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Pregnancy

Introduction
What are the signs of pregnancy?
How do I know I’m pregnant?
What is prenatal care and why is it important?
What is a high-risk pregnancy?
Tests
Taking Care of Your Health

Pregnancy is an exciting time of major change. From the very start, your baby-to-be alters your body and the way you live your daily life. The best way to approach pregnancy, labor, delivery, and the postpartum period is to be informed. If you are planning to become pregnant, see your doctor for a preconception care visit. As soon as you suspect you are pregnant, call your doctor, get regular prenatal care, make sure you are well-informed when making decisions, and follow a healthy lifestyle. You will be helping your baby to have a healthy start in life and helping yourself to feel your best.

Pregnancy is the term used to describe when a woman has a growing fetus inside of her. In most cases, the fetus grows in the uterus. Human pregnancy lasts about 40 weeks, or just more than 9 months, from the start of the last menstrual period to childbirth

The primary sign of pregnancy is missing one or more consecutive menstrual periods. However, because many women experience menstrual irregularities that may cause missed periods, women who miss a period should see their health care provider to find out whether they are pregnant or whether there is another health problem.

Others signs and symptoms of pregnancy may include:

• Nausea or vomiting, morning sickness
• Sore breasts or nipples
• Fatigue
• Headaches
• Food cravings or aversions
• Mood swings
• Frequent urination

A pregnancy test is the best way to determine if you are pregnant. Home pregnancy test kits are available over-the-counter and are considered highly accurate. A health care provider can also do a pregnancy test.

NICHD research in the 1970s found that high levels of the hormone human chorionic gonadatropin (HCG) in the urine were associated with pregnancy. This research led to the development of the home pregnancy test that is commercially available today.

If you think you may be pregnant, or have a positive home pregnancy test, see a health care provider.

Prenatal care is the care woman gets during a pregnancy. Getting early and regular prenatal care is important for the health of both mother and the developing baby.

In addition, health care providers are now recommending a woman see a health care provider for preconception care, before she is even trying to get pregnant.

Health care providers recommend women take the following steps to ensure the best health outcome for mother and baby:

• Getting at least 400 micrograms of folic acid every day to help prevent many types of neural tube defects. Health care providers recommend taking folic acid both before and during pregnancy.
• Being properly vaccinated for certain diseases (such as chicken pox and rubella) that could harm a developing fetus-it is important to have the vaccinations before becoming pregnant
• Maintaining a healthy weight and diet and getting regular physical activity before, during, and after pregnancy
• Avoiding smoking, alcohol, or drug use before, during, and after pregnancy

All pregnancies involve a certain degree of risk to both mother and baby. But, factors present before pregnancy or that develop during pregnancy can place the mother and baby at higher risk for problems. Women with high-risk pregnancies may need care from specialists or a team of health care providers to help promote healthy pregnancy and birth.

Factors present before pregnancy that can increase risk may include:

• Young or old maternal age
• Being overweight or underweight
• Having had problems in previous pregnancies, such as miscarriage, stillbirth, or preterm labor or birth
• Pre-existing health conditions, such as high blood pressure, diabetes, or HIV/AIDS

During pregnancy, problems may also develop even in a woman who was previously healthy. These may include (but are not limited to) gestational diabetes or preeclampsia/eclampsia.

Getting good prenatal care and seeing a health care provider regularly during pregnancy are important ways to promote a healthy pregnancy.

During pregnancy, certain routine lab tests are done on all women. Depending on your health history and the results of your routine tests, your doctor may recommend that you have other tests.

To confirm a pregnancy, your blood or urine may be tested for the hormone human chorionic gonadotropin (hCG). Also, the doctor can order lab tests to check for any diseases or infections. These tests may include:

• Urine tests. A urine sample is checked to look for sugar, protein, and bacteria, which can signal diabetes or a bladder or kidney problem.

• Blood tests. Blood samples are checked for anemia and certain infections. Your blood type and Rh factor also are noted.

• Pap test or cervical culture. The cells from the cervix collected during a pelvic exam may be checked for signs of infection, cancer, or conditions that could lead to cancer.

• Glucose screening test. The sugar level in the woman's blood is measured to test for gestational diabetes.

• Group B streptococcus (GBS) testing. The cells from the woman's vagina and rectum are tested for the presence of GBS, which can be passed to the baby during delivery and cause infection.

• Human immunodeficiency virus (HIV) test. A blood sample is checked for HIV antibodies. If the test result is positive, another test is used to confirm the results. If you have HIV, you could pass it to your baby during pregnancy, labor, delivery, and breastfeeding. There are things you can do to help prevent this from happening.

You and your doctor will discuss your results and decide what treatment and other tests, if any, are best for you.

Fetal Monitoring

Based on the results of routine prenatal care, your doctor may suggest tests to check the health of the baby. Most of the time, these tests help assure you and your doctor that all is going well. If problems arise, these tests may pinpoint them early. The following tests are used to monitor the well-being of the fetus:

• Kick count-A record of how often you feel your baby move. A healthy baby tends to move the same amount each day. You may be asked to keep track of this movement in the latter part of pregnancy and to contact your doctor if the baby is not active.

• Ultrasound exam-An exam that uses sound waves to create pictures of the baby. This allows the doctor to check its growth and development.

• Electronic fetal monitoring-These tests, including the nonstress test and the contraction stress test, help your doctor detect signs of problems the fetus may be having late in pregnancy. For these tests, monitors are placed on the woman's abdomen to continuously measure the heartbeat and activity of the baby, as well as contractions of the woman's uterus.

• Biophysical profile-A combination of electronic fetal monitoring and ultrasound results are used to assess the well-being of your baby.

Tests can be done to help detect certain birth defects. These tests are done at various times during pregnancy. Some may need to be done in a special center equipped to perform them.

Some tests are offered to all women to help assess the risk of certain birth defects. These screening tests do not diagnose birth defects, but they may tell if there is an increased risk for a problem. Types of screening tests include:

• First trimester screening. The results of special ultrasound tests and blood tests are combined to determine your baby's risk for Down syndrome and trisomy 18. These tests are done between 10 and 14 weeks of pregnancy.

• Maternal serum screening. A group of blood tests (also called "triple" or "quad" screen) that check for abnormal levels of substances linked with certain birth defects, such as Down syndrome and neural tube defects. These tests are done between 15 and 20 weeks of pregnancy.

• Cystic fibrosis testing. A lab test done on a sample of blood or saliva to see if a couple is at an increased risk for giving birth to a child who will have cystic fibrosis. This test can be done before pregnancy or early in pregnancy.

• Detailed ultrasound exam. A type of ultrasound exam that can help explain abnormal results and provide more detailed information.

• Amniocentesis. A procedure in which a needle is used to withdraw a small amount of amniotic fluid and cells from the sac surrounding the fetus. This fluid and cells are then sent to a lab and tested. This procedure most often is done between 15 and 20 weeks of pregnancy.

• Chorionic villus sampling (CVS). A procedure in which a small sample of cells is taken from the placenta and tested. This is done between 10 and 12 weeks of pregnancy.

If the results show that there is a problem, a counselor can help explain how the baby will be affected. In some cases, it is not known how severe a birth defect will be. Sometimes surgery or treatment is possible. In other cases, there is no treatment for a defect. The counselor and doctor can explain the results and provide guidance in making choices and considering options.

It is important to take good care of both your physical and mental health during pregnancy. Many choices you make in your daily life during pregnancy can affect your health as well as the health of your baby.

Nutrition

A good diet is even more important during pregnancy, when there are added demands on your body to meet the needs of the growing fetus. A variety of foods can be used to create a healthy diet for you and your baby.

The U.S. Department of Agriculture offers guidelines to help you get the nutrients both of you need. It stresses a diet that is low in fat, sugar, and cholesterol (a substance that carries fat through the bloodstream) and high in vegetables, fruits, and grains.

Your diet should include proteins, carbohydrates, vitamins, minerals, and fat. You often can get enough of these nutrients if you eat a healthy diet, but your doctor may suggest you take a supplement or prenatal vitamin to ensure you get the right amount. During pregnancy, you need more of these nutrients:

Calories to help nourish your growing baby

• Iron and folic acid to help make the extra blood needed in pregnancy
• Protein to help make blood and build your baby's tissues and muscles
• Calcium to help build your baby's bones and teeth