Family planning is the planning of when to have children,[1] and the use of birth

control[2][3] and other techniques to implement such plans. Other techniques commonly
used include sexuality education,[3][4] prevention and management of sexually transmitted
infections,[3] pre-conception counseling[3] and management, and infertility management.[2]

Family planning is sometimes used as a synonym for the use of birth control, though it
often includes more. It is most usually applied to a female-male couple who wish to limit
the number of children they have and/or to control the timing of pregnancy (also known
as spacing children). Family planning may encompass sterilization, as well as pregnancy
termination.[5]

Family planning services are defined as "educational, comprehensive medical or social

activities which enable individuals, including minors, to determine freely the number and
spacing of their children and to select the means by which this may be achieved."[4]

Marriage is a social union or legal contract between individuals that creates kinship. It is
an institution in which interpersonal relationships, usually intimate and sexual, are
acknowledged in a variety of ways, depending on the culture or subculture in which it is
found. Such a union may also be called matrimony, while the ceremony that marks its
beginning is usually called a wedding.

People marry for many reasons, including one or more of the following: legal, social,
emotional, economical, spiritual, and religious. These might include arranged marriages,
family obligations, the legal establishment of a nuclear family unit, the legal protection of
children and public declaration of commitment.[1][2]

Marriage practices are very diverse across cultures, may take many forms, and are often
formalized by a wedding.[3] The act of marriage usually creates normative or legal
obligations between the individuals involved. In some societies these obligations also
extend to certain family members of the married persons. Almost all cultures that
recognize marriage also recognize adultery as a violation of the terms of marriage.[4]

Marriage is usually recognized by the state, a religious authority, or both. It is often

viewed as a contract. Civil marriage is the legal concept of marriage as a governmental
institution irrespective of religious affiliation, in accordance with marriage laws of the
jurisdiction. If recognized by the state, by the religion(s) to which the parties belong or by
society in general, the act of marriage changes the personal and social status of the
individuals who enter into it. Conjugal Rights refer to the mutual rights and privileges
between two individuals arising from the state of being married. These rights include
mutual rights of companionship, support, sexual relations, affection, joint property rights
and the like. Loss of conjugal rights will also amount to loss of consortium.[5]

Pregnancy is the carrying of one or more offspring, known as a fetus or embryo, inside
the womb of a female. In a pregnancy, there can be multiple gestations, as in the case of
twins or triplets. Human pregnancy is the most studied of all mammalian pregnancies.
Childbirth usually occurs about 38 weeks after conception ; i.e., approximately 40 weeks
from the last normal menstrual period (LNMP) in humans. The World Health
Organization defines normal term for delivery as between 37 weeks and 42 weeks. One
scientific term for the state of pregnancy is gravid, and a pregnant female is sometimes
referred to as a gravida.[1] Neither word is used in common speech. Similarly, the term
"parity" (abbreviated as "para") is used for the number of previous successful live births.
Medically, a woman who has never been pregnant is referred to as a "nulligravida", a
woman who is (or has been only) pregnant for the first time as a "primigravida"[2], and a
woman in subsequent pregnancies as a multigravida or "multiparous". Hence, during a
second pregnancy a woman would be described as "gravida 2, para 1" and upon live
delivery as "gravida 2, para 2". An in-progress pregnancy, as well as abortions,
miscarriages, or stillbirths account for parity values being less than the gravida number,
whereas a multiple birth will increase the parity value. Women who have never carried a
pregnancy achieving more than 20 weeks of gestation age are referred to as "nulliparous".
[5]

The term embryo is used to describe the developing offspring during the first 8 weeks
following conception, and the term fetus is used from about 2 months of development
until birth.[6][7]
In many societies' medical or legal definitions, human pregnancy is somewhat arbitrarily
divided into three trimester periods, as a means to simplify reference to the different
stages of prenatal development. The first trimester carries the highest risk of miscarriage
(natural death of embryo or fetus). During the second trimester, the development of the
fetus can be more easily monitored and diagnosed. The beginning of the third trimester
often approximates the point of viability, or the ability of the fetus to survive, with or
without medical help, outside of the uterus.[8]
Pregnancy occurs as the result of the female gamete or oocyte merging with the male
gamete, spermatozoon, in a process referred to, in medicine, as "fertilization", or more
commonly known as "conception". After the point of fertilization, it is referred to as a
zygote or fertilized egg. The fusion of male and female gametes usually occurs through
the act of sexual intercourse, resulting in spontaneous pregnancy. However, the advent of
artificial insemination and in vitro fertilization have also made achieving pregnancy
possible in cases where sexual intercourse does not result in fertilization (e.g., through
choice or male/female infertility).
The process of fertilization occurs in more than a single step, and the interruption of any
of these can lead to a failure. Therefore, what is commonly known as "conception" is
much more than the fusion between the female gamete and male spermatozoon. Through
fertilization, the egg and sperm are saved: the egg is activated to begin its developmental
program, and the haploid nuclei of the two gametes come together to form the genome of
a new diploid organism [9]
At the very beginning of the process, the sperm undergoes a series of changes which
makes pregnancy likely to occur. As freshly ejaculated sperm is unable or poorly able to
fertilize [10], the sperm undergoes the phenomenon called "capacitation". It is estimated
that during the ejaculation, 300,000,000 sperma is released, from which only 200 reach
the oviduct. Capacitation is the process through which the spermatozoon is prepared for
the merging with the egg. Capacitation occurs in 5 to 6 hours and it takes place once the
sperm reaches the vagina. This is also the process through which the spermatozoon
becomes hyperactivated and prepared for the acrosome reaction. In order to be able to
fecundate the egg, the sperm must get through the coat surrounding the egg, the so called
"zona pellucida". Once zona pellucida is penetrated, the sperm is able to reach the oocyte.
But in order to get through the egg's coat, the sperm undergoes an acrosome reaction that
provides it with and enzymatic drill which is able to penetrate zona pellucida. The
acrosome itself is a modified lysosome, situated on the anterior part of the head of the
sperm.
Once a sperm penetrates the zona pellucida, it binds to and fuses with the plasma
membrane of the oocyte. Binding occurs at the posterior (post-acrosomal) region of the
sperm head. [10] After binding occurs, the egg must also undergo a series of metabolic and
physical changes which may influence the further development of the zygote. These
changes are called in medicine egg activation, mainly because prior to fertilization, the
egg is in a latent state.
Methods to assist reproduction also include intracytoplasmic sperm injection, gamete
intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), and embryo
cryopreservation (frozen fertilized egg and sperm). These techniques are considered as
alternatives to get pregnant by women who have tried unsuccessfully for at least one
year. It is estimated that only in the United States more than 6 million adults are affected
by infertility which makes about 10% of the population of reproductive age in this
country. [11]
Prenatal period
Prenatal defines the period occurring "around the time of birth", specifically from 22
completed weeks (154 days) of gestation (the time when birth weight is normally 500 g)
to 7 completed days after birth.[12]
Legal regulations in different countries include gestation age beginning from 16 to 22
weeks (5 months) before birth.
Postnatal period
The postnatal period begins immediately after the birth of a child and then extends for
about six weeks. During this period, the mother's body returns to pre-pregnancy
conditions as far as uterus size and hormone levels are concerned.
Perinatal period
The perinatal period is immediately before to after birth. Depending on the definition, it
starts between the 20th to 28th week of gestation and ends between 1 to 4 weeks after
birth (the word "perinatal" is a hybrid of the Greek "peri-" meaning 'around or about' and
"natal" from the Latin "natus" meaning "birth.").
Duration
The expected date of delivery (EDD) is 40 weeks counting from the first day of the last
menstrual period (LMP), and birth usually occurs between 37 and 42 weeks. [13] The actual
pregnancy duration is typically 38 weeks after conception. Though pregnancy begins at
conception, it is more convenient to date from the first day of a woman's last menstrual
period, or from the date of conception if known. Starting from one of these dates, the
expected date of delivery can be calculated. Forty weeks is 9 months and 6 days, which
forms the basis of Naegele's rule for estimating date of delivery. More accurate and
sophisticated algorithms take into account other variables, such as whether this is the first
or subsequent child (i.e., pregnant woman is a primip or a multip, respectively), ethnicity,
parental age, length of menstrual cycle, and menstrual regularity.
Pregnancy is considered "at term" when gestation attains 37 complete weeks but is less
than 42 (between 259 and 294 days since LMP). Events before completion of 37 weeks
(259 days) are considered preterm; from week 42 (294 days) events are considered
postterm.[14] When a pregnancy exceeds 42 weeks (294 days), the risk of complications
for woman and fetus increases significantly.[13][15] As such, obstetricians usually prefer to
induce labor, in an uncomplicated pregnancy, at some stage between 41 and 42 weeks.
Recent medical literature prefers the terminology preterm and post term to premature
and postmature. Preterm and post term are unambiguously defined as above, whereas
premature and postmature have historical meaning and relate more to the infant's size
and state of development rather than to the stage of pregnancy.
Fewer than 5% of births occur on the due date; 50% of births are within a week of the
due date, and almost 90% within 2 weeks.[20] It is much more useful and accurate,
therefore, to consider a range of due dates, rather than one specific day, with some online
due date calculators providing this information.
Accurate dating of pregnancy is important, because it is used in calculating the results of
various prenatal tests (for example, in the triple test). A decision may be made to induce
labor if a fetus is perceived to be overdue. Furthermore, if LMP and ultrasound dating
predict different respective due dates, with the latter being later, this might signify slowed
fetal growth and therefore require closer review.
The age of viability has been receding because of continued medical progress. Whereas it
used to be 28 weeks, it has been brought back to as early as 23, or even 22 weeks in some
countries. Unfortunately, there has been a profound increase in morbidity and mortality
associated with the increased survival to the extent it has led some to question the ethics
and morality of resuscitating at the edge of viability.
Childbirth
Childbirth is the process whereby an infant is born. It is considered by many to be the
beginning of the infant's life, and age is defined relative to this event in most cultures.
A woman is considered to be in labor when she begins experiencing regular uterine
contractions, accompanied by changes of her cervix — primarily effacement and dilation.
While childbirth is widely experienced as painful, some women do report painless labors,
while others find that concentrating on the birth helps to quicken labor and lessen the
sensations. Most births are successful vaginal births, but sometimes complications arise
and a woman may undergo a caesarean section.
During the time immediately after birth, both the mother and the baby are hormonally
cued to bond, the mother through the release of oxytocin, a hormone also released during
breastfeeding.
The beginning of pregnancy may be detected in a number of different ways, either by a
pregnant woman without medical testing, or by using medical tests with or without the
assistance of a medical professional.
Most pregnant women experience a number of symptoms[22] , which can signify
pregnancy. The symptoms can include nausea and vomiting, excessive tiredness and
fatigue, craving for certain foods not normally considered favorite and frequent urination
particularly during the night.
A number of early medical signs are associated with pregnancy.[23][24] These signs
typically appear, if at all, within the first few weeks after conception. Although not all of
these signs are universally present, nor are all of them diagnostic by themselves, taken
together they make a presumptive diagnosis of pregnancy. These signs include the
presence of human chorionic gonadotropin (HCG) in the blood and urine, missed
menstrual period, implantation bleeding that occurs at implantation of the embryo in the
uterus during the third or fourth week after last menstrual period, increased basal body
temperature sustained for over 2 weeks after ovulation, Chadwick's sign (darkening of the
cervix, vagina, and vulva), Goodell's sign (softening of the vaginal portion of the cervix),
Hegar's sign (softening of the uterus isthmus), and pigmentation of linea alba – Linea
nigra, (darkening of the skin in a midline of the abdomen, caused by hyperpigmentation
resulting from hormonal changes, usually appearing around the middle of pregnancy). [23]
[24]

Pregnancy detection can be accomplished using one or more various pregnancy [21] tests,
which detect hormones generated by the newly formed placenta. Clinical blood and urine
tests can detect pregnancy 12 days after implantation [25], which is as early as 6 to 8 days
after fertilization. Blood pregnancy tests are more accurate than urine tests. [26] Home
pregnancy tests are personal urine tests, which normally cannot detect a pregnancy until
at least 12 to 15 days after fertilization. Both clinical and home tests can only detect the
state of pregnancy, and cannot detect the date the embryo was conceived.
In the post-implantation phase, the blastocyst secretes a hormone named human chorionic
gonadotropin, which in turn stimulates the corpus luteum in the woman's ovary to
continue producing progesterone. This acts to maintain the lining of the uterus so that the
embryo will continue to be nourished. The glands in the lining of the uterus will swell in
response to the blastocyst, and capillaries will be stimulated to grow in that region. This
allows the blastocyst to receive vital nutrients from the woman.
Despite all the signs, some women may not realize they are pregnant until they are quite
far along in their pregnancy. In some cases, a few women have not been aware of their
pregnancy until they begin labor. This can be caused by many factors, including irregular
periods (quite common in teenagers), certain medications (not related to conceiving
children), and obese women who disregard their weight gain. Others may be in denial of
their situation.
An early sonograph can determine the age of the pregnancy fairly accurately. In practice,
doctors typically express the age of a pregnancy (i.e., an "age" for an embryo) in terms of
"menstrual date" based on the first day of a woman's last menstrual period, as the woman
reports it. Unless a woman's recent sexual activity has been limited, she has been charting
her cycles, or the conception is the result of some types of fertility treatment (such as IUI
or IVF), the exact date of fertilization is unknown. Without symptoms such as morning
sickness, often the only visible sign of a pregnancy is an interruption of the woman's
normal monthly menstruation cycle, (i.e., a "late period"). Hence, the "menstrual date" is
simply a common educated estimate for the age of a fetus, which is an average of 2
weeks later than the first day of the woman's last menstrual period. The term "conception
date" may sometimes be used when that date is more certain, though even medical
professionals can be imprecise with their use of the two distinct terms. The due date can
be calculated by using Naegele's rule. The expected date of delivery may also be
calculated from sonogram measurement of the fetus. This method is slightly more
accurate than methods based on LMP.[27] The beginning of labor, which is variously
called confinement or childbed, begins on the day predicted by LMP 3.6% of the time
and on the day predicted by sonography 4.3% of the time.
Diagnostic criteria are: Women who have menstrual cycles and are sexually active, a
period delayed by a few days or weeks is suggestive of pregnancy; elevated B-HCG to
around 100,000 mIU/mL by 10 weeks of gestation.[2]
Physiology
Pregnancy is typically broken into three periods, or trimesters, each of about three
months. While there are no hard and fast rules, these distinctions are useful in describing
the changes that take place over time.
First trimester
Traditionally, doctors have measured pregnancy from a number of convenient points,
including the day of last menstruation, ovulation, fertilization, implantation and chemical
detection. In medicine, pregnancy is often defined as beginning when the developing
embryo becomes implanted into the endometrial lining of a woman's uterus. In some
cases where complications may have arisen, the fertilized egg might implant itself in the
fallopian tubes or the cervix, causing an ectopic pregnancy. Most pregnant women do not
have any specific signs or symptoms of implantation, although it is not uncommon to
experience minimal bleeding at implantation. Some women will also experience
cramping during their first trimester. This is usually of no concern unless there is spotting
or bleeding as well. After implantation the uterine endometrium is called the decidua.
The placenta, which is formed partly from the decidua and partly from outer layers of the
embryo, is responsible for transport of nutrients and oxygen to, and removal of waste
products from the fetus. The umbilical cord is the connecting cord from the embryo or
fetus to the placenta. The developing embryo undergoes tremendous growth and changes
during the process of fetal development.
Morning sickness occurs in about seventy percent of all pregnant women and typically
improves after the first trimester. Although described as "morning sickness", women can
experience this nausea during afternoon, evening, and throughout the entire day.
In the first 12 weeks of pregnancy, the nipples and areolas darken due to a temporary
increase in hormones.[29]
Most miscarriages occur during this period.
The first 12 weeks of pregnancy are considered to make up the first trimester. The first
two weeks from the first trimester are calculated as the first two weeks of pregnancy even
though the pregnancy does not actually exist. These two weeks are the two weeks before
conception and which include the woman's last period.
The third week is the week in which fertilization occurs and the 4th week is the period
when implantation takes place. In the 4th week, the fecundated egg reaches the uterus and
burrows into its wall which provides it with the nutrients it needs. At this point, the
zygote becomes a blastocyst and placenta starts to form. Moreover, most of the
pregnancy tests may detect a pregnancy beginning with this week.
The 5th week marks the start of the embryonic period. This is when the baby's brain,
spinal cord, heart and other organs begin to form. [30] The embryo is made at this point
from three layers, from which the top one (called ectoderm) will give rise to the baby's
outermost layer of skin, central and peripheral nervous systems, eyes, inner ear, and
many connective tissues.[30] The heart and the beginning of the circulatory system as well
as the bones, muscles and kidneys are made up from the mesoderm (the middle layer).
The inner layer of the embryo will serve as the starting point of the development of the
baby's lungs, intestine and bladder. This layer is referred to as endoderm. The dimensions
of a baby at 5 weeks are normally between 1/16 and 1/8 inch (in length).
In the 6th week, the baby will be developing basic facial features and its arms and legs
start to grow. At this point, the embryo is usually not longer than 1/6 to 1/4 inch. In the
following week, the brain, face and arms and legs quickly develop. In the 8th week, the
baby starts moving and in the next 3 weeks, the baby's toes, neck and genitals develop as
well. According to the American Pregnancy Association, by the end of the first trimester,
the fetus will be about 3 inches long and will weigh approximately one ounce. [31]
Second trimester
Weeks 13 to 28 of the pregnancy are called the second trimester. Most women feel more
energized in this period, and begin to put on weight as the symptoms of morning sickness
subside and eventually fade away.
In the 20th week the uterus, the muscular organ that holds the developing fetus, can
expand up to 20 times its normal size during pregnancy. Although the fetus begins to
move and takes a recognizable human shape during the first trimester, it is not until the
second trimester that movement of the fetus, often referred to as "quickening", can be
felt. This typically happens in the fourth month, more specifically in the 20th to 21st
week, or by the 19th week if the woman has been pregnant before. However, it is not
uncommon for some women not to feel the fetus move until much later. The placenta
fully functions at this time and the fetus makes insulin and urinates. The reproductive
organs distinguish the fetus as male or female.
Third trimester
Comparison of growth of the abdomen between 26 weeks and 40 weeks gestation.
Final weight gain takes place, which is the most weight gain throughout the pregnancy.
The fetus will be growing the most rapidly during this stage, gaining up to 28 g per day.
The woman's belly will transform in shape as the belly drops due to the fetus turning in a
downward position ready for birth. During the second trimester, the woman's belly would
have been very upright, whereas in the third trimester it will drop down quite low, and the
woman will be able to lift her belly up and down. The fetus begins to move regularly, and
is felt by the woman. Fetal movement can become quite strong and be disruptive to the
woman. The woman's navel will sometimes become convex, "popping" out, due to her
expanding abdomen. This period of her pregnancy can be uncomfortable, causing
symptoms like weak bladder control and backache. Movement of the fetus becomes
stronger and more frequent and via improved brain, eye, and muscle function the fetus is
prepared for ex utero viability. The woman can feel the fetus "rolling" and it may cause
pain or discomfort when it is near the woman's ribs and spine.
There is head engagement in the third trimester, that is, the fetal head descends into the
pelvic cavity so that only a small part (or nothing) of it can be felt abdominally.[32]
It is during this time that a baby born prematurely may survive. The use of modern
medical intensive care technology has greatly increased the probability of premature
babies surviving, and has pushed back the boundary of viability to much earlier dates
than would be possible without assistance. [33] In spite of these developments, premature
birth remains a major threat to the fetus, and may result in ill-health in later life, even if
the baby survives.
Embryonic and fetal development
Prenatal development is divided into two primary biological stages. The first is the
embryonic stage, which lasts for about two months. At this point, the fetal stage begins.
At the beginning of the fetal stage, the risk of miscarriage decreases sharply, [34] all major
structures including hands, feet, head, brain, and other organs are present, and they
continue to grow and develop. When the fetal stage commences, a fetus is typically about
30 mm (1.2 inches) in length, and the heart can be seen beating via sonograph; the fetus
bends the head, and also makes general movements and startles that involve the whole
body.[35] Some fingerprint formation occurs from the beginning of the fetal stage.[36]
Electrical brain activity is first detected between the 5th and 6th week of gestation,
though this is still considered primitive neural activity rather than the beginning of
conscious thought, something that develops much later in fetation. Synapses begin
forming at 17 weeks, and at about week 28 begin multiply at a rapid pace which
continues until 3–4 months after birth. It isn't until week 23 that the fetus can survive,
albeit with major medical support, outside of the womb. It is not until then that the fetus
possesses a sustainable human brain.[37]
One way to observe prenatal development is via ultrasound images. Modern 3D
ultrasound images provide greater detail for prenatal diagnosis than the older 2D
ultrasound technology.[42] While 3D is popular with parents desiring a prenatal
photograph as a keepsake,[43] both 2D and 3D are discouraged by the FDA for non-
medical use,[44][dead link] but there are no definitive studies linking ultrasound to any adverse
medical effects.[45] The following 3D ultrasound images were taken at different stages of
pregnancy:
Some people are confused about the differences between an ultrasound and a sonogram.
An ultrasound is the actual machine that lets you observe pregnancy. A sonogram is the
image of the baby that the ultrasound produces. 4D Ultrasounds take 3D sonograms.
Some people refer to the procedure as prenatal imaging, 3D imaging, a 3D scan, or 4D
scan.
Maternal physiological changes
During pregnancy, the woman undergoes many physiological changes, which are entirely
normal, including cardiovascular, hematologic, metabolic, renal and respiratory changes
that become very important in the event of complications. The body must change its
physiological and homeostatic mechanisms in pregnancy to ensure the fetus is provided
for. Increases in blood sugar, breathing and cardiac output are all required. Levels of
progesterone and estrogens rise continually throughout pregnancy, suppressing the
hypothalamic axis and subsequently the menstrual cycle. The woman and the placenta
also produce many hormones.
Management
Main article: Prenatal care
Prenatal medical care is the medical and nursing care recommended for women before
and during pregnancy. The aim of good prenatal care is to detect any potential problems
early, to prevent them if possible (through recommendations on adequate nutrition,
exercise, vitamin intake etc), and to direct the woman to appropriate specialists, hospitals,
etc. if necessary.
Nutrition
Main article: Nutrition and pregnancy
A balanced, nutritious diet is an important aspect of a healthy pregnancy. Eating a healthy
diet, balancing carbohydrates, fat, and proteins, and eating a variety of fruits and
vegetables, usually ensures good nutrition. Those whose diets are affected by health
issues, religious requirements, or ethical beliefs may choose to consult a health
professional for specific advice. Eating well is very important both for you and your
baby.
Adequate periconceptional folic acid (also called folate or Vitamin B 9) intake has been
proven to limit fetal neural tube defects, preventing spina bifida, a very serious birth
defect. The neural tube develops during the first 28 days of pregnancy, explaining the
necessity to guarantee adequate periconceptional folate intake. [46][47] Folates (from folia,
leaf) are abundant in spinach (fresh, frozen, or canned), and are found in green leafy
vegetables e.g. salads, beets, broccoli, asparagus, citrus fruits and melons, chickpeas (i.e.
in the form of hummus or falafel), and eggs. In the United States and Canada, most wheat
products (flour, noodles) are fortified with folic acid.[48] Cosmetically, a deficiency in B
vitamins can become apparent through increased pigmentation over areas of the body
such as the forehead and cheeks (a condition known as 'pregnancy mask' or melasma). [49]
DHA omega-3 is a major structural fatty acid in the brain and retina, and is naturally
found in breast milk. It is important for the woman to consume adequate amounts of
DHA during pregnancy and while nursing to support her well-being and the health of her
infant. Developing infants cannot produce DHA efficiently, and must receive this vital
nutrient from the woman through the placenta during pregnancy and in breast milk after
birth.[50]
Several micronutrients are important for the health of the developing fetus, especially in
areas of the world where insufficient nutrition is prevalent.[51] In developed areas, such as
Western Europe and the United States, certain nutrients such as Vitamin D and calcium,
required for bone development, may require supplementation.[52][53][54]
Dangerous bacteria or parasites may contaminate foods, particularly Listeria and
toxoplasma, toxoplasmosis agent. Careful washing of fruits and raw vegetables may
remove these pathogens, as may thoroughly cooking leftovers, meat, or processed meat.
Soft cheeses may contain Listeria; if milk is raw, the risk may increase. Cat feces pose a
particular risk of toxoplasmosis. Pregnant women are also more prone to Salmonella
infections from eggs and poultry, which should be thoroughly cooked. Practicing good
hygiene in the kitchen can reduce these risks.[55]
Weight gain
Caloric intake must be increased to ensure proper development of the fetus. The amount
of weight gained during a singleton pregnancy varies among women. The Institute of
Medicine recommends an overall pregnancy weight gain for women starting pregnancy at
a normal weight, with a body mass index of 18.5-24.9, of 25-35 pounds (11.4-15.9 kg).
[56]
Woman that are underweight, with a BMI of less than 18.5, may need to gain between
28-40 lbs. Overweight woman are be advised to gain between 15-25 lbs, whereas an
obese woman may expect to gain between 11-20 lbs. Doctors and dietitians may make
different, or more individualized, recommendations for specific patients, based on factors
including low maternal age, nutritional status, fetal development, and morbid obesity.
During pregnancy, insufficient or excessive weight gain can compromise the health of the
mother and fetus. All women are encouraged to choose a healthy diet regardless of pre-
pregnancy weight. Exercise during pregnancy, such as walking and swimming, is
recommended for healthy pregnancies. Exercise has notable health benefits for both
mother and baby, including preventing excessive weight gain.[57]
Immune tolerance
Main article: Immune tolerance in pregnancy
The fetus inside a pregnant woman may be viewed as an unusually successful allograft,
since it genetically differs from the woman.[58] In the same way, many cases of
spontaneous abortion may be described in the same way as maternal transplant rejection.
[58]

Medication use
Main article: Drugs in pregnancy
Drugs used during pregnancy can have temporary or permanent effects on the fetus.
Therefore many physicians would prefer not to prescribe for pregnant women, the major
concern being over teratogenicity of the drugs.
Drugs have been classified into categories A,B,C,D and X based on the Food and Drug
Administration (FDA) rating system to provide therapeutic guidance based on potential
benefits and fetal risks. Drugs like multivitamins that have demonstrated no fetal risks
after controlled studies in humans are classified as Category A. On the other hand drugs
like thalidomide with proven fetal risks that outweigh all benefits are classified as
Category X.[59]
Exposure to toxins
Various toxins pose a significant hazard to fetuses during development:
Alcohol ingestion during pregnancy may cause fetal alcohol syndrome, a permanent and
often devastating birth-defect syndrome. A number of studies have shown that light to
moderate drinking during pregnancy might not pose a risk to the fetus, although no
amount of alcohol during pregnancy can be guaranteed to be absolutely safe.[60][61][62]
Women who have suffered mercury poisoning in pregnancy have sometimes given birth
to children with serious birth defects, termed Minamata disease.
Sexual activity during pregnancy
Most pregnant women can enjoy sexual activity during pregnancy throughout gravidity.
Most research suggests that, during pregnancy, both sexual desire and frequency of
sexual relations decrease.[63][64] In context of this overall decrease in desire, some studies
indicate a second-trimester increase, preceding a decrease. [65] However, these decreases
are not universal: a significant number of women report greater sexual satisfaction
throughout their pregnancies.[66]
] Abortion
Main article: Abortion
An abortion is termination of the fetus either naturally or via medical methods. Natural
abortion (miscarriage) is rare more than two months after fertilization.[34]
Stem cell collection
Two different types of stem cells can be collected before childbirth: amniotic stem cells
and umbilical cord blood stem cells. The collection of amniotic stem cells is part of the
process of amniocentesis. Umbilical cord blood stem cells can be stored in both public
and private banks, such as the Biocell Center in Boston.[67][68][69].
Complications and complaints
Main article: Complications of pregnancy
Each year, according to the WHO, ill-health as a result of pregnancy is experienced
(sometimes permanently) by more than 20 million women around the world.
Furthermore, the "lives of eight million women are threatened, and more than 500,000
women are estimated to have died in 1995 as a result of causes related to pregnancy and
childbirth".[70]
The following are complaints that may occur during pregnancy:
Back pain. A particularly common complaint in the third trimester when the patient's
center of gravity has shifted.
Carpal tunnel syndrome in between an estimated 21% to 62% of cases, possibly due to
edema.[71]
Constipation. A complaint that is caused by decreased bowel mobility secondary to
elevated progesterone (normal in pregnancy), which can lead to greater absorption of
water.
Braxton Hicks contractions. Occasional, irregular, and often painless contractions that
occur several times per day.
Edema (swelling). Common complaint in advancing pregnancy. Caused by compression
of the inferior vena cava (IVC) and pelvic veins by the uterus leads to increased
hydrostatic pressure in lower extremities.
Regurgitation, heartburn, and nausea. Common complaints that may be caused by
Gastroesophageal Reflux Disease (GERD); this is determined by relaxation of the lower
esophageal sphincter (LES) and increased transit time in the stomach (normal in
pregnancy), as well as by increased intraabdominal pressure, caused by the enlarging
uterus.
Haemorrhoids. Complaint that is often noted in advancing pregnancy. Caused by
increased venous stasis and IVC compression leading to congestion in venous system,
along with increased abdominal pressure secondary to the pregnant space-occupying
uterus and constipation.
Pelvic girdle pain. PGP disorder is complex and multi-factorial and likely to be
represented by a series of sub-groups with different underlying pain drivers from
peripheral or central nervous system,[72] altered laxity/stiffness of muscles,[73] laxity to
injury of tendinous/ligamentous structures[74] to ‘mal-adaptive’ body mechanics.[75]
Musculo-Skeletal Mechanics involved in gait and weightbearing activities can be mild to
grossly impaired. PGP can begin peri or postpartum. There is pain, instability or
dysfunction in the symphysis pubis and/or sacroiliac joints.
Round Ligament Pain. Pain experienced when the ligaments positioned under the uterus
stretch and expand to support the woman's growing uterus
Increased urinary frequency. A common complaint referred by the gravida, caused by
increased intravascular volume, elevated GFR (glomerular filtration rate), and
compression of the bladder by the expanding uterus.
Varicose veins. Common complaint caused by relaxation of the venous smooth muscle
and increased intravascular pressure.
PUPPP skin disease that develop around the 32nd week. (Pruritic Urticarial Papules and
Plaques of Pregnancy), red plaques, papules, itchiness around the belly button that spread
all over the body except for the inside of hands and face.

Common Signs of Pregnancy

No menstrual period
Although this is not proof positive, absence of your menstrual cycle is a good indicator of
pregnancy.

Fatigue and sleepiness

For many women, fatigue is the first symptom of pregnancy. If you suddenly find
yourself needing an afternoon nap, you could be pregnant.

Breast changes

Along with fatigue, breast changes are possibly the earliest sign of pregnancy. Breast
changes include fullness, tenderness, sensitivity to touch, change in size, and darkening
of the areola.

Nausea and vomiting

Nausea and vomiting, also known as morning sickness, is another symptom of

pregnancy. Not all women experience morning sickness and morning sickness may not
occur until two to four weeks after a missed period. Generally, morning sickness resolves
or improves in the second trimester.

Frequent urination

Once you become pregnant, your blood volume increases and your kidneys increase in
size. These factors can lead to an increase in urination.

Fullness, bloating, achiness in the abdominal area

Believe it or not for many women the symptoms of pregnancy mimic the symptoms of
PMS. If you are experiencing PMS symptoms, don't rule out the possibility of pregnancy.
Some women will also complain of diarrhea or constipation in pregnancy

Mood swings and irritability

Hormonal changes combined with fatigue may cause mood swings and irritability. If you
find yourself incredibly crabby this could be a sign of pregnancy. Keep in mind,
Pregnancy Warning Sign No. 1: Bleeding During Any Trimester
Bleeding means different things throughout your pregnancy. “If you are bleeding heavily
and have severe abdominal pain and menstrual-like cramps or feel like you are going to
faint during first trimester, it could be a sign of an ectopic pregnancy,” says Peter
Bernstein, MD. Bernstein is a professor of clinical obstetrics and gynecology and
women’s health at Albert Einstein College of Medicine and Montefiore Medical Center
in the Bronx. Ectopic pregnancy occurs when the fertilized egg implants somewhere
other than the uterus, and it can be life-threatening.
Heavy bleeding with cramping could also be a sign of miscarriage in first or early second
trimester. By contrast, bleeding in the third trimester with abdominal pain may indicate
placental abruption, which occurs when the placenta separates from the uterine lining.
“Bleeding is always serious,” says Donnica Moore, MD. Moore is a women's health
expert in Far Hills, N.J., and the editor-in-chief of Women’s Health for Life. She tells
WebMD that any bleeding during pregnancy needs immediate attention. If you start
bleeding, don’t wait. Call your doctor or go to the emergency room.
Pregnancy Warning Sign No. 2: Severe Nausea and Vomiting
Severe nausea and vomiting to the point you can’t keep anything down is a dangerous
situation. “If you can’t eat or drink anything, you run the risk of becoming dehydrated,”
Bernstein says. You also run the risk of becoming malnourished, and dehydration.
Malnutrition can cause serious complications ranging from birth defects to premature
labor.
Bernstein says it’s important to contact your doctor when you experience severe nausea.
There are safe medications your doctor can prescribe for controlling nausea. Your doctor
may also advise some dietary changes to help you find food you can keep you are usually
pretty careful, but lately you and your partner have been throwing caution to the wind.
All you keep hearing about is how much trouble your friends have trying to conceive, so
really what are the odds? Still, you have been so tired lately, get up from your desk 20
times a day to use the ladies' room, and your bra feels like it has a stranglehold on your
chest. It's too early to know if you've missed your period, but are these the early signs of
pregnancy?
They just may be. Fatigue, frequent urination, and breast tenderness are some of more
subtle first signs of pregnancy and may occur even if it is still too early to take an at-
home pregnancy test.
“Always suspect that you could be pregnant, even if you are using contraception -- as
nothing except abstinence is 100 percent,” says Xavier Pombar, MD, an obstetrician at
Rush University Medical Center in Chicago. “The earlier you know, the better prenatal
care you can get. So it’s always important to watch out for the early signs of pregnancy.”
If you are pregnant, it’s never too early (or too late) to start making important lifestyle
changes, such as cutting out caffeine, nicotine, sushi, and alcohol. And if you are not
already doing so, you’ll need to take prenatal vitamins. “You may also be taking
medications to treat other conditions that will need to be stopped or adjusted if you are
pregnant,” he says.
So what are the early signs of pregnancy that you should be on the lookout for?
1. Fatigue.
“Extreme, unexplainable fatigue is probably the most common sign of early pregnancy,”
says high-risk obstetrician Gil Gross, MD, an associate professor of obstetrics and
gynecology at the Washington University School of Medicine in St. Louis.
“Don’t treat fatigue with excessive caffeine if there is a chance you may be pregnant.”
Instead, “listen to your body, take it easy, and try to keep well-rested,” says Donnica
Moore, MD, a women's health expert in Far Hills, N.J.
2. Food aversions.
The thought of chicken makes you wince, and you can’t even walk past the local Chinese
restaurant without gagging. Sound familiar? If it does, you could be pregnant. Many
women report that such intense food aversions are one of the first signs of early
pregnancy. These can be caused by rising levels of beta-HCG hormone, Moore says.
There isn’t all that much to do except steer clear of triggers.
3. Sensitivity to smells.
Scents that were never pleasant (like cigarette smoke) and even ones that were agreeable
(like Blame it on rising levels of hormones in early pregnancy -- nausea and vomiting can
be signs that you are with child. “One of the things that help expectant moms get through
first trimester is the reassurance that the nausea and vomiting will likely pass by 12
weeks,” Moore says. “It also helps to know that morning sickness can be a good thing"
because rising levels of the beta-HCG hormone, which may cause morning sickness,
indicate a growing pregnancy. Beat back morning (or all-day sickness, as the case can be)
by eating offensively as opposed to defensively. “The key is not to let your stomach get
too empty,” she says. “Keep crackers by your bedside and have them before you get out
of bed in the morning,” she says. Prenatal vitamins can also trigger nausea for some
expectant moms. “Don’t take your vitamins on an empty stomach,” Moore says. “A lot of
people feel better if they take them at nighttime or with dinner.”
5. Breast swelling and tenderness.
Other early signs of pregnancy may include breast changes. “The best thing to do about
breast tenderness is to get a better bra,” says Washington University’s Gross.
6. Frequent urination.
“In early pregnancy, the uterus grows and pushes on the bladder, triggering the urge to
urinate more often,” Pombar says. This sensation usually goes away by the second
trimester, but not for long. “In your third trimester, it recurs again because of your
enlarged uterus and the pressure of the fetus's head on your bladder,” he says. There is no
way to avoid this, but going to the bathroom right before bed may allow you to get a little
more sleep. “You will probably still have to get up at least once in the night to use the
bathroom,” he says.
7. Shortness of breath.
Some women feel short of breath when they first become pregnant. “This is because you
need extra oxygen due to the growing fetus,” Pombar says. “The further along you are,
the worse this gets. Tell your doctor if there is a sudden onset of shortness of breath that
is not associated with exercise, you also have pain, or it is worse when you are lying
down, as these can be signs of something more serious.”
8. Physical changes.
If you think that you may be pregnant because you have been sexually active without
contraception, make an appointment with your doctor because there are changes in the
color of the vagina and the softness of the cervix that a good clinician can pick up on
during a pelvic exam, Pombar says.
Although all of these may be among the first signs of pregnancy, they are by no means
definitive.
“Remember that while these are early signs of pregnancy, these are also the symptoms of
other things, including premenstrual syndrome (PMS),” Moore says. “The most reliable
early sign of pregnancy is your first missed period if you have regular periods
Your partner’s cologne can also make you gag during the beginning of pregnancy. “For
some women, this can be a tip-off that they are expecting,” Moore says. This is likely a
result of rising hormone levels. Unfortunately, “there is really nothing you can do except
avoid them where you can,” she says, “especially cigarette smoke, which is not good for
you or the baby.”
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Addressing the nausea and vomiting will allow you and your baby to get the nutrition you
both need.
Pregnancy Warning Sign No. 3: The Baby’s Activity Level Significantly Declines
What does it mean if your previously active baby -- the one that made you feel like the
Incredible Hulk was about to burst from your abdomen -- seems to have less energy? “If
your baby is not moving as much as it was, it could be that the baby is not getting enough
oxygen and nutrients from the placenta," Bernstein says.

however, that crabbiness is also a sign of PMS.

Other common signs of pregnancy include an increase in vaginal secretions, aversion to

certain foods or smells, weight gain, and constipation.

Less common signs of pregnancy

Implantation bleeding

An estimated twenty percent of women will experience bleeding when the fertilized egg
implants into the uterus. Implantation

Bleeding is typically light in color and amount and generally occurs six to ten days past
ovulation.

Headaches

For women that suffer from headaches, pregnancy usually decreases the frequency of
headaches. For some, however, there will be a marked increase in the amount of
headaches during pregnancy