Week 12: Time To Tell?

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This is your Pea in the Podcast for week 12 of your pregnancy. I'm Bonnie Petrie joined by Dr. Laurie Swaim, an obstetrician with Houston Women's Care Associates in Houston, Texas.

One of the great controversies of maternity the world over is: when does the first trimester end and the second trimester begin? Is it week 12? It seems like it should be, "The reason week 12 stands out is because it seems like that is when the first trimester is over and I'll you most obstetricians consider that to be true but if you multiply 12 by 3 then you only wind up 36 weeks pregnant and that's completely unfair because you have another month to go but in my mind the first trimester is pretty much over at 12 weeks. And why did that even matter? Well there are certain disorders that if they occur in the second trimester may be more significant for pregnancies in the future. Someone miscarries at 13 weeks: is that a miscarriage? did she have an incompetent surge? What if it's 14 weeks; is that a miscarriage? That kind of stuff. The other thing is women, when they are pregnant, they sort of like to achieve milestones so we'll toss them that one, 'Hey, you're done with your first trimester.'" Technically the first trimester doesn't end until the end of next week. Regardless for many women this is the moment that they've been waiting for, a safe time to announce their pregnancies to the world. "I think once again that probably harkens back to the olden days where we couldn't tell if women miscarried until they started bleeding and passing tissue. What can happen is the fetus or embryo can die at six weeks but the body doesn't realize it. It can take a number of weeks for that embryo to pass. The same thing can happen at eight weeks or what have you, so people used to miscarry quoted 12 weeks but really it was at six weeks it just took a while to realize. But now we see a woman at six weeks, of course there are a whole host of women who have no prenatal care or don't have access so they may fall into that category. People in our practice call us the second the sperm hits the egg and want prenatal care, so they tend to have a visit at 6 weeks. At 10 weeks if we can't hear the baby the first thing we do is put the ultrasound on their belly and so we're likely to diagnose their miscarriage earlier or if they start to have bleeding and cramping earlier. So I think that people feel 'safe' because the risk of miscarriage goes way down at 12 weeks with the heartbeat but the fact is it's actually pretty low at 10 weeks with the heartbeat, it's actually fairly low if there is a fetal heartbeat at six, seven, eight weeks the risk of miscarriage goes down to less than 10%." So the 12 week safe zone is now more traditional than more anything else but a lot of women like this milestone for sharing their good news, that's fine, go share.

Now while you're busy telling everyone about baby, baby is dancing for joy. In ultrasound your little one is moving and shaking in there though you still can't feel a thing, your baby's face has a distinctly human appearance, the amniotic sac contains about 1 � ounces of fluid, the placenta takes over progesterone production from you now, this is especially important for moms who've been taking progesterone supplements to help support their pregnancies, they'll be allowed to stop now. Your baby can make a fist and maybe put its little thumb inside its tiny mouth. They're about the size of a large grade A egg.

Now as you and your baby grow it's really time for you to pay attention to your health. You're at risk for things now you may never even give a second thought to when not pregnant. All pregnant women for example are at risk for gestational diabetes and will be tested for it during the second trimester but Dr. Swaim says some will need to be tested now, "Well there are certain women who we will test in the first trimester. The recommendations are to test all women between 24 and 28 weeks. But obviously there are some women who are diabetic before they get pregnant and hopefully they know who they are, although sometimes they don't. The women who have specific risk factors or are at specific risk, I'll test them, and I'm not saying everybody needs to test them, but I think that it's a wise idea. So women with strong family history, women who are significantly overweight, women with a history of polycystic ovarian disorder or glucose intolerance, women who have a history of having a really big baby even if they didn't have diabetes that pregnancy, women with a history of gestational diabetes, maybe a woman who's 42, 43, 44 especially if she's got one other little risk factor I may go ahead and screen her earlier in pregnancy as well." Now if your test comes back positive this early in pregnancy you will see a nutritionist right away and you will begin trying to control your blood sugar through food and, if necessary, medication. Uncontrolled diabetes in a pregnant woman can cause miscarriage or it could cause the baby to be born with birth defects, to be born early and have a low birth weight or be stillborn. Also the baby of a diabetic mom can grow too large while having underdeveloped lungs so you'll really want to do all that you can to control your diabetes while pregnant.

Okay what else is going on with you now as the first trimester starts to wind down? Dr. Swaim says your uterus is moving on up, "You can feel the uterus coming out of the pelvis, a little hump, at least I can, some women can feel their own too but other than that I don't think she's going to be feeling that much different. And really mom is not going to feel that much different week to week, she's not going to start to feel different until milestones, like when she can feel the baby move, when she really starts to look pregnant, when she develops reflux and heartburn, when she starts swallowing that kind of stuff but going week to week she's not necessarily going to really feel that different. Although this week there is light at the end of the tunnel, we're heading into the period known as the honeymoon of pregnancy, "If they had nausea the first trimester it's getting better, if they had significant constipation it's getting better or they at least know how to deal with it, if they had a lot of urinary frequency it's going away, they're starting to wake up a little bit and they're not really fat and they don't really feel really big, they don't feel cumbersome and not necessarily swollen, most aren't actually, they don't have back pain, they don't have reflux so they're feeling good. And then eventually in this trimester, most women will start to look a little pregnant so people start to smile at them in public. That's all ahead for you. You're 12 weeks pregnant and you have 28 weeks to go until week 40.

That's your Pea in the Podcast for week 12 of your pregnancy. Dr. Swaim and I look forward to talking to you again next week. Enjoy this week, we'll talk to you then. I'm Bonnie Petrie, thanks for listening.