Pregnancy

Pregnancy

What is pregnancy?

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

What are the signs of pregnancy?

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

How do I know I’m pregnant?

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.

What is prenatal care and why is it important?

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

What is a high-risk 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.

Prenatal (preconception) Care

What is prenatal care/preconception care?

Prenatal care is the care woman gets before pregnancy and before her baby is born. Getting early and regular prenatal care is important for both the mother and the developing baby.

Prenatal care includes health care, along with education and counseling about how to handle different aspects of pregnancy. A health care provider may discuss many issues, such as nutrition and physical activity, what to expect during the birth process, and basic skills for caring for an infant.

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.

What can a woman do to promote a healthy pregnancy?

Many health care providers recommend that a woman who is thinking about becoming pregnant see a health care provider to ensure she is in good preconception health. There are steps a woman can take to reduce the risk of certain problems during pregnancy:

1. Folic acid – The U.S. Public Health Service recommends that women of childbearing age get at least 400 micrograms of folic acid every day, through food and/or supplements. Many health care providers recommend supplementing the diet with folic acid for 3 months before getting pregnant and at least the first 3 months of pregnancy.

2. Proper immunizations for the mother – Women who are thinking about getting pregnant should make sure they have been properly vaccinated for certain diseases that could harm a developing fetus (such as chicken pox or rubella). It is important to get these vaccinations before becoming pregnant because they can harm a developing fetus.

3. Healthy behaviors – Having a healthy weight and diet and getting regular physical activity can help both the mother and fetus during pregnancy. Avoiding smoking, alcohol, or drug use is also important. In addition, certain medications and exposures in the environment can be harmful to the fetus and it is important to avoid them during pregnancy.

For more information about preconception and prenatal care, talk to your health care provider.

High-Risk Pregnancy

What causes a high-risk pregnancy?

Before a woman becomes pregnant, it is important for her to have good nutrition and a healthy lifestyle. Good prenatal care and medical treatment during pregnancy can help prevent complications.

But there are factors that can be present before a woman becomes pregnant, that can cause a high-risk pregnancy. Risk factors for a high-risk pregnancy can include:

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

Health problems can also develop during a pregnancy that can make it high-risk. Such problems may occur even in a woman who was previously healthy.

What are some conditions that may cause a high-risk pregnancy?

• Preeclampsia and Eclampsia – Preeclampsia is a syndrome that includes high blood pressure, urinary protein, and changes in blood levels of liver enzymes during pregnancy. It can affect the mother’s kidneys, liver, and brain. With treatment, many women will have healthy babies. If left untreated, the condition can be fatal for the mother and/or the baby and can lead to long-term health problems. Eclampsia is a more severe form of preeclampsia that can cause seizures and coma in the mother.
• Gestational Diabetes Mellitus (or gestational diabetes) is a type of diabetes that only pregnant women get. If a woman gets diabetes when she is pregnant, but never had it before, then she has gestational diabetes. Many women with gestational diabetes have healthy pregnancies and healthy babies because they follow a treatment plan from their health care provider.
• HIV/AIDS kills or damages cells of the body’s immune system, progressively destroying the body’s ability to fight infections and certain cancers. The term AIDS applies to the most advanced stages of HIV infection.

Women can give HIV to their babies during pregnancy, while giving birth, or through breastfeeding. But, there are effective ways to prevent the spread of mother-to-infant transmission of HIV.

• Preterm Labor is labor that begins before 37 weeks of pregnancy. Because the baby is not fully grown at this time, it may not be able to survive outside the womb. Health care providers will often take steps to try to stop labor if it occurs before this time.

Although there is no way to know which women will experience preterm labor or birth, there are factors that place women at higher risk, such as certain infections, a shortened cervix, or previous preterm birth.

• Other medical conditions like high blood pressure, diabetes, or heart, breathing, or kidney problems can become more serious during a woman’s pregnancy. Regular prenatal care can help ensure a healthier pregnancy for a woman and her baby.

What can a woman do to promote a healthy pregnancy?

Many health care providers recommend that a woman who is thinking about becoming pregnant see a health care provider to ensure she is in good preconception health.

During pregnancy, there are also steps a woman can take to reduce the risk of certain problems:

1. Getting at least 400 micrograms of folic acid every day if she thinks she could become pregnant, and continuing folic acid when she does get pregnant
2. Getting proper immunizations
3. Maintaining a healthy weight and diet, getting regular physical activity, and avoiding smoking, alcohol, or drug use
4. Starting prenatal care appointments early in pregnancy

Miscarriage

What is a miscarriage?

A miscarriage, sometimes called pregnancy loss, is the loss of pregnancy from natural causes before the 20th week of pregnancy. Most miscarriages occur very early in the pregnancy, often before a woman even knows she is pregnant.
What causes a miscarriage?

There are many different causes for a miscarriage, some known and others unknown. In most cases, there is nothing a woman can do to prevent a miscarriage.

There are some factors that may contribute to miscarriage.

• The most common cause of miscarriage in the first trimester is a chromosomal abnormality in the fetus. This is usually results from a problem with the sperm or egg that prevents the fetus from developing properly.
• During the second trimester, problems with the uterus or cervix can contribute to miscarriage.
• Women with a disorder called polycystic ovary syndrome are three times more likely to miscarry during the early months of pregnancy than women who don’t have the syndrome.

Women who have miscarriages can and often do become pregnant again, with normal pregnancy outcomes.

What are the symptoms of and treatments for miscarriage?

Signs of a miscarriage can include:

• Vaginal spotting or bleeding
• Cramping or abdominal pain
• Fluid or tissue passing from the vagina

Although vaginal bleeding is a common symptom when a woman has a miscarriage, many pregnant women have spotting early in their pregnancy but do not miscarry. But, pregnant women who have symptoms such as bleeding should contact their health care provider immediately.

Women who miscarry early in their pregnancy usually do not need any treatment. In some cases, a woman may need a procedure called a dilatation and curettage (D&C) to remove tissue remaining in the uterus.  A D&C can be done in a health care provider’s office, an outpatient clinic, or a hospital.

Stillbirth

What is a stillbirth?

A stillbirth is the loss of pregnancy due to natural causes after the 20th week of pregnancy. It can occur before delivery or during delivery.

What are the signs of a stillbirth?

In some cases of stillbirth, the mother may notice a decrease in the movement or kicking of the fetus. In these cases, the health care provider uses an ultrasound, a machine that uses sound waves to create a picture of the fetus, to learn more about its health.

If the fetus has died, an autopsy and placental examination is performed to get information on why the baby died. But it is not always possible to tell why the baby died.

If you are pregnant and have concerns about stillbirth, ask your health care provider if there are ways he or she wants you to track movement.

What are the causes of a stillbirth?

Causes of a stillbirth may include:

• Problems with the placenta, such an abruption in which the placenta peels away from the uterine wall
• Chromosomal abnormalities resulting from defects in the sperm or egg that make the fetus unable to develop properly
• Other physical problems in the fetus
• Fetuses that are small for their gestational age or not growing at an appropriate rate
• Bacterial infections that can cause complications and death to the fetus

In at least half of all cases, researchers can find no cause for the pregnancy loss.

What medical procedures are used when there is a stillbirth?

In some cases it is medically necessary for a woman to deliver the fetus immediately after the diagnosis of a stillbirth.

In other cases, the couple can decide when they want to deliver the fetus.

A health care provider can induce labor or perform a caesarean section to deliver the fetus. A woman will usually go into labor on her own within two weeks after the fetal death.

Preterm Labor and Birth

What are preterm labor and birth?

Preterm labor (also called premature labor) is labor that begins before 37 weeks of pregnancy. Because the fetus is not fully grown at this time, it may not be able to survive outside the womb. Health care providers will often take steps to try to stop labor if it occurs before this time.

A baby born before 37 weeks of pregnancy is considered a preterm birth (or premature birth). Preterm births occur in about 12 percent of all pregnancies in the U.S. It is one of the top causes of infant death in this country.

Who is at risk for preterm labor and birth?

Health care providers currently have no way of knowing which women will experience preterm labor or deliver their babies preterm. But there are factors that place a woman at higher risk for preterm labor or birth:

• Certain infections, such as bacterial vaginosis and trichomoniasis
• Shortened cervix
• Previously given birth preterm

What are the challenges to a baby born preterm?

Premature infants may face a number of health challenges, including:

• Low birth weight
• Breathing problems because of underdeveloped lungs
• Underdeveloped organs or organ systems
• Greater risk for life-threatening infections
• Greater risk for a serious lung condition, known as respiratory distress syndrome
• Greater risk for cerebral palsy (CP)
• Greater risk for learning and developmental disabilities

They may need to stay in the hospital for several weeks or more, often in a neonatal intensive care unit (NICU).
What methods are used to prevent preterm delivery?

Research supported by the NICHD found that treating high-risk pregnant women (those who have previously had a spontaneous preterm baby) with a certain type of progesterone reduces the risk of another preterm delivery. The treatment worked among all ethnic groups in the study and improved outcomes for the babies. Efforts to find out whether the treatment works for other at-risk women, such as those having twins and triplets, are ongoing.

Bed rest and medications that relax the muscles in the uterus are also commonly used to try to stop preterm labor.

Researchers have found that other methods of stopping preterm labor are not as effective as once thought. For instance, NICHD-supported researchers have found that home uterine monitors are not effective for predicting or preventing preterm labor.

In addition, NICHD-funded research found that screening women who don’t show any symptoms of infection, but who have bacterial vaginosis, and treating them with antibiotics did not prevent preterm birth.

Neural Tube Defects (NTDs)

What are neural tube defects?

Neural tube defects are birth defects of the brain and spinal cord.

The most common neural tube defects are:

• Spina bifida – In spina bifida, the tube that forms the spinal cord and spine does not close properly, causing damage to the developing spinal cord.

People with spina bifida have paralysis of the nerves below the affected area of the spine. This may cause difficulty walking or make them unable to walk without help. They may also have problems related to increased pressure in the brain and to lack of bladder and bowel control. In some babies born with spina bifida, the problems are severe enough to result in death.

• Anencephaly. Anencephaly is a more serious neural tube defect. In this condition, much of the brain does not develop. Babies with anencephaly are either stillborn or die shortly after birth.

Is there a way to prevent neural tube defects?

Research has shown that getting enough folic acid before and during pregnancy can prevent most neural tube defects.

The U.S. Public Health Service (PHS) recommends that all women of childbearing age, who are capable of becoming pregnant, get 400 micrograms of folic acid each day.

The neural tube develops in the first four weeks of pregnancy, often before many women even know they are pregnant. For this reason, the PHS recommends folic acid to all women of childbearing age, even those not trying to get pregnant.

What are the treatments for neural tube defects?

Treatments vary depending on the type of neural tube defect. For instance, some mild versions of spina bifida need minimal treatment, but other forms require surgery to correct the problems.

Physical therapy may also be needed to help the child learn to walk with or without assistive devices, such as leg braces.

Birth Defects

What are birth defects?

Birth defects are structural or functional abnormalities present at birth that cause physical or mental disability.  Some may be fatal.

Researchers have identified thousands of different birth defects. Currently, birth defects are the leading cause of death for infants during the first year of life.
What causes birth defects?

Birth defects have a variety of causes, such as:

• Genetic problems caused when one or more genes doesn’t work properly or part of a gene is missing
• Problems with chromosomes, such as having an extra chromosome or missing part of a chromosome
• Environmental factors that a woman is exposed to during pregnancy, such as rubella or German measles while pregnant, or using drugs or alcohol during pregnancy (for more information about prenatal health, visit the Prenatal Care section of this Web site)

What are the different types of birth defects?

There are two main types of birth defects: structural and functional/developmental.

Structural birth defects are related to a problem with body parts. Some physical problems include cleft lip or cleft palate, heart defects, such as missing or misshaped valves, and abnormal limbs, such as a club foot.They also include neural tube defects, such as spina bifida, problems that are related to the growth and development of the brain and spinal cord.

Functional birth defects are related to a problem with how a body part or body system works.  These problems often lead to developmental disabilities and can include things such as:

• Nervous system or brain problems – such as learning disabilities, mental retardation, behavioral disorders, speech or language difficulties, convulsions, and movement trouble.  Some examples of birth defects that affect the nervous system include Autism, Down syndrome, Prader-Willi syndrome, and Fragile X syndrome.
• Sensory problems – such as blindness, cataracts and other visual problems, and varying degrees of  hearing loss including deafness
• Metabolic disorders – involve a body process or chemical pathway or reaction, such as conditions that limit the body’s ability to get rid of waste materials or harmful chemicals. Two common metabolic disorders are phenylketonuria (PKU) and hypothryroidsim.
• Degenerative disorders–are conditions that might not be obvious at birth, but cause one or more aspects of health to steadily get worse. For example, X-linked adrenoleukodystrophy (X-ALD), which was the focus of the movie Lorenzo’s Oil, Rett syndrome, muscular dystrophy, and lysosomal disorders are examples of degenerative disorders.

In some cases, birth defects are caused by a combination of factors. Some recognized patterns of birth defects affect many parts or processes in the body, leading to both structural and functional problems.
What are the treatments for birth defects?

Treatments for birth defects vary by disorder. Talk to your health care provider for more information about treatments for birth defects.

Developmental Disabilities

What are developmental disabilities?

Developmental disabilities are birth defects related to a problem with how a body part or body system works. They may also be known as functional birth defects. Many of these conditions affect multiple body parts or systems.

Nervous system disabilities

What are the different types of developmental disabilities?

These are birth defects that affect the functioning of the brain, spinal cord, and nervous system, which can impact intelligence and learning. These conditions can also cause problems such as behavioral disorders, speech or language difficulties, convulsions, and movement disorders.  Some of the common nervous system disabilities include:

• Mental retardation – The term mental retardation describes a certain range of scores on an IQ (intelligence quotient) test. Mental retardation can result from a number of different conditions, including (but not limited to):
  • Down syndrome – a set of mental and physical characteristics related to having an extra copy of Chromosome 21.
  • Fragile X syndrome- the most common inherited form of mental retardation caused by a defect in a specific part of the Fragile X Mental Retardation-1 gene that causes the body to produce low amounts or none of a certain protein.  Without the protein, the brain doesn’t develop normally.
• Autism Spectrum Disorders – a range of problems that can affect a person’s communication skills, social skills, and intelligence. Because autism is diagnosed on a spectrum, people with this condition can have mild symptoms or severe symptoms; but they all have a type of autism.

Sensory-related disabilities Sensory-related problems are often a key part of complex birth defect patterns. For instance:

• Children with congenital rubella are likely to be deaf, and to develop cataracts of the eyes.
• Children with Williams syndrome have trouble seeing spatial relationships between objects around them.
• Those with Fragile X syndrome are often very sensitive to loud noises; they may overreact or have outbursts in reaction to such sounds.

Metabolic Disorders

This group of functional birth defects affects a person’s metabolism, which is the way the body builds up, breaks down, and otherwise processes the materials it needs to function. For example, how your body breaks down sugar to create energy is a metabolic process. Two commonly known metabolic disorders include:

• Phenylketonuria (PKU) – a condition in which a problem with a specific enzyme, a protein that speeds up certain chemical reactions, causes mental retardation.
• Hypothyroidism – a hormonal condition that, if left untreated in an infant, can cause mental retardation.

Degenerative Disorders

Some infants born with degenerative disorders appear normal at birth, but then lose abilities or functions due to the in condition. In these cases, the defect is usually not detected until an older age, when the child or person starts to show signs of loss of function. Some degenerative disorders are the result of metabolic disorders.

Degenerative disorders can cause physical, mental, and sensory problems, depending on the specific defect. Rett syndrome is an example of a degenerative birth defect. This disorder, which usually affects girls, is most often caused by a specific genetic abnormality.
What are the treatments for developmental disabilities?

Many developmental disabilities have no cure, but there are often ways to treat the symptoms.  For example:

• Children with Down syndrome can often benefit from speech therapy, occupational therapy, and exercises for gross and fine motor skills. They might also be helped by special education and attention at school.  Surgery can also help correct heart defects.
• People with Fragile X syndrome can get help to reduce or eliminate some of the learning, physical, social and emotional, speech and language, and sensory problems common in Fragile X. The sooner those with Fragile X get help, the more they can learn and the better their outcomes.
• There are a variety of treatment options to help with the symptoms of autism spectrum disorders.  This may include behavioral, occupational, physical, and speech-language therapy.  In addition, educational specialists can help guide the child’s school experiences.
• Girls with Rett syndrome can be treated for some of the problems associated with the condition. These treatments generally aim to slow the loss of abilities, improve or preserve movement, and encourage communication and social contact. Treatments may include help from physical therapists, occupational therapists, and speech-language therapists. Other options, such as medication or surgery are also effective for treating some of the symptoms of Rett syndrome.
• Treatment for hypothyroidism, or underactive thyroid, includes daily oral hormone treatment.
• The most effective treatment for PKU is a special diet that carefully limits the protein phenylalanine (Phe).  People with PKU who are on this diet from birth or shortly thereafter develop normally and usually have no symptoms of PKU.