ahd . Swangar , mhd . And mnd . Swanger ) is detectable in unchanged significance since the 8th century, that is already in some of the oldest evidence of the German language. The further derivation is not entirely clear. An exact equivalent can only be found in Dutch zwanger , which is a late loan (16th / 17th century) from German. Safely used otherwise only the old English swongor, swangor , "heavy, cumbersome, slow, sluggish," in probably the original, on indogermanisch the su (s) nk (be difficult, cumbersome, pregnant ') recyclable meaning of the word ( West or early Germanic (?) * swangra ), maybe you can also follow the Lithuanian sunkùs , "arduous."
The noun pregnancy is generally only used in relation to humans, other viviparous mammals ( Eutheria ) are referred to as “ gestation ”. In medical terminology, pregnancy is also referred to using the Latin terms graviditas or gestatio , which is also Germanized as "pregnancy" or "gestation". Events that occur during pregnancy are referred to as " prepartal ", "antepartal" or "peripartal", if they affect the mother ( e.g. antenatal hemorrhage ), but as " prenatal ", "antenatal" or "perinatal", see above they affect the fetus (e.g. prenatal growth retardation ).
Redensartlich there are numerous euphemisms for pregnancy. A widespread euphemism is “to be in circumstances” (also in “other circumstances” or “special circumstances”); it is thanks to it that the term “ maternity clothing” for garments that take the “baby bump” of pregnant women into account. In English it corresponds to the phrase interesting condition (literally "interesting condition"), which plays a significant role in the interpretation of a work of world literature: noted in William Makepeace Thackeray's novel Vanity Fair (1847/1848, German " Vanity Fair " ) the narrator casually states that the protagonist Amelia Sedley - one of the most chaste virgins in English literature - is in a most interesting situation , but this is already in the 26th chapter, well before her wedding. “Carrying a child under your heart” goes back to Martin Luther's translation of the Bible ( Tob 4,4 and 2 Makk 7,27), but like “being in good hope” is almost only used ironically. Obsolete are “heavy bodies” or “blessed bodies”, and in a raised way “looking forward to the joys of motherhood”. A crude but widespread idiom is “having a roast in the oven.” Neutral and commonly used is “expecting a child”, “expectant mother” is also harmless for “pregnant woman”, but the term “unborn child” is ideologically charged "And especially strongly charged" developing life "for the fetus, since it is used in the social debate about abortion above all by anti-abortionists (the" right to life movement "), but their opponents use it as a fighting term . In jurisprudence, the Latin term nasciturus (“who will be born”), which is actually synonymous, is discursively neutral and is often used instead.
Determination of pregnancy
The onset of pregnancy can be determined in a variety of ways only a few days after intercourse. In differentiating it from pseudo-pregnancies, a distinction is made between uncertain , probable and certain signs of pregnancy. Missing menstrual periods, morning vomiting, and nausea are uncertain signs of pregnancy. A pregnancy test by measuring the levels of the “pregnancy hormone” ( hCG hormone ) in the blood or urine is a likely but not certain sign of pregnancy. Proof of a fetus is considered certain, for example by sonography , hearing heart sounds or feeling the child's movements.
If the first ultrasound examination is carried out before or at the beginning of the fifth week of pregnancy, an embryonic system, especially in the vicinity of the fallopian tubes, can sometimes not yet be shown, despite the existing pregnancy. This is also known colloquially as a corner stool .
Calculation of the due date
Pregnancy lasts an average of 268 days from conception to birth. Usually, however, the duration of pregnancy is calculated from the first day of the last menstruation , as this is the only known reference value for many women. The calculation is based on the Naegele rule , which also includes the duration of the menstrual cycle. According to this calculation method, fertilization takes place in the second week of pregnancy (SSW).
Pregnancy, calculated from the first day of the last menstruation , lasts on average about 280 days or 40 weeks. Traditionally, the duration of pregnancy is given as nine months. For the sake of simplicity, doctors assume months of four weeks each (so-called lunar months, which are one to two days shorter than astronomical or calendar lunar months, see lunation ); pregnancy therefore lasts ten lunar months instead of nine calendar months.
Exactly on the day of the calculated date, 4 percent of the children are born, within one week (date ± 3 days) around the calculated due date around 26% and within three weeks (= ± 10 d) around the calculated due date 66%. Birth before the 37th week of pregnancy (-21 days) is called premature birth .
In industrialized countries, especially at an early stage of pregnancy, the actual progress of the pregnancy is verified by means of ultrasound examinations .
Course of pregnancy
The course of pregnancy is divided into three sections of three months (medical trimester or trimester), or 13 weeks of pregnancy. The term trimester was introduced by Ernst Moro .
The age of pregnancy from the day of conception is called post conceptionem , pc. Since the date of conception (syn. Conception date ) can seldom be precisely determined, in medicine it is calculated from the first day of the last menstruation, post menstruationem (pm). The age of the embryo / fetus is effectively about two weeks less than the week of pregnancy (SSW). In the following, the length of pregnancy is given in SSW (pm) without further notice.
The embryo develops particularly quickly in the first trimester. For pregnant women, the beginning of pregnancy is associated with very large hormonal changes, which in around 50 to 90% of those affected leads to very pronounced nausea in some cases, and in 25 to 50% to vomiting, which usually occurs as the pregnancy progresses again lays. From the third week on, the sensitivity of the breast can increase, usually accompanied by a feeling of tension. Since most spontaneous abortions ( disposals ) through twelfth SSW happen is by this time often not notify pregnancy.
- Weeks 3-4 of pregnancy: fertilization and implantation
The naturally during sexual intercourse (also artificial u. U.) or at the insemination in the vagina reached sperm pass through the womb (uterus) to the ampulla of the oviduct . There they meet the egg cell picked up by the fimbrial funnel after ovulation . After penetration ( impregnation ) there is a second maturation with loss of a polar body . The two sets of chromosomes of egg and sperm merge with each other ( conjugation ) and now form a viable cell ( zygote ), which migrates into the uterus under hormonal control within three days . During this time, the cells divide via the morula to the germinal vesicle or blastocyst . 24 hours after fertilization, the cells of the early form of the placenta ( placenta ) - the so-called syncytiotrophoblast - start producing the hormone hCG . This stimulates the release of another hormone, progesterone , in the corpus luteum in the ovary , which signals to the ovaries that no ovulation is necessary for the near future - menstruation does not occur. At the same time, these hormones loosened up the lining of the uterus to make it easier for the blastocyst to implant. The implantation in the uterine wall begins around the fifth day after fertilization and is completed after 14 days. Until then, twinning is possible. The blastocyst now divides into its outer layer, the trophoblasts , from which the placenta develops, and the embryoblasts , from which the embryo develops. The tissue connecting the two parts becomes the umbilical cord .
- Weeks of pregnancy 5-8: creation of the larger organs
The pregnant woman's body is now adjusting to the pregnancy. This is very common with symptoms such as morning sickness , nausea and vomiting during pregnancy linked by the pregnancy hormone hCG trigger. In addition, severe fatigue, food cravings and mood swings are common. The first amniotic fluid begins to form. Stretching the ligaments of the mother sometimes causes a pull in the groin area .
In the embryo, the spine gradually begins to form in the sixth week. The neural tube that gives rise to the brain and spinal cord closes at the end of the sixth week. The heart activity can now be detected in the ultrasound. By the seventh week, the head and torso begin to take shape. You can see small buds from which the limbs will later develop. The embryo now measures approx. 3 to 8 mm (crown-rump length). At the end of the eighth week, the places on the hand plates can be seen where the fingers will later develop. Eye and ear systems become visible. Gradually all organs and organ systems are created. In the eighth week of pregnancy, the embryo measures 9 to 15 mm, and its heart beats 140 to 150 times a minute.
- Pregnancy week 9–12: Further differentiation
The amount of blood in the maternal circulation increases from approx. 5 to 6.5 l to ensure the supply of the fetus. Because of the larger amount of blood, the heart beats faster, which reduces physical performance. Spider veins or varicose veins can occur as a result of the hormonal vasodilatation . Occasionally there is also a stuffy nose , nosebleeds, or bleeding gums . Estrogens cause increased fluid storage in the tissue. The hormone progesterone relaxes the muscles. Since the sphincter muscles are also affected, an increased urge to urinate is often noticeable. This is reinforced by the increased metabolism between the pregnant woman and the embryo, also by the constant renewal of the amniotic fluid .
At the end of the ninth week, the first signs of the formation of toes and nose can be seen, in the tenth week also the auricles. The retina becomes pigmented. The pair of eyes are wide apart; the eyes are initially open, the eyelids begin to form. First movements are possible. At the end of the tenth week of pregnancy, all of the organs are present. The buds for the 20 milk teeth are formed. At the end of this phase (end of the twelfth week of pregnancy) the embryo is 5 to 6 cm in size and weighs around 14 g. The embryonic period is now being replaced by fetogenesis.
In the second stage of pregnancy, the initial complications such as nausea usually disappear. Because of this, and because the risk of a miscarriage has now decreased significantly, many women find this time very pleasant. While some still struggled with alternating emotions in the 1st trimester, this trimester is usually characterized by balance and satisfaction. For these reasons, midwives consider the second trimester to be an ideal time to travel. The first movements of the fetus can now be felt.
- 13-16 weeks of pregnancy: child movements
The more stable phase of pregnancy begins now. The production of hormones from the ovary is no longer required because the placenta has matured to the point where it can produce the pregnancy-maintaining hormones itself. This is why the hCG concentration is less high from the twelfth week of gestation onwards, and any morning sickness that may be present now usually improves. The rule of thumb is that the weight gain is approx. 1 to 1.5 kg per month or approx. 250 g per week. Reddish or brownish stretch marks , due to the stretching of the connective tissue occur. Often there is a dark line ( linea nigra ) that runs between the navel and the pubic bone . This hormone-related color change usually disappears after pregnancy. The increased water retention can lead to swelling of the arms and legs or hands and feet.
The fetus begins to grow rapidly in the fourth month and the organs continue to develop. The eyelids close and don't open again for three months. Spontaneous movements of the head, arms and legs set in. The swallowing muscles develop. The lungs and digestive system continue to develop as the fetus “inhales and exhales” or “drinks” amniotic fluid by contracting and expanding the diaphragm; it has hiccups. Salivary glands, stomach, kidneys and intestines are already working. The swallowed amniotic fluid is released back into the amniotic fluid as urine, which is replaced every ten to twelve hours by new production. The fetus receives nutrients and antibodies via the placenta, and waste materials are excreted at the same time. The so-called wool or lanugo hair forms. It almost disappears again by the time you are born. Towards the end of this month of pregnancy, the genitals develop. The sex can be determined by ultrasound if the unborn child is in a favorable position. At the 16th week of pregnancy the fetus is about 10 cm tall and weighs up to 100 g. Its head diameter is approx. 35 mm.
- Pregnancy week 17–20: child movements mostly noticeable
The uterus is now about the size of a honeydew melon and almost navel level. From the 18th to 20th week of pregnancy, the first child movements are usually felt as a fine, light tingling sensation. A relatively symptom-free period of pregnancy begins. However, changes in visual acuity , back pain, and leg cramps may occur during this period .
The fetus measures 14 to 16 cm at the end of the month and weighs between 150 and 300 g.
- Pregnancy week 21–24: the child begins to react to external stimuli
Towards the end of the month, the uterus reaches the level of the navel. The breasts enlarge under the influence of the hormones hCG , estrogen and progesterone . Heartburn may occur due to a change in the position of the stomach.
In the fetus, the subcutaneous fatty tissue begins to multiply. The skin itself is covered by a protective layer of fat (vernix caseosa, also cheese smear). This enables easier sliding in the birth canal later. The skin is still shimmering reddish, fingernails and toenails are almost completely developed. The hair begins to grow and the ossification of the skeleton progresses. The brain begins to grow rapidly. Towards the end of the month the expectant child reacts to acoustic and visual stimuli from outside (voices, sound, light). Whether pain perception is already possible at this point is controversial. An analysis of the existing research concluded that pain sensations before the third trimester are unlikely. At the end of the sixth month, the fetus is approx. 26 cm tall (from top to bottom) and weighs 500 g.
In the final stage of pregnancy, the fetus fully matures and the mother-to-be's body prepares for childbirth. For women, this section can be more uncomfortable again, mainly because of the extra weight, especially in summer. Through intensive medical treatment survival of the child is at a premature birth during this period already possible.
- Pregnancy weeks 25–28: opening the eyelids
In pregnant women, water retention in arms and legs can increase due to the high need for fresh amniotic fluid to exchange . The expanding uterus puts pressure on the digestive organs and the lungs , causing shortness of breath and the risk of hemorrhoids . The increased weight can cause back and foot pain in the last trimester. The discharge from the breasts ( colostrum ) can begin.
Towards the end of the month, the fetus's eyelids open again. It now measures around 35 cm and weighs around 1000 g. From about the 23rd week of pregnancy, the child has a small chance of surviving outside the uterus with a high level of intensive medical care. The chances of survival in the 25th week of pregnancy are approx. 32 to 43%, in the 28th week of pregnancy 79%. The earlier the child is born, the greater the risk of permanent damage to health. Before the end of week 25, this risk is 50%.
- Pregnancy week 29–32: First practice contractions
The first painless contractions (including downward pains , pre- pains , practice pains or preparatory pains ) can now occur. The abdomen hardens through rhythmic contraction of the uterus . It is possible that the sphincter and bladder weaknesses become apparent, which can be alleviated by training the sphincter. The growing uterus continues to displace the other organs in the abdomen. Due to the disturbed pH value of the vaginal mucous membrane , fungal infections or bacterial infections can occur more frequently.
Except for the lungs, all organs of the developing child are almost completely developed. At the end of the month, it measures around 40 cm and weighs 1700 to 2000 g.
- 33–36 weeks of pregnancy: lowering of the child
The pregnant woman gained an average of 10–12 kg. Towards the end of the 36th week of pregnancy, the child's head enters the small pelvis, and the uterus lowers slightly. Breathing becomes easier for the pregnant woman. Sleep disturbances often occur now.
From the 35th week of pregnancy, lung maturation is complete. Most unborn children (92 to 93%) are now in the correct birth position with their heads down. Up to the 37th week of pregnancy, the child can turn from a breech position to a skull position . Movements are only possible to a limited extent for the child. Towards the end of the month it is around 45 cm tall and weighs around 2800 g.
- 37–40 weeks of pregnancy: Birth is imminent
The expectant mother's average weight gain over the course of pregnancy is approximately 10–15 kg. The weight of many pregnant women stagnates shortly before giving birth and can even lose weight easily. There may be more frequent contractions.
In the last few weeks, the child has mainly gained weight. It absorbs antibodies from the mother's bloodstream through the placenta . The baby measures approx. 48 cm to 54 cm at birth and weighs 2800 g to 4000 g. The diameter of the head is between 9.5 cm and 10.5 cm.
Pregnancy usually ends with the birth of the mother (the birth of the child). It can be announced by the following symptoms:
- through the onset of opening contractions (duration approx. 30 to 60 seconds, every ten minutes for a period of one to two hours)
- due to a possible slightly bloody discharge as a result of the loosening mucus plug from the cervix (a few days before the birth)
- the rupture of the membranes (the bursting of the amniotic sac)
- Diarrhea or vomiting
After the birth, the regression of pregnancy begins , i.e. the regeneration of the abdominal wall , uterus , pelvic floor muscles , vaginal canal, vagina and hormonal balance . The recovery time varies from person to person, but it lasts roughly as long as pregnancy.
Prenatal examinations and treatments
In Germany every mother-to-be has the right to care by a midwife or a doctor during pregnancy, at birth and a few weeks after the birth. In the case of an uncomplicated pregnancy, visits are initially recommended at an interval of four weeks after the pregnancy becomes known, from the 32nd week of pregnancy at an interval of two weeks and, if the due date is exceeded, every two days. All findings are entered in the mother passport (or mother-child passport in Austria).
The sonography , commonly known as ultrasound, is an imaging technique that has changed dramatically in recent decades, the medical practice of pre-natal examinations. Among other things, it enables monitoring of fetal development, the determination of multiple pregnancies and gender. Although ultrasound examinations are generally regarded as harmless for the unborn child, two social tendencies are still emerging: on the one hand, the production of two- and three-dimensional recordings for the family album, on the other hand, the limitation to the medically necessary number of ultrasound examinations (approx. One examination per trimester ).
In the case of obese mothers-to-be, imaging of the child using ultrasound is more difficult or not flawless. As malformations of the child often occur, especially in overweight women , experts recommend performing the examination in a sitting position from above or in a lateral position from the flank.
The aim of prenatal diagnostics is to identify diseases of the expectant mother and diseases or disabilities (e.g. Down syndrome / trisomy 21) in the growing child at an early stage or to calculate an individual probability. A positive diagnosis often implies an abortion from a medical indication as a treatment in the womb ( therapy in utero ) only a few cases is possible. Hence, many studies are controversial. Ethically questionable is, among other things, how an unborn life can be judged as worth living or not worth living, especially since reliable statements about the postnatal development of the child are only possible in comparatively few cases. In particular, the non-invasive methods of prenatal diagnosis such as the nuchal translucency measurement, the first-trimester screening or triple test , parents can often strongly psychologically burden, since they never reliable results, but only probabilities based on statistical averages indicate by she z. B. take into account the age of the mother, the condition of the embryo, etc. On the other hand, a DNA test based on a blood sample from the mother gives a reliable result from the 9th week of pregnancy, as the fetal DNA itself is examined, which can be detected in the mother's blood from this phase of pregnancy. A paternity test in the unborn is also possible with this method .
High risk pregnancy
The main goal of medical care is to identify possible or existing risks for pregnant women and their child. In 1990, 34% of all pregnancies in Germany were classified as high-risk pregnancies. The Bavarian Working Group for Quality Control speaks of 65% for 2002 and of around 73% in Lower Saxony.
The proportion of high-risk pregnancies among all pregnancies increased from 68.5 to 73.4 percent between 2001 and 2010. In fact, however, 95% of children born in Germany are born healthy. The high number of so-called “high-risk pregnancies” can be explained, among other things, by the fact that many couples nowadays plan to have children very late . As a consequence, pregnant women at risk receive additional medical services from the health insurance companies in addition to the standard services, such as more frequent checks, referrals to appropriate specialists, the use of other diagnostic tools such as amniotic fluid tests, hormone analyzes or, if necessary, admission to an obstetric center with intensive medical care.
The following factors, among others, lead to the classification of a risk pregnancy:
- Age under 18 years or over 35 years (first-time mothers) or over 40 years ( late mothers )
- Multiple pregnancies
- Many who have given birth to more than four children
- Sterility treatments
- two or more miscarriages prior to pregnancy
- Previous Birth Complications
- Rh incompatibility
- Positional anomalies of the child
- Gestational diabetes or diabetes , gestational high blood pressure
- prolonged use of medication, alcohol, nicotine or other drugs
- retarded growth or abnormally large child
- Changes in the amniotic fluid content
- acute general illnesses or infections
- Weak cervix (cervical insufficiency)
- Renal insufficiency or missing organs such as a kidney
- Coagulation disorders , such as factor V Leiden mutation
Complications and problems
During pregnancy, the mother can experience disturbances or impairments that only occur during pregnancy (medical gestures ). For other diseases such as deep vein thrombosis or the very rare sinus thrombosis , the pregnancy situation poses an increased risk; that for deep vein thrombosis is increased by a factor of 5 and affects 1–2 pregnant women per thousand. Some chronic diseases are less noticeable during pregnancy: for example, the frequency of relapses in pregnant women with multiple sclerosis or rheumatoid arthritis may be reduced during pregnancy.
Every year around 600,000 women and girls worldwide die from complications during pregnancy or childbirth, 99% of them in developing countries. In sub-Saharan Africa, one in 16 women dies as a result of pregnancy or childbirth, as the majority of births occur even with complications without medical care. In developed countries the risk is 1: 2800.
According to the time it occurs, the gestosis is divided into early (first trimester ) and late gestosis (third trimester). The main representatives are excessive vomiting ( hyperemesis gravidarum ) and pregnancy-induced high blood pressure ( pregnancy hypertension ). High blood pressure can be a sign of the onset of preeclampsia , so it is measured regularly in prenatal care. Other symptoms are water retention ( edema ) and protein excretion in the urine . The eclampsia is the most severe form of preeclampsia, symptoms include convulsions and / or loss of consciousness. Most of the patients had previously had preeclampsia. Osteoporosis can rarely occur.
Mental illnesses in pregnancy
A large-scale English study reports on the accumulation of depression during pregnancy (see also pregnancy depression ), around 10% of all women are affected by it. The symptoms can be extremely different. The main symptom is a lowered mood, whereby this does not have to be sadness in the narrower sense, but is also often described by the patients concerned with terms such as “inner emptiness”, “despair” and “indifference”. Negative future prospects and a feeling of hopelessness dominate. Self-esteem is low. The depressive symptoms during pregnancy are often influenced by “issues” typical of pregnancy. These could be concerns about the role of mother or the child's health. The first occurrence of a psychotic disorder during pregnancy is rare. Existing psychotic illnesses are more likely to get worse. On the one hand, this is due to the special biological and emotional situation of the pregnant woman; on the other hand, it can be caused by a reduction in or discontinuation of antipsychotic medication. Obsessive-compulsive disorder can get worse during pregnancy. In the panic disorder that is also the case. Some patients who previously had only mild symptoms can experience a massive accumulation of panic attacks during pregnancy.
Addictive substances and drugs
- Psychotropic Substances
An English study (2012), which included around 4000 pregnant women, came to the result that even small amounts of alcohol have a negative effect on the child's intelligence. Even low alcohol consumption during pregnancy can lead to alcohol-related damage ( Fetal Alcohol Spectrum Disorder , FASD); The full picture of the disorder is the fetal alcohol syndrome (FAS), a combination of serious mental and physical damage that is one of the most common congenital disabilities in Germany. It is estimated that 10,000 babies are born with FASD nationwide each year, around 4000 of them with FAS.
Pregnant women who smoke have an increased risk of miscarriage , a doubling of the frequency of premature birth and a three times higher risk of stillbirth or perinatal mortality . The risk of the child having attention deficit / hyperactivity disorder (ADHD) is 16.5% for mothers who smoke during pregnancy, 4.6% otherwise - 3.6 times higher than for non-smokers . Smoking during pregnancy also increases the risk of later childhood asthma and results in a significantly lower birth weight. In particular, it can lead to fetal tobacco syndrome .
Cocaine and heroin
The use of cocaine can lead to malformations in the child and, due to the vasoconstricting effect, to circulatory disorders in various organs and pregnancy complications, for example premature placenta detachment and premature birth.
If a drug addict is planning to become pregnant, it is advisable to stop using the drug before the onset of pregnancy, as the effects of the drugs can affect the health of the fetus. If a woman who is addicted to heroin (or polytoxicomaniac ) becomes pregnant, admission to a substitution program is indicated as the fluctuations between satiety / overdose and withdrawal pose a risk to the pregnancy itself and the unborn child in particular. The benefits of substitution therapy for mother and child outweigh the dangers of a (possible) withdrawal syndrome in the newborn if the mother does not consume anything . In a study by the TU Dresden it was shown that approx. 58.9% of the people who take part in a substitution program consume additional substances. The substitution of the mother has an impact on the health and development of the fetus. There are numerous contraindications to the drugs administered during pregnancy in the substitution program . These are described in the respective technical and user information and package leaflets from the manufacturer and described by the approval of the medicinal product by the BfArM , such as: methadone .
Methaddict : Neurological findings with hearing impairment , mental and motor development delays , ocular abnormalities, and an increased incidence of otitis media were observed. It is recommended to gradually end the methadone substitution before birth . If tapering off is not possible, the newborn must be withdrawn in an intensive care unit.
L-polamidon : A connection between the consumption of L-polamidon and sudden infant death syndrome is assumed. There were neurological findings with hearing impairments , mental and motor development delays and eye abnormalities and an increased incidence of otitis media observed.
Subutex : Respiratory depression has been observed in newborns when high doses of Subutex were consumed towards the end of pregnancy (even after a short period of substitution). The reproductive toxicity for animals was experimental studies demonstrated. So far, the potential risk of reproductive toxicity to the pregnant woman and the fetus is unknown. Long-term use during the three months prior to delivery can lead to neonatal abstinence syndrome. For example, hypertension , neonatal tremor , neonatal agitation , myoclonus or convulsions were observed .
A high risk for the health of the fetus is the co- consumption , which can be carried out in addition to the participation in a substitution program. The Federal Institute for Drugs and Medical Devices (BfArM) warns "Abusive improper consumption of drugs / addictive substances / pharmaceuticals must in particular during pregnancy and breastfeeding are strictly avoided. ” According to a study by Ruthard Stachowske , who examined 100 in the specialist clinic and youth welfare facility“ Therapeutische Gemeinschaft Wilschenbruch ”in Lüneburg, the additional consumption of pregnant women while participating in a substitution program Pregnancies (of which 24 pregnancies occurred with substitution with concomitant consumption) was carried out for the following diseases: 22 of the children born suffered from neonatal abstinence syndrome up to 3 months after withdrawal ; had behavioral and emotional disorders . 21.7% of the mothers questioned had a premature birth . Out of 24 mothers, 21 mothers gave false information to their substitution doctor , such as fake drug tests . Further diseases and abnormalities are described in the scientific publication of the research work.
A naltrexone -load (the administration of an opioid - opponent ) should not be present since this can lead to miscarriage and premature onset of labor in pregnancy. The prenatal and postnatal care should be carried out in cooperation with the attending gynecologist and a specialist trained in addiction issues.
Data are inconsistent on the effects of marijuana use during pregnancy. Very often other substances such as cigarettes and alcohol are consumed at the same time; In addition, the study results could be falsified by socio-demographic risk factors. However, the available evidence suggests that it will adversely affect the growth of the fetus.
Cocaine and crack
If cocaine and crack are used during pregnancy , the risk of premature birth increases . The risk of a rupture of the placenta increases with the consumption of these drugs during pregnancy. Cocaine also increases the likelihood of birth defects , neurological problems, convulsions, and developmental problems.
Narcotics and opiates
If there is considerable and long-term consumption of narcotics and opiates during pregnancy , this has harmful consequences for the unborn child. It can lead to growth problems of the fetus, premature birth , permanent brain damage and a below-average head size.
Amphetamines and stimulants
There is little information about the side effects of amphetamine and stimulant use during pregnancy. However, it is known that these substances curb the appetite, which can impair the growth of the fetus. Research has shown that there is an increased risk of fetal growth problems, including a small head size. In addition, it can lead to a rupture of the placenta , permanent damage to the brain of the fetus. The consumption of amphetamines and stimulants during pregnancy can cause the fetus to die.
Almost all drugs, including those not sold in pharmacies , can also have special effects on the developing child. Therefore, the intake is usually discussed with the attending physician. Comprehensive overviews of drug use during pregnancy and breastfeeding are available; the German Federal Ministry of Health has been offering the database www.arzneimittel-in-der-schwangerschaft.de since 2008. Some drugs have a teratogenic effect (for example thalidomide ( Contergan ® )), which means that taking them can lead to malformations . Medicines (including over-the-counter and herbal products) should only be taken during pregnancy after consulting a doctor or pharmacist.
Infections during pregnancy
Infections can lead to miscarriages and can be transmitted to the unborn child or to the newborn child during birth and result in serious illness, permanent damage and death. Since there have been vaccinations for a few infectious diseases so far , the vaccination protection of the future mother should be checked and supplemented if necessary during the family planning phase. For example, the pathogens mentioned below can be dangerous during pregnancy.
- Chlamydia ( Chlamydia trachomatis ): Chlamydial conjunctivitis and pneumonia of the newborn
- Gonococci ( Neisseria gonorrhoeae ): Gonoblennorrhea
- Listeriosis ( Listeria monocytogenes ): Granulomatosis infantiseptica
- Group B streptococci ( Streptococcus agalactiae ): sepsis ( early-onset ) and meningitis ( late-onset ) in newborns
- Syphilis ( Treponema pallidum ): Lues connata
- Hepatitis B (hepatitis B virus, HBV)
- Hepatitis E (hepatitis E virus, HEV): only Asian genotype HEV-1, European type HEV-3 irrelevant in pregnancy
- Herpes simplex ( herpes simplex virus , HSV): Herpes neonatorum
- Human immunodeficiency virus (HIV): The HI virus is not necessarily transmitted from an infected pregnant woman to the unborn child. However, the likelihood of transmission during childbirth is high if proper medical protective measures are not in place. The risk of infection to a child by an HIV-infected mother during pregnancy or childbirth is estimated to be around 15 to 30% without treatment. If the mother is known to be infected with HIV, the risk of transmission to the child can be reduced to less than five percent by administering antiretroviral drugs and giving birth by caesarean section. The measures necessary to prevent mother-to-child transmission of HIV can only be used successfully if the mother is known to be infected with HIV. The AWMF therefore recommends offering an HIV antibody test to every pregnant woman. Its implementation is subject to the express consent of the expectant mother.
- Influenza virus
- Lymphocytic Choriomeningitis Virus (LCMV)
- Measles ( measles virus )
- Mumps ( Rubulavirus ): only rarely miscarriages in the 1st trimester
- Rubella ( Parvovirus B19 ): fetal anemia , hydrops fetalis
- Rubella ( Rubella Virus ): Rubella embryo fetopathy
- Chickenpox ( varicella zoster virus , VZV): varicella embryo fetopathy , perinatal : neonatal varicella
- Cytomegaly ( human cytomegalovirus , CMV)
Due vaccinations with dead vaccines can be given to expectant mothers without hesitation in the second and third trimester of pregnancy according to the current recommendations of the Robert Koch Institute responsible for this in Germany ; in the first third , on the other hand, only urgent dead substance vaccinations should be carried out. Vaccinations made before pregnancy are not a reason to postpone pregnancy. Vaccinations with live vaccines (such as against measles , mumps and rubella ) from three months before and during the entire pregnancy are contraindicated . During the subsequent breastfeeding period , vaccinations are generally possible without restrictions.
Allogeneic immunological complications
If the pregnant woman does not have certain characteristics on her blood cells, but which were inherited from the father to the child in the womb, the mother can recognize these characteristics as foreign. Then the mother makes antibodies against them. The antibodies can penetrate the child and destroy the trait-bearing blood cells there. The erythrocytes (red blood cells) are referred to as rhesus incompatibility , the thrombocytes (blood platelets) are referred to as fetal or (after birth) neonatal alloimmune thrombocytopenia and the neutrophils (white blood cells) as fetal or neonatal alloimmune neutropenia ( FAIN or NAIN).
In the first three months of pregnancy, the risk of miscarriage is relatively high. It is estimated that a quarter of all pregnancies end in the first twelve weeks ( early abortion ). It is assumed that up to 50% of the egg cells implanting in the uterus end up as an early abortion. This miscarriage is viewed as a late menstrual period and mostly goes unnoticed. A consciously perceived miscarriage can be a highly traumatic experience for a woman. To counter any disappointment and social pressure, it is common to wait until the end of the twelfth week of pregnancy to officially announce the pregnancy.
Termination of pregnancy for medical reasons
In contrast to premature births and miscarriages, an abortion deliberately terminates the pregnancy. A health risk to the pregnant woman or a severe disability of the fetus that cannot be reasonably expected of her psychologically is regarded as a medical reason. However, medical abortions are rare. In Germany, a total of 116,871 pregnancies were terminated in 2007. H. 17 per 100 births. In 2014 there were 99,700 abortions, only 4% of the cases were due to medical and criminological indications.
Before, during or after a pregnancy, there may be further impairments. See also:
- Pregnancy outside the uterus ( ectopic pregnancy ), e.g. B. Ectopic pregnancy
- Stretch marks in the tissue
- Perineal tear at birth
- Postpartum mood crises
- Postnatal Depression
- Pregnancy tumor ( granuloma gravidarum )
- Pruritic urticarial papules and plaques of pregnancy (pregnancy-related skin disease)
About 35 to 50% of all pregnant women develop gingivitis during their pregnancy .
The mother's breathing changes during pregnancy: an increased breathing rate and deeper breaths increase the uptake of additional oxygen for the child. Because more carbon dioxide is exhaled, it leads to a slight respiratory alkalosis of the blood. The maternal carbon dioxide value in the arterial blood is given as the usual value at 32mmHg. At the same time the amount of is bicarbonate in the blood decreases, so that with a lack of buffer capacity for pregnant women. B. develop acidosis faster if you have breathing problems .
Heartburn during pregnancy
In addition to the familiar symptoms during pregnancy such as nausea and back pain, heartburn can become a problem. A study has shown that more than 70 percent of women suffer from persistent heartburn during pregnancy, making them one of the most common symptoms during pregnancy. For many women, heartburn does not appear until the last trimester of pregnancy and disappears again after giving birth. Two factors are responsible for heartburn during pregnancy. During pregnancy, the placenta produces the hormone progesterone . It causes the uterine muscle to relax. At the same time, the sphincter muscle, which lies between the esophagus and the stomach, is also relaxed. The stomach acid can thus rise into the esophagus. The stomach acid irritates the esophagus and causes heartburn. In addition, the hormone progesterone slows the woman's digestion and by the end of the pregnancy the child has grown to occupy most of the abdomen; this pushes the stomach upwards, and at the same time the stomach acid is also carried upwards. This position of the stomach helps the stomach acid rise. Frequent lying down also eases the gastric acid reflux. The typical symptoms of heartburn are a burning stomach, burning esophagus, and acidic belching. If heartburn persists, you may feel nauseated. According to scientists and doctors, heartburn is not harmful to both mother and child. Women who suffer from pregnancy-related heartburn should avoid the classic triggers. Scientists have found that 60 percent of the time, diet triggers heartburn during pregnancy. Pregnant women should avoid fatty and abundant food; food that is too spicy is also a good breeding ground for heartburn. You should also avoid stress. To prevent heartburn during pregnancy, the pregnant woman should avoid tight clothing. If the heartburn becomes too uncomfortable for the pregnant woman, doctors advise you to make an appointment with the gynecologist to talk about possible drug treatment. You can also counteract heartburn with home remedies such as milk, water or bananas.
Healthy and balanced nutrition is important for the development of the unborn child. Since many women are prone to constipation during pregnancy , it is even more important than usual to eat a high-fiber mixed diet. This should also contain high-quality proteins (around 15%), sufficient carbohydrates (55%, if possible no rapidly absorbable ones because of reduced glucose tolerance) and fats with predominantly unsaturated fatty acids (30%). The average energy requirement of a pregnant woman is around 2000 to 2200 kcal / d, after the fourth month it is 2200 to 2500 kcal / d.
Overweight in the mother often leads to health problems, birth disorders and developmental disorders in the child (→ perinatal obesity prevention ). Diet plays an important role not only during pregnancy but also before fertilization . For example, slim women who eat fruit at least three times a day before and during pregnancy have fewer problems during pregnancy than others.
It is recommended that you avoid raw animal foods as much as possible during pregnancy. These include:
- Raw milk and raw milk products such as soft cheese made from raw milk,
- raw meat such as mett and tartare as well as raw sausage such as salami or tea sausage,
- raw fish and smoked fish as well as fish products from the cooling shelf.
In addition, there are the following special needs during pregnancy:
Folic acid (also called vitamin B9) is required in sufficient quantities, especially at the beginning of pregnancy, and thus in a period in which the pregnant woman may not yet know about her pregnancy or only want to have children.
Folic acid serves to prevent a neural tube defect . The risk of severe deformity can be minimized by taking folic acid as a dietary supplement . Folic acid is found in whole grain products , green leafy vegetables , spinach , broccoli , carrots , asparagus , Brussels sprouts , tomatoes , egg yolks , nuts and liver . The liver should be avoided during pregnancy because the high concentration of vitamin A could have a toxic effect and there is a possibility of the transmission of harmful substances stored in the liver. Folic acid is artificially added to foods in several countries, including Switzerland, Canada and the USA .
Calcium, iron and vitamin D.
Calcium and iron are particularly required by the rapidly growing fetus. Calcium is found in particularly high concentrations in hard cheese and other dairy products ; Iron is particularly abundant in meat , legumes and whole grain bread . The liver contains a lot of iron, but the vitamin A content is so high that it can harm the child. If there is a threat of iron deficiency ( anemia ), iron supplements can also be taken. Since calcium is only absorbed in the presence of vitamin D , and this is formed by sunlight, you should ensure that you are sufficiently outdoors. Fatty fish meat (such as salmon ) is also a source of vitamin D. Vitamin D supplementation during pregnancy can be insufficient. Lisa Bodnar and colleagues found deficits in a study in 80% of African American women and just under half of white US women, even though nine out of ten of the total of 400 pregnant women took a vitamin supplement.
Fluoride is considered important not only for hardening tooth enamel, but also for bone growth. Foods with a high fluoride content are sea fish, black tea and many mineral waters (those with a fluoride content of more than 1.5 mg per liter must be marked with the warning “contains fluoride”). In many regions, the amount of about 1 milligram of fluorine (as fluoride) referred to as the “daily requirement” cannot be covered by diet. That is why fluoridated table salt and fluoridated toothpaste are commercially available. In some countries, fluoride is added to drinking water, which is said to lead to better teeth.
Omega-3 fatty acids
Omega-3 fatty acids cannot be produced by the body itself. The omega-3 fatty acid eicosapentaenoic acid is used to form hormone-like substances that influence the duration of pregnancy, while another omega-3 fatty acid, docosahexaenoic acid, is responsible for the structure and function of the brain and eye (e.g. formation of neuronal - Membranes) is important. Sea fish such as salmon , anchovy , sardine , mackerel and tuna in particular provide the two long-chain omega-3 fatty acids eicosapentaenoic and docosahexaenoic acid. However, long-lived predatory fish such as tuna or swordfish often have a relatively high proportion of mercury , making them unsuitable for pregnant women. Raw fish should be avoided. In Lein -, hemp -, walnut - and rapeseed oil is the vegetable omega-3 fatty acid alpha-linolenic acid, which is transformed in our eating habits insufficient to eicosapentaenoic acid and docosahexaenoic acid.
In the placenta there is a protein that ensures the supply of the growing child primarily with docosahexaenoic acid - at the expense of the mother. If the mother's supply of omega-3 fatty acids is particularly good, there will be fewer tendencies to preterm birth, the pregnancy will be somewhat longer (plus 1.6 to 2.6 days), and there will be fewer postpartum depression. In children, the functions of the eye and brain develop better (e.g. four-point higher intelligence quotient in a four-year-old). For this reason, new recommendations for pregnant women have been drawn up by the major specialist societies. During pregnancy at least 200 mg DHA / day should be taken, although it has been pointed out that up to 2.7 g / day omega-3 fatty acids have been tolerated in scientific studies without significant side effects. Nutritional deficiencies should be identified early in pregnancy. The omega-3 index (content of omega-3 fatty acids in long-term storage, the red blood cells) is suitable for this.
Iodine deficiency during pregnancy can be the cause of goiter formation in the unborn child, but it can also be a trigger for deficient growth, a disturbance in brain development or miscarriages and stillbirths. The German Nutrition Society recommends eating milk and dairy products on a regular basis and using only iodized table salt. An additional intake of iodide tablets is often necessary.
While nuts are in principle an important part of a good and balanced diet, in the past it was not advisable to eat peanuts and other nuts during pregnancy . This could lead to an intolerance or allergy in the child in the future . However, recent studies show that exposure to allergens at an early stage can prevent later allergies. According to the more recent studies, it no longer seems necessary to avoid nuts during pregnancy, but rather consuming nuts in moderation to be recommended.
Preparation for childbirth
Positive behaviors of the mother towards the unborn child
Exercise during pregnancy
Linda May has studied the effects of exercise during pregnancy on a child's heart health. In women who exercised at least three times a week during pregnancy, the fetal heart rate was slower and more variable. This is considered a sign of a healthy heart. The unborn babies show a training effect , although it is primarily the mothers who exert themselves. Examination of the babies after birth showed that the more the mothers moved during pregnancy, the more trained the newborns were. May cites a possible explanation that hormones are released during exercise and enter the baby's blood through the placenta . There the hormones are supposed to stimulate the heart of the unborn child.
Overloading should be avoided, however, as there is a higher risk of injury from loosened ligaments , tendons and joints. Overheating from exertion, especially at the beginning of pregnancy, is also not good for embryonic development .
Listen to classical music
Birth preparation courses
To prepare for the birth, pregnant women can attend a birth preparation course together with their partner, which is offered as a regular weekly appointment or as a weekend course in midwifery practices, maternity hospitals and hospitals. Content of these courses include setting up a birth plan (choice of place of birth, birth positions ), natural pain processing, artificial painkillers and anesthesia techniques , pelvic floor exercises , relaxation exercises, psychological and social aspects of family formation, breastfeeding and baby care. A support for birth preparation is the haptonomy .
place of birth
Until 1950 it was taken for granted in Germany to give birth at home. Since then, home births have steadily declined and today 97% of children are born in hospitals, especially in high-risk pregnancies. There are also the alternatives of a birth in the birthing center . In developing countries, due to the generally poor medical care, only one in two births is cared for by a doctor or midwife (see maternal mortality ).
From around the 18th week of pregnancy, movements of the fetus can be felt by the pregnant woman. The heartbeat can be heard with a stethoscope from the 23rd week at the earliest . Other people may feel the unborn child move through the abdominal wall from the sixth month onwards. Modern medical methods ( e.g. sonography ) can be used to prove that the fetus already has well-developed senses in the womb and can perceive its outside world (mother's voice, music, movement).
In most cultures, the pregnant woman has a special social status and special (gentle) treatment is given to her. At the same time, expectations are placed on them, which can exert great psychological pressure on them, for example to give birth to sons as ancestors (see India , China ). In many traditional societies, pregnancy must be preceded by marriage , otherwise this will result in the social ostracism of the expectant mother and the illegitimate child.
The image of a pregnant woman is often given mystical significance as a symbol of fertility. A reference to a fertility cult in Central Europe in prehistoric times is the Venus von Willendorf , 25,000 BC. With their exaggerated female gender characteristics (large breasts, lush belly, prominent pubic mound ).
Pregnancy is also an important topic in family sociology, because the coming child will have to be socially placed in various social roles (e.g. as a future heir or welfare recipient ) (this speeds up weddings, for example), and the relationship of parents to each other and in their social environment (e.g. in marriage ) is also changed beforehand (noticeable in hereditary monarchies ).
In the fine arts there is a long tradition of depicting pregnant women due to the importance of Our Lady in Christianity . Modern artists such as Vanessa Beecroft , Louise Bourgeois , Annegret Soltau or Ron Mueck have tried to portray the beauty of the pregnant woman in the field of tension between biology and self-determination. In the philosophy of art, the dazzling term "miracle belly" was coined for this.
The average age of first-time mothers is rising steadily across Europe. In 1975 it was 24.8 years in western Germany and 21.8 years in eastern Germany. In 2000 the average age of West German women at the birth of their first child was 29 years, in East Germany 28.4 years. At the same time, there is a birth deficit in most western industrialized countries (see demographics ).
Wanted, unwanted and forced pregnancies
A forced pregnancy is a pregnancy that was forced on the mother , for example in the context of slavery , a forced marriage or a genocide. Forced pregnancies can be punishable under international criminal law as war crimes , crimes against humanity or genocide .
In the years from 2015 to 2019, an average of around 6 out of 100 women worldwide became pregnant unplanned (i.e. a total of 121 million pregnancies annually). 30 years ago (1990 to 1994) around 8 out of 100 women (aged 15 to 49) had an unwanted pregnancy. Worldwide, however, 61 percent of unplanned pregnancies are still terminated.
Abortion for social reasons
Failure of contraception, inadequate contraception , poor family planning or criminal offenses (rape) can lead to unwanted pregnancies. Currently, social reasons are the main motives for abortions in Germany. Of the 110,694 abortions in 2009, only 2.9% were medically or criminologically indicated (if there were compelling reasons to believe that the pregnancy was due to a sexual offense).
Criminalized a few decades ago, termination of pregnancy in the first three months of pregnancy is now unpunished in most Western European countries . The handling is very strict in Northern Ireland, Malta and Poland. In Germany, an abortion can take place within the completed first 14 weeks, calculated from the last menstrual period (12 weeks from fertilization), provided that pregnancy conflict counseling has preceded it. If there is a medical need (serious risk to the mother's health), a termination of pregnancy is theoretically possible up to the birth (see above).
Legal protective measures of pregnancy
In most European countries, pregnancy is linked to various statutory regulations for the protection of mother and child, e.g. B. Protection against dismissal . Certain activities such as lifting heavy loads or night work are no longer permitted. In Germany, maternity leave begins six weeks before the presumed delivery date and extends to eight weeks after the birth, and for premature and multiple births up to twelve weeks afterwards.
|Period / point||Before the pregnancy||Beginning of pregnancy||Communication to the employer||remaining time of pregnancy||6 weeks before the calculated due date||Day of birth||8 weeks after giving birth||up to 4 months
after the birth
|up to 12 months
after the birth
|Max. up to the completion of the 3rd year of life (partly up to the completion of the 8th year of life)||Getting back to work||Raising children||After raising children|
|Pay and other financial benefits:||Net salary x € / month
Maternity allowance : 13 € / day
|Net salary x € / month
|Entitlement to continued payment,MuSchG||Net salary x € / month minus maternity allowance
minimum € 300, max. 1800 €
|Child benefit 204 € / month, or child allowance, EStG|
|Right to unpaid leave :||Parental leave , BEEG|
|Right to part-time work :||TzBfG||BEEG||TzBfG|
|Special occupational safety :||Maternity leave , MuSchArbV|
|Employment ban :||if applicable, prohibition of employment in accordance withMuSchG||Maternity protection , MuSchG|
|optional||required by law
(12 instead of 8 weeks for premature and multiple births or a medically determined disability)
|Protection against dismissal :||MuSchG (protection against dismissal continues for 4 months after a miscarriage after the 12th week of pregnancy)|
The youngest person to give birth to a healthy child was the Peruvian Lina Medina (see also: Motherhood of Minors ). Pregnancy began at the age of four and she was five and a half years old when her son was born. The world record age for childbirth is currently held by a Spanish woman from Barcelona who gave birth to twins at the age of 67 in 2006 after artificial insemination. The youngest mother of seven children is likely to be a 16-year-old girl from Argentina who had triplets for the second time, three girls again, in 2008. After having a son as the first child at the age of 14, she gave birth to triplets in 2006. Before the birth of her son, she said she had already lost a child to a miscarriage.
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