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Week 23
MDAdvice.com Home > Health Library > Your Pregnancy: Week by Week > Previous Week > Contents > Next Week

How Big Is Your Baby?

By this week, your baby weighs almost 1 pound (455g)! Its crown-to-rump length is 8 inches (20cm). Your baby is about the size of a small doll.

How Big Are You?

Your uterus extends about 1.5 inches (3.75cm) above your bellybutton or about 9.2 inches (23cm) from the pubic symphysis. The changes in your abdomen are progressing slowly, but you definitely have a round appearance now. Your weight gain should be between 12 and 15 pounds.

How Your Baby Is Growing and Developing

Your baby is continuing to grow. Its body is getting plumper, but its skin is still wrinkled because it will gain even more weight. See the illustration on page 194. Lanugo hair on the body occasionally turns darker at this time. The baby's face and body begin to assume more of the appearance of an infant at birth.

Pancreas Function

Your baby's pancreas is developing. It is important in hormone production, particularly insulin production; insulin is necessary for the body to break down and use sugar.

When the fetus is exposed to high blood-sugar levels, the fetal pancreas responds by increasing the blood-insulin level. Insulin has been identified in a fetal pancreas as early as 9 weeks of pregnancy. Insulin in the blood has been detected as early as 12 weeks of pregnancy.

Insulin levels are generally high in the blood of babies born to diabetic mothers. That is one reason your doctor may monitor you for diabetes.

Changes in You

At this point, friends may comment on your size. They may say you must be carrying twins because you're so large. Or they may say you're too small for how far along you think you are. If these comments concern you, discuss them with your doctor.

Your doctor will measure you at every visit after this point. He or she is watching for changes in your weight gain and in the size of your uterus. Remember that women and babies are different sizes and grow at different rates. What's important for you is continual change and continual growth.

As your baby gets larger, the placenta gets larger. The amount of amniotic fluid also increases.

Loss of Fluid

As your pregnancy progresses, your uterus grows larger and gets heavier. In early pregnancy, it lies directly behind the bladder, in front of the rectum and the lower part of the colon, which is part of the bowel.

Later in pregnancy, the uterus sits on top of the bladder. As it increases in size, it can put a great deal of pressure on your bladder. You may notice times when your underwear is wet. You may be uncertain whether you have lost urine or if you are leaking amniotic fluid. It may be difficult to tell the difference between the two. However, when your membranes rupture, you usually experience a gush of fluid or a continual leaking from the vagina. If you experience this, call your doctor immediately!

Urinary-Tract Infections

The possibility of a urinary-tract infection (UTI) increases during pregnancy because of changes in your urinary tract. As the uterus grows larger, it sits directly on top of the bladder and on the ureters, the tubes leading from the kidneys to the bladder.

Urinary-tract infections may cause you to lose urine more frequently while you're pregnant. A UTI is the most common problem involving your bladder or kidneys during pregnancy.

Your doctor may do a urinalysis and urine culture at your first prenatal visit. He or she may check your urine on subsequent visits to look for infection.

Symptoms of a urinary-tract infection include frequent urination, burning urination and a feeling that you need to urinate and nothing will come out. A severe urinary tract infection can cause blood to appear in the urine.

If you think you have a bladder infection, contact your doctor. He or she may order a urine culture to look for specific bacteria causing the infection.

Pyelonephritis

A more serious problem resulting from a bladder infection is pyelonephritis (kidney infection). This type of infection occurs in 1% to 2% of all pregnant women. The right kidney is most often affected.

Symptoms include frequent urination, burning urination, the feeling you need to urinate and nothing will come out, high fever, chills and back pain. Pyelonephritis may require hospitalization and treatment with intravenous antibiotics.

If you have pyelonephritis or recurrent bladder infections during pregnancy, you may have to take antibiotics during your entire pregnancy to prevent reinfection.

Kidney Stones

Another problem involving the kidneys and bladder is kidney stones or urinary calculi. They occur about once in every 1500 pregnancies. Kidney stones cause severe pain in the back or lower abdomen. They may also be associated with blood in the urine.

A kidney stone during pregnancy can usually be treated with pain medication and by drinking lots of fluid. In this way, the stone may be passed without having to be removed surgically or with lithotripsy (an ultrasound treatment).

Emotional Changes Continue

Do you find your mood swings are worse? Are you still crying easily? Do you wonder if you'll ever be in control again?

Don't worry. These emotions are typical at this point in your pregnancy. Most authorities believe they occur from the hormonal changes that continue throughout pregnancy.

There is little you can do about periods of moodiness. If you think your partner or others are suffering from your emotional outbursts, talk about it with them. Explain that these feelings are common in pregnant women. Ask them to be understanding. Then relax; try not to get upset about it. Feeling emotional is a normal part of being pregnant.

How Your Actions Affect Your Baby's Development

Diabetes in Pregnancy

Once a very serious problem during pregnancy, diabetes continues to be an important complication of pregnancy. Today, however, many diabetic women go through pregnancy safely with proper medical care, good nutrition and following their doctor's instructions.

Diabetes is a condition defined as a lack of insulin in the bloodstream. Insulin is important for breaking down sugar and transporting it to the cells. If you do not have insulin, you will have high blood sugar and a high sugar content in your urine.

The condition can cause several medical problems, including kidney problems, eye problems and other blood or vascular

problems, such as atherosclerosis or myocardial infarction (heart attack). These can be serious for you and your baby.

Before insulin was available, it was unusual for a diabetic woman to get pregnant. With the discovery of insulin and the development of various ways to monitor a fetus, it is uncommon to have a severe problem today. Survival rate of babies is good.

Pregnancy is well known for its tendency to reveal women who are predisposed to diabetes. Women who have trouble with high blood-sugar levels during pregnancy are more likely to develop diabetes in later life. Symptoms of diabetes include:

ò an increase in urination

ò blurred vision

ò weight loss

ò dizziness

ò increased hunger

It may be necessary to do blood tests to diagnose diabetes during pregnancy. In some areas, this testing is done routinely.

If you have diabetes or know members of your family have had diabetes in the past, tell your doctor. He or she will decide what course of action is best for you.

Gestational Diabetes

Some women develop diabetes only during pregnancy, called gestational diabetes. Gestational diabetes affects about 10% of all pregnancies. After pregnancy is over, nearly all women who experience this problem return to normal, and the problem disappears. However, if gestational diabetes occurs with one pregnancy, there is almost a 90% chance it will recur in subsequent pregnancies.

We believe gestational diabetes occurs for two reasons. One is the mother's body produces less insulin during pregnancy. The second is the mother's body can't use insulin appropriately. Both situations result in high blood-sugar levels.

If left untreated, gestational diabetes can be very serious for you and your baby. You will both be exposed to a high concentration of sugar, which is not healthy for either of you. You might experience polyhydramnios (excessive amounts of amniotic fluid). This may cause premature labor because the uterus becomes overdistended.

A woman with gestational diabetes may have a very long labor because the baby is quite large. Sometimes a baby cannot fit through the birth canal, and a Cesarean is required.

If your blood-sugar level is high, you may experience more infections during pregnancy. The most common include those in the kidneys, the bladder, the cervix and the uterus.

Treatment of gestational diabetes includes regular exercise and increased fluid intake. Diet is essential in handling this problem. Your doctor will probably recommend a six-meal, 2000- to 2500- calorie/day eating plan. You may also be referred to a dietitian.

Sodium Intake

Avoid foods that contain a large amount of salt, such as salted nuts, potato chips, pickles, and canned and processed foods. Sodium is the culprit; most salty foods contain large amounts of sodium. Consuming too much sodium may make you retain water. This can cause you to swell and to bloat.

To watch your sodium intake during pregnancy, read labels. Food labels list the amount of sodium in a serving. Some books contain sodium content of foods without labels, such as fast foods. Look at them. You'll be surprised how many milligrams of sodium a fast-food hamburger contains!

Look at the following chart of some foods and their sodium content. You can see foods that contain sodium do not always taste salty. Read labels, and check other available information before you eat!

You Should also Know

Appendicitis

Appendicitis can happen, even during pregnancy. Martha's husband called me from the emergency room; Martha was having pain in her abdomen. They had done an ultrasound, and the baby was fine. The ER doctor thought Martha might have appendicitis.

Pregnancy can make the diagnosis difficult because some of the symptoms are typical in a normal pregnancy, such as nausea and vomiting. Diagnosis is also difficult because as the uterus grows larger, the appendix moves upward and outward, so pain and tenderness are located in a different place than normal. See the illustration on page 200.

Treatment for appendicitis is immediate surgery. This is major abdominal surgery, with a 3- or 4-inch incision, and requires a few days in the hospital. Laparoscopy, with smaller incisions, is used in some situations, but laparoscopy may be more difficult to perform during pregnancy because of the enlarged uterus.

Serious complications can arise when an infected appendix ruptures. Most physicians believe it's better to operate and remove a ônormalö appendix than to risk infection of the abdominal cavity if the infected appendix ruptures. Antibiotics are administered; many antibiotics are safe to use during pregnancy.

Are Microwave Ovens Safe?

Many women express concerns over the safety of microwave ovens. Is there exposure to radiation from a microwave oven? Microwave ovens are helpful to busy people who prepare meals. However, we don't know if there is danger to you if you use a microwave oven during pregnancy. More research is needed.

Initial research indicates tissues developing in the body, which would include the human fetus, may be particularly sensitive to the effects of microwaves. A microwave oven heats tissues from the inside.

Follow the directions provided with your microwave oven. It's not good to stand next to or directly in front of the microwave oven while it is in use.

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