Pregnancy Health & Safety

Pregnancy can be an exciting time for many women and their partners. But it can also be a scary time due to the amount of changes that the body goes through, and women whose pregnancies are high risk or unplanned – perhaps due to the failure of contraception – may experience additional stress that could lead to health or safety concerns for both herself and her baby.

What Is Pregnancy?

Pregnancy is the period between conception and childbirth, during which the future child grows and develops inside the woman’s body. In the case of multiple pregnancies, the woman carries more than one baby, resulting in twins or higher-order multiples (triplets, quadruplets, etc.).

In healthy pregnancies, the fetus grows inside the uterus and receives oxygen and nutrients from the mother through the placenta. An ectopic pregnancy is when the fetus begins to grow in the woman’s fallopian tube instead of the uterus, a situation that can become fatal to the mother if left untreated. It is rare for the fetus to survive an ectopic pregnancy. (Scroll down for more on ectopic pregnancy.)

Early Signs of Pregnancy

The first symptom of pregnancy is often missing a period. Other symptoms include:

  • Light vaginal spotting or bleeding (the blood is not as dark as menstrual blood)
  • Tenderness or swelling in the breasts and/or nipples
  • Appetite changes, including unusual food cravings or aversions
  • Nausea or vomiting – also known as “morning sickness,” although it can occur throughout the day
  • Frequent urination
  • Fatigue
  • Gas
  • Headaches
  • Mood swings

Pregnancy can often be confirmed by taking a home pregnancy test. You should schedule an appointment with your doctor as soon as you soon as you discover you might be pregnant.

If you are sexually active and of reproductive age, it is possible to become pregnant even if you are taking birth control. No contraceptive is 100% effective, including sterilization.

Pregnancy Duration and Stages

Pregnancy usually lasts 40 weeks, which doctors split into approximately three-month periods known as trimesters. After 42 weeks, if natural labor has not begun, your healthcare provider may induce labor by stimulating uterine contractions through a medication called oxytocin (Pitocin). Premature or preterm births are those that occur before the 37th week of pregnancy, potentially resulting in lifelong health problems for the child.

First Trimester

The first trimester is a period of early rapid growth of the embryo/fetus and a number of changes to the woman’s body that indicate early signs of pregnancy. Many women may not initially know they are pregnant, thinking that the changes they are experiencing are symptoms of an unrelated sickness or health condition. In some women, symptoms of pregnancy like morning sickness can become so severe that they take an antiemetic such as Zofran for relief. While commonly prescribed as an off-label drug for morning sickness, Zofran has not been approved for such use, and could result in severe health problems and birth defects.

The first trimester starts at conception, at which time the combined egg and sperm cells are known as a zygote. Within the first day, the zygote will split into two cells, forming the embryo. Around the 7th or 8th day of pregnancy, the embryo will attach (implant) to the uterine lining, after which the pace of cell division will increase rapidly until approximately the eighth week. At this point, the embryo becomes a fetus, its features start to look more human, and certain organs like the kidneys and brain begin to function.

First Trimester Changes
Pregnant WomanEmbryo/Fetus
  • Missed period
  • Fatigue
  • Tender or swollen breasts
  • Morning sickness (nausea and/or vomiting)
  • Food cravings or aversions
  • Constipation and frequent urination
  • Rapid mood changes
  • Heartburn
  • Headaches
  • Changes in weight
4 Weeks

  • Nervous system (brain and spinal cord)
  • Heart
  • Arm and leg buds

8 weeks

  • Major organs start to develop
  • Longer arms and legs, fingers and toes start to form
  • Facial features start to appear
  • Sex organs begin to form

12 weeks

  • Nerves and muscles working
  • Eyelids close
  • Head growth slows down

Second Trimester

Many women tend to find the second trimester easier than the first trimester, with some of the more severe symptoms like morning sickness subsiding. At the same time, the second trimester tends to bring about many more noticeable changes to the pregnant woman’s body, not the least of which is the appearance of a “baby bump.”

The second trimester begins around week 13 of the pregnancy. During this period, the fetus will continue to develop its body structure, such as the musculoskeletal system, as well as organs and skin. The fetus will also become more active, such as by making sucking motions with the mouth, and around week 20 is when many women start to feel kicking or movement. By the end of the second semester, the fetus will have developed all of the major organs, including lungs and sex organs, plus the more minor features such as hair, fingernails and toenails, and even taste buds.

Second Trimester Changes
Pregnant WomanFetus
  • Pain or aching in the abdomen, back, groin, or thighs
  • Stretch marks may appear on the abdomen, thighs, buttocks, and/or breasts
  • Melanocyte-stimulating hormones – which can cause darkened nipples, skin discolorations (melasma), and linea nigra (“black line”), a dark line that appears on the abdomen in about 75% of all pregnancies
  • Carpal tunnel syndrome – tingly or numb hands
  • Itchy abdomen, palms, and soles of the feet
  • Swelling around the ankles, face, and fingers

Note: A combination of nausea, vomiting, loss of appetite, or jaundice along with increased itchiness could be a sign of a severe liver problem. Talk with your doctor if you experience these symptoms together.

16 Weeks

  • Musculoskeletal system continues developing
  • Translucent skin forms
  • Sucking reflex

20 weeks

  • Kicking and moving activity becomes noticeable
  • Fingernails, toenails, eyelashes, and eyebrows have developed

24 weeks

  • Bone marrow starts producing blood cells
  • Taste buds, head hair, and fingerprints/footprints are present
  • Sex organs are formed and in place

Third Trimester

Many of the changes that pregnant women experience in the second trimester continue into the third trimester, often with greater intensity as the fetus continues to grow and put pressure on abdominal organs and the spine. As the baby nears its due date, the woman’s cervix will thin and soften (a condition known as “effacement”), which will help with vaginal childbirth.

During the third trimester, most of the fetus’s body parts are well their way to becoming fully formed and working, although some components like the skeleton and the lungs will continue to develop over the last few months of pregnancy. In addition, in most cases the baby will begin to move and shift its position in preparation for delivery.

Third Trimester Changes
Pregnant WomanFetus
  • Continued swelling of the ankles, face, and fingers
  • Breast tenderness or leaking of colostrum
  • Protruding belly button
  • Shifting of the “baby bump” as the fetus drops and rotates
  • Contractions as the due date approaches
  • Difficulty sleeping
  • Heartburn
  • Shortness of breath
32 Weeks

  • Bones are fully formed, but still soft
  • Lung begin “practice breathing” (but are not yet fully developed)
  • Increased kicking and movement activity

36 weeks

  • Thickening of the vernix, a protective waxy coating
  • Movement may be less forceful as the fetus has less room to maneuver

Final weeks

  • After 37 weeks, the baby is considered “full term”
  • Organs can function independently
  • Baby starts to turn head down in preparation for birth

Birth

Pregnancy ends at birth. There are two primary types of birth: vaginal and cesarean.

Vaginal Birth: In the U.S., a little more than two-thirds of babies are delivered vaginally. Vaginal births are often considered “normal” births, although modern medical techniques allow for a wide range of variations in technique, depending on the needs of the woman. Spontaneous vaginal birth occurs when a woman goes into labor without the use of drugs or other techniques to induce labor, while an assisted vaginal delivery occurs when the use of instruments is required. Induced vaginal delivery occurs when labor is prompted through the use of drugs or other techniques.

Cesarean Birth (C-Section): Nearly a third of births in the U.S. are cesarean, which is higher than the percentage of C-section births recommended by the World Health Organization (WHO). Most cesarean sections are  A cesarean birth involves making an incision in the woman’s abdomen and uterus, through which the baby is delivered. C-sections are often necessary when a woman experiences complications (such as breech birth or fetal distress) or is carrying multiple babies. A longer recovery period is often needed after a C-section, and the procedure will leave a permanent scar.

Termination

Pregnancy can also end through an termination of the embryo or fetus, whether spontaneously (miscarriage) or purposely through inducement using a drug or medical procedure (abortion). Spontaneous terminations of pregnancy can happen as a result of complications experienced during a high-risk pregnancy (see below). Abortion laws vary from country to country, and even from state to state within the U.S.. While there are a wide variety of reasons why a woman might want to terminate her pregnancy, a number of abortions are performed due to significant risk to the woman’s own health or the health of the fetus, such as the development of cervical cancer or another form of cancer during pregnancy.

High-Risk Pregnancy

Some pregnant women are at greater risk of experiencing complications than others. A number of drugs and medical devices have also been linked to pregnancy complications, some of which can be life-threatening for both mother and child.

Common Factors for High-Risk Pregnancies
Teen pregnancy

Pregnant women aged 15-19 are more likely to deliver prematurely and have babies with a low birth weight. The stigma surrounding teen pregnancies also makes young women less likely to seek and receive regular prenatal care, increasing the likelihood of other pregnancy complications going untreated.

Pregnancy over age 35

Women aged 35 – 44 are more likely to experience pregnancy complications including gestational diabetes and gestational hypertension (high blood pressure). There is also a higher risk of the fetus developing chromosome abnormalities like Down syndrome, and a greater likelihood of the mother requiring a C-section, miscarrying, or delivering a stillborn child.

Pre-existing health conditions
Some pre-existing conditions, like diabetes and high blood pressure, can affect the health of both mother and fetus. If you have a health condition, speak to your doctor before trying to conceive, and inform him or her as soon as you become pregnant.
Excess weight and obesity
Carrying excess weight during pregnancy increases the mother’s risk of developing a condition called preeclampsia, and makes premature birth more likely.

Another risk factor is multiple pregnancies. Women carrying more than one baby are at far greater risk of preterm delivery, with more than 60% of twins delivered prematurely. This risk is even greater in triplets and higher-order multiples. Multiple pregnancy also increases a woman’s risk of developing anemia and gestational hypertension, and of losing at least one baby. Twins and other multiples are more likely to be born with birth defects like heart abnormalities and cerebral palsy.

Pregnancy Complications

With regular prenatal care and monitoring, most women do not experience complications in their pregnancy. When caught early and treated, most complications can be managed. Unfortunately, some complications like miscarriage can occur suddenly and cannot be prevented.

Sudden Termination (Miscarriage or Stillbirth)

It is possible to lose a baby suddenly at any point during a pregnancy. This most often occurs before the 20th week, sometimes before the woman knows she is pregnant, and is called a miscarriage. After 20 weeks, it is known as a stillbirth. In some cases, a woman may experience a threatened miscarriage, meaning she is showing signs of miscarriage but the pregnancy is not lost.

The symptoms of pregnancy loss include vaginal bleeding and spotting, cramping, and pain in the abdomen, pelvis, or lower back. Always contact your doctor if you experience bleeding while pregnant.

Some medications have been linked to a higher risk of pregnancy loss. Speak to your doctor before taking any drugs while pregnant.

Gestational Diabetes

Gestational diabetes is diabetes that occurs during pregnancy. It will usually go away after you give birth. Symptoms include excessive hunger and/or thirst, frequent urination, and fatigue. But some women with gestational diabetes experience no symptoms. Your doctor will typically test for the condition during your second trimester.

A healthy diet can often control gestational diabetes. You may also need to take insulin. Left untreated, the condition can increase the risk of other complications, like preeclampsia and premature birth, and can result in the death of the baby before or just after birth. Diabetes drugs like Invokana are generally not a good option for controlling gestational diabetes, especially considering the Invokana lawsuit headlines over the drug’s side effects.

Preeclampsia

Preeclampsia is a condition that causes high blood pressure and a range of other symptoms, including kidney problems, protein in your urine, and swelling in the hands or face. It typically starts after a woman’s 20th week of pregnancy, and can only be cured by delivering the baby.

If you are close to your due date when preeclampsia is diagnosed, your doctor may recommend inducing pregnancy. In other cases, bed rest and medications may be prescribed so that your health may be closely monitored.

Premature Birth

If a baby is delivered prior to the 37th week of pregnancy, it is considered premature. Medication can sometimes prevent premature labor from progressing to delivery.

Babies born prematurely are at greater risk of developing health conditions that can be lifelong, including cerebral palsy and developmental problems. If their organs and immune system are underdeveloped, they may be more susceptible to infections and respiratory issues, and have more difficulty staying warm. This can result in pneumonia.

Preterm babies often require specialized care in a Neonatal Intensive Care Unit (NICU) for several weeks after birth, until they are able to breathe, eat, and stay warm without the help of machines. Survival rates vary depending on how prematurely birth occurred. Babies born after just 24 weeks have a 50% chance of surviving. This increases to 92% after 28 weeks.

Placental Abruption

If the placenta separates from the wall of the uterus before delivery, this is known as placental abruption, and can interrupt the flow of oxygen to the fetus. The most common symptom is vaginal bleeding, often accompanied by abdominal pain or cramping.

In less severe cases, your doctor may prescribe bedrest. If your or your baby’s life are in danger, an emergency delivery may be required.

Hyperemesis Gravidarum (HG)

HG is a condition that causes severe and persistent nausea and/or vomiting that is worse than regular morning sickness. It can result in weight loss and dehydration.

HG usually improves by the 20th week of pregnancy, and can often be managed by eating a bland diet and taking nausea medication. Some women with HG require require hospitalization so that their fluid and nutrient intake can be delivered intravenously (through the vein).

Infections During Pregnancy

Developing an infection during pregnancy can be harmful to both mother and baby. Most infections can be prevented by following good hygiene procedures, practicing safe sex, and avoiding certain foods and contact with farm animals while pregnant. Described below are some common types of infections that can occur during pregnancy.

Group B Streptococcus (GBS) Infection

The bacteria GBS is found in the vagina and rectum of about one in four women, and is rarely harmful to the mother. But if passed to the baby during delivery, it can lead to complications, including pneumonia and kidney problems.

Your doctor will likely test you for GBS during your third trimester. This involves swabbing the vagina and rectum, and is painless. If you test positive for GBS, you may be given antibiotics during labor to protect your baby from the bacteria.

Urinary tract infections

About one in 10 women develop a urinary tract infection during pregnancy. This condition is usually easily treatable with a course of antibiotics, but can result in complications including premature birth if left untreated.

Common symptoms of a urinary tract infection include frequent urination (often accompanied by a burning sensation) and pain during sexual intercourse. You may also notice blood or mucus in your urine, and the urine itself may appear cloudy or unusually dark, and may be foul-smelling.

Listeriosis

Listeria is a bacteria found in some refrigerated and ready-to-eat foods, like certain deli meats, pâtés, and soft cheeses made with unpasteurized milk (such as feta and Brie). Ingesting this bacteria can make pregnant women sick and increases the risk of premature birth and pregnancy loss.

Ask your doctor for a list of food to avoid during your pregnancy. If you experience symptoms like fever and muscle aches, speak to your doctor at once. Listeriosis can be treated with antibiotics.

Sexually transmitted infections (STIs)

Many STIs (including syphilis and HIV) can be passed to the baby during pregnancy, and they increase a woman’s risk of premature birth or pregnancy loss. STIs can be prevented by practicing safe sex, especially if engaging in sexual intercourse with a new partner.

You may have an STI and not experience any symptoms. If you believe you could have an STI, go for a screening early in your pregnancy. Some can be treated with antibiotics.

Ectopic Pregnancy

An ectopic pregnancy (also known as an extrauterine or tubal pregnancy) occurs when the fertilized egg implants and begins to grow in the fallopian tube before reaching the uterus. About one in 50 pregnancies are ectopic, and most result in the death of the fetus.

The fallopian tubes are not designed to support a growing fetus. This can cause the tube to stretch or rupture, leading to internal bleeding that can be fatal to the mother. Ectopic pregnancies are the leading cause of pregnancy-related death among women in their first trimester.

Ectopic pregnancies are usually caused by a blockage in the fallopian tube. Risk factors include:

  • Pregnancy late in life (ages 35-44)
  • Pelvic inflammatory disease (PID)
  • Smoking
  • Pregnancy with aid of fertility treatments
  • Conceiving while implanted with an intrauterine device (IUD)
  • Conceiving after tubal ligation surgery (medical sterilization)
  • Previous ectopic pregnancy
  • Previous induced abortions
  • Endometriosis (tissue that normally lines the uterus growing outside of it)

The early symptoms of an ectopic pregnancy can resemble a healthy pregnancy. Warning signs include vaginal bleeding, and pain in the pelvis and/or abdomen that may be sharp, stabbing, or cramping in nature. If you are at high-risk of ectopic pregnancy or experience these symptoms, speak to your doctor. Seek immediate medical assistance if you experience severe abdominal or pelvic pain, or pain in your shoulder and/or neck, as this often indicates a rupture in the fallopian tube.

Ectopic pregnancies are often diagnosed during the first ultrasound when the sonographer notices the fetus is not visible in the uterus. A transvaginal ultrasound (in which the probe is inserted into the vagina) and blood or urine tests can confirm this.

If caught early, the drug Methotrexate can allow the body to absorb the pregnancy tissue. In other cases, laparoscopic surgery may be required, and the fallopian tube may need to be removed. Ectopic pregnancies can affect a woman’s future fertility.