Pregnancy

Pregnancy
Other names	Gestation
iron supplements[9][10]
Frequency	213 million (2012)[11]
Deaths	230,600 (2016)[12]

Pregnancy is the time during which one or more offspring develops (gestates) inside a woman's uterus (womb).^[4][13] A multiple pregnancy involves more than one offspring, such as with twins.^[14]

Pregnancy usually occurs by

—or, more accurately, contraception—are used to avoid pregnancy.

Pregnancy is divided into three trimesters of approximately three months each. The

, though babies born at this time will likely experience serious health complications such as heart and respiratory problems and long-term intellectual and developmental disabilities.

Terminology

Associated terms for pregnancy are gravid and parous. Gravidus and gravid come from the

and other multiple births are counted as one pregnancy and birth.

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 is referred to as a primigravida,

A pregnancy is considered term at 37 weeks of gestation. It is preterm if less than 37 weeks and postterm at or beyond 42 weeks of gestation. American College of Obstetricians and Gynecologists have recommended further division with early term 37 weeks up to 39 weeks, full term 39 weeks up to 41 weeks, and late term 41 weeks up to 42 weeks.[24] The terms preterm and postterm have largely replaced earlier terms of premature and postmature. Preterm and postterm are defined 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.^[25][26]

Demographics and statistics

About 213 million pregnancies occurred in 2012, of which, 190 million (89%) were in the

Signs and symptoms

The usual signs and symptoms of pregnancy do not significantly interfere with activities of daily living or pose a health-threat to the mother or baby. However, pregnancy complications can cause other more severe symptoms, such as those associated with anemia.

Common signs and symptoms of pregnancy include:

• Tiredness
• Morning sickness
• Constipation
• Pelvic girdle pain
• Back pain
• Braxton Hicks contractions. Occasional, irregular, and often painless contractions that occur several times per day.
• hydrostatic pressure
  in lower extremities.
• Low blood pressure often caused by compression of both the inferior vena cava and the abdominal aorta (aortocaval compression syndrome).
• bladder
  by the expanding uterus.
• Urinary tract infection^[29]
• Varicose veins. Common complaint caused by relaxation of the venous smooth muscle and increased intravascular pressure.
• Hemorrhoids (piles). Swollen veins at or inside the anal area. Caused by impaired venous return, straining associated with constipation, or increased intra-abdominal pressure in later pregnancy.^[30]
• Regurgitation, heartburn, and nausea.
• Stretch marks
• Breast tenderness is common during the first trimester, and is more common in women who are pregnant at a young age.^[31]
• Melasma, also known as the mask of pregnancy, is a discoloration, most often of the face. It usually begins to fade several months after giving birth.

Timeline

Comparison of dating systems for a typical pregnancy

Event	Gestational age (from the start of the last menstrual period )	Fertilization age	Implantation age
Menstrual period begins	Day 1 of pregnancy	Not pregnant	Not pregnant
Has sex and ovulates	2 weeks pregnant	Not pregnant	Not pregnant
cleavage stage begins[32]	Day 15[32]	Day 1[32][33]	Not pregnant
Implantation of blastocyst begins	Day 20	Day 6[32][33]	Day 0
Implantation finished	Day 26	Day 12[32][33]	Day 6 (or Day 0)
missed period	4 weeks	Day 15[32]	Day 9
detected	5 weeks, 5 days[32]	Day 26[32]	Day 20
Fetal stage begins	10 weeks, 1 day[32]	8 weeks, 1 day[32]	7 weeks, 2 days
First trimester ends	13 weeks	11 weeks	10 weeks
Second trimester ends	26 weeks	24 weeks	23 weeks
Childbirth	39–40 weeks	37–38 weeks[33]: 108	36–37 weeks

The

, which is the age of the embryo since conception.

Start of gestational age

The

• Directly calculating the days since the beginning of the last menstrual period.
• Early
  reference group of pregnancies of known gestational age (such as calculated from last menstrual periods), and using the mean gestational age of other embryos or fetuses of the same size. If the gestational age as calculated from an early ultrasound is contradictory to the one calculated directly from the last menstrual period, it is still the one from the early ultrasound that is used for the rest of the pregnancy.^[34]
• In case of
  co-incubation and adding 14 days.^[35]

Trimesters

Pregnancy is divided into three trimesters, each lasting for approximately three months.[4] The exact length of each trimester can vary between sources.

• The first trimester begins with the start of gestational age as described above, that is, the beginning of week 1, or 0 weeks + 0 days of gestational age (GA). It ends at week 12 (11 weeks + 6 days of GA)^[4] or end of week 14 (13 weeks + 6 days of GA).^[36]
• The second trimester is defined as starting, between the beginning of week 13 (12 weeks +0 days of GA)^[4] and beginning of week 15 (14 weeks + 0 days of GA).^[36] It ends at the end of week 27 (26 weeks + 6 days of GA)^[36] or end of week 28 (27 weeks + 6 days of GA).^[4]
• The third trimester is defined as starting, between the beginning of week 28 (27 weeks + 0 days of GA)^[36] or beginning of week 29 (28 weeks + 0 days of GA).^[4] It lasts until childbirth.

Estimation of due date

Due date estimation basically follows two steps:

• Determination of which time point is to be used as
  gestational age
  , as described in the section above.
• Adding the estimated gestational age at childbirth to the above time point. Childbirth on average occurs at a gestational age of 280 days (40 weeks), which is therefore often used as a standard estimation for individual pregnancies.^[38] However, alternative durations as well as more individualized methods have also been suggested.

The American College of Obstetricians and Gynecologists divides full term into three divisions:^[39]

• Early-term: 37 weeks and 0 days through 38 weeks and 6 days
• Full-term: 39 weeks and 0 days through 40 weeks and 6 days
• Late-term: 41 weeks and 0 days through 41 weeks and 6 days
• Post-term: greater than or equal to 42 weeks and 0 days

Naegele's rule is a standard way of calculating the due date for a pregnancy when assuming a gestational age of 280 days at childbirth. The rule estimates the expected date of delivery (EDD) by adding a year, subtracting three months, and adding seven days to the origin of gestational age. Alternatively there are mobile apps, which essentially always give consistent estimations compared to each other and correct for leap year, while pregnancy wheels made of paper can differ from each other by 7 days and generally do not correct for leap year.^[40]

Furthermore, actual childbirth has only a certain probability of occurring within the limits of the estimated due date. A study of singleton live births came to the result that childbirth has a standard deviation of 14 days when gestational age is estimated by first trimester ultrasound, and 16 days when estimated directly by last menstrual period.^[37]

Physiology

Capacity

Fertility and fecundity are the respective capacities to fertilize and establish a clinical pregnancy and have a live birth. Infertility is an impaired ability to establish a clinical pregnancy and sterility is the permanent inability to establish a clinical pregnancy.^[41]

The capacity for pregnancy depends on the

, as well as on the condition of a person.

Initiation

Through an interplay of hormones that includes

.

Fertilization (conception) is sometimes used as the initiation of pregnancy, with the derived age being termed

fertilization age

. Fertilization usually occurs about two weeks before the next expected menstrual period.

A third point in time is also considered by some people to be the true beginning of a pregnancy: This is time of implantation, when the future fetus attaches to the lining of the uterus. This is about a week to ten days after fertilization.[44]

Development of embryo and fetus

human embryogenesis

The sperm and the egg cell, which has been released from one of the female's two

.

The development of the mass of cells that will become the infant is called

. The placenta connects the developing embryo to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. The umbilical cord is the connecting cord from the embryo or fetus to the placenta.

After about ten weeks of gestational age—which is the same as eight weeks after conception—the embryo becomes known as a fetus.^[45] At the beginning of the fetal stage, the risk of miscarriage decreases sharply.^[46] At this stage, a fetus is about 30 mm (1.2 inches) in length, the heartbeat is seen via ultrasound, and the fetus makes involuntary motions.^[47] During continued fetal development, the early body systems, and structures that were established in the embryonic stage continue to develop. Sex organs begin to appear during the third month of gestation. The fetus continues to grow in both weight and length, although the majority of the physical growth occurs in the last weeks of pregnancy.

Electrical

Although the fetus begins to move during the first trimester, it is not until the second trimester that movement, known as

maternity clothes

may be worn.

• 
  Embryo at 4 weeks after fertilization (gestational age of 6 weeks)
• 
  Fetus at 8 weeks after fertilization (gestational age of 10 weeks)
• 
  Fetus at 18 weeks after fertilization (gestational age of 20 weeks)
• 
  Fetus at 38 weeks after fertilization (gestational age of 40 weeks)

• 
  Relative size in 1st month (simplified illustration)
• 
  Relative size in 3rd month (simplified illustration)
• 
  Relative size in 5th month (simplified illustration)
• 
  Relative size in 9th month (simplified illustration)

Maternal changes

During pregnancy, a woman undergoes many normal

The fetus is

During the first trimester,

During the second trimester, most women feel more energized and put on weight as the symptoms of morning sickness subside. They begin to feel regular fetal movements, which can become strong and even disruptive.^{[citation needed]}

Braxton Hicks contractions are sporadic uterine contractions that may start around six weeks into a pregnancy; however, they are usually not felt until the second or third trimester.^[56]

Final weight gain takes place during the third trimester; this is the most weight gain throughout the pregnancy. The woman's abdomen will transform in shape as the fetus turns in a downward position ready for birth. The woman's navel will sometimes become convex, "popping" out, due to the expanding abdomen. The uterus, the muscular organ that holds the developing fetus, can expand up to 20 times its normal size during pregnancy.

It is during the third trimester that maternal activity and sleep positions may affect

Childbirth

Childbirth, referred to as labor and delivery in the medical field, is the process whereby an infant is born.^[59]

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

.

During the time immediately after birth, both the mother and the

Childbirth maturity stages

Stages of pregnancy term

stage	starts	ends
Preterm[61]	-	at 37 weeks
Early term[62]	37 weeks	39 weeks
Full term[62]	39 weeks	41 weeks
Late term[62]	41 weeks	42 weeks
Postterm[62]	42 weeks	-

In the ideal childbirth, labor begins on its own when a woman is "at term".^[17] Events before completion of 37 weeks are considered preterm.^[61] Preterm birth is associated with a range of complications and should be avoided if possible.^[63]

Sometimes if a woman's water breaks or she has contractions before 39 weeks, birth is unavoidable.^[62] However, spontaneous birth after 37 weeks is considered term and is not associated with the same risks of a preterm birth.^[59] Planned birth before 39 weeks by caesarean section or labor induction, although "at term", results in an increased risk of complications.^[64] This is from factors including underdeveloped lungs of newborns, infection due to underdeveloped immune system, feeding problems due to underdeveloped brain, and jaundice from underdeveloped liver.^[65]

Babies born between 39 and 41 weeks' gestation have better outcomes than babies born either before or after this range.^[62] This special time period is called "full term".^[62] Whenever possible, waiting for labor to begin on its own in this time period is best for the health of the mother and baby.^[17] The decision to perform an induction must be made after weighing the risks and benefits, but is safer after 39 weeks.^[17]

Events after 42 weeks are considered postterm.^[62] When a pregnancy exceeds 42 weeks, the risk of complications for both the woman and the fetus increases significantly.^[66][67] Therefore, in an otherwise uncomplicated pregnancy, obstetricians usually prefer to induce labor at some stage between 41 and 42 weeks.^[68]

Postnatal period

The postpartum period also referred to as the puerperium, is the postnatal period that begins immediately after delivery and extends for about six weeks.^[59] During this period, the mother's body begins the return to pre-pregnancy conditions that includes changes in hormone levels and uterus size.^[59]

Diagnosis

The beginning of pregnancy may be detected either based on symptoms by the woman herself, or by using pregnancy tests. However, an important condition with serious health implications that is quite common is the denial of pregnancy by the pregnant woman. About 1 in 475 denials will last until around the 20th week of pregnancy. The proportion of cases of denial, persisting until delivery is about 1 in 2500.^[69] Conversely, some non-pregnant women have a very strong belief that they are pregnant along with some of the physical changes. This condition is known as a false pregnancy.^[70]

Physical signs

Most pregnant women experience a number of symptoms,

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 two weeks after ovulation
• vulva
  )
• Goodell's sign (softening of the vaginal portion of the cervix)
• Hegar's sign (softening of the uterine isthmus)
• Pigmentation of the linea alba, called linea nigra (darkening of the skin in a midline of the abdomen, resulting from hormonal changes, usually appearing around the middle of pregnancy).^[72][73]
• Darkening of the nipples and areolas due to an increase in hormones.^[74]

Biomarkers

Pregnancy detection can be accomplished using one or more various

Ultrasound

Management

Prenatal care

Pre-conception counseling is care that is provided to a woman or couple to discuss conception, pregnancy, current health issues and recommendations for the period before pregnancy.^[87]

Prenatal medical care is the medical and nursing care recommended for women during pregnancy, time intervals and exact goals of each visit differ by country.^[88] Women who are high risk have better outcomes if they are seen regularly and frequently by a medical professional than women who are low risk.^[89] A woman can be labeled as high risk for different reasons including previous complications in pregnancy, complications in the current pregnancy, current medical diseases, or social issues.^[90][91]

The aim of good prenatal care is prevention, early identification, and treatment of any medical complications.^[92] A basic prenatal visit consists of measurement of blood pressure, fundal height, weight and fetal heart rate, checking for symptoms of labor, and guidance for what to expect next.^[87]

Nutrition

Weight gain

The amount of healthy weight gain during a pregnancy varies.^[100] Weight gain is related to the weight of the baby, the placenta, extra circulatory fluid, larger tissues, and fat and protein stores.^[16] Most needed weight gain occurs later in pregnancy.^[101]

The

These values reference the expectations for a term pregnancy.

During pregnancy, insufficient or excessive weight gain can compromise the health of the mother and fetus.

Around 50% of women of childbearing age in developed countries like the United Kingdom are overweight or obese before pregnancy.[104] Diet modification is the most effective way to reduce weight gain and associated risks in pregnancy.^[104]

Medication

Drugs used during pregnancy can have temporary or permanent effects on the fetus.

Recreational drugs

The use of

• Alcoholic drinks consumed during pregnancy can cause one or more fetal alcohol spectrum disorders.^[59] According to the CDC, there is no known safe amount of alcohol during pregnancy and no safe time to drink during pregnancy, including before a woman knows that she is pregnant.^[109]
• placenta previa.^[111] Smoking is associated with 30% higher odds of preterm birth.^[112]
• attention deficit disorder.^[59]
• congenital abnormalities.^[113] Short-term neonatal outcomes in methamphetamine babies show small deficits in infant neurobehavioral function and growth restriction.^[114] Long-term effects in terms of impaired brain development may also be caused by methamphetamine use.^[113]
• teratogenic in large doses in animals, but has not shown any teratogenic effects in humans.^[59]

Exposure to toxins

Intrauterine exposure to

Pregnant women can also be exposed to toxins in the workplace, including airborne particles. The effects of wearing an N95 filtering facepiece respirator are similar for pregnant women as for non-pregnant women, and wearing a respirator for one hour does not affect the fetal heart rate.^[117]

Death by violence

Pregnant women or those who have recently given birth in the U.S. are more likely to be murdered than to die from obstetric causes. These homicides are a combination of intimate partner violence and firearms. Health authorities have called the violence "a health emergency for pregnant women", but say that pregnancy-related homicides are preventable if healthcare providers identify those women at risk and offer assistance to them.^{[118][119][120]}

Sexual activity

Most women can continue to engage in sexual activity, including sexual intercourse, throughout pregnancy.^[121] Research suggests that during pregnancy both sexual desire and frequency of sexual relations decrease during the first and third trimester, with a rise during the second trimester.^[122][123] I^[124][125] Sex during pregnancy is a low-risk behavior except when the healthcare provider advises that sexual intercourse be avoided for particular medical reasons.^[121] For a healthy pregnant woman, there is no single safe or right way to have sex during pregnancy.^[121]

Exercise

Regular

The Clinical Practice Obstetrics Committee of Canada recommends that "All women without contraindications should be encouraged to participate in aerobic and strength-conditioning exercises as part of a healthy lifestyle during their pregnancy".[131] Although an upper level of safe exercise intensity has not been established, women who were regular exercisers before pregnancy and who have uncomplicated pregnancies should be able to engage in high intensity exercise programs, without a higher risk of prematurity, lower birth weight, or gestational weight gain.^[128] In general, participation in a wide range of recreational activities appears to be safe, with the avoidance of those with a high risk of falling such as horseback riding or skiing or those that carry a risk of abdominal trauma, such as soccer or hockey.^[132]

Sleep

It has been suggested that shift work and exposure to bright light at night should be avoided at least during the last trimester of pregnancy to decrease the risk of psychological and behavioral problems in the newborn.^[133]

Stress

The children of women who had high stress levels during pregnancy are slightly more likely to have

Dental care

The increased levels of

Flying

In low risk pregnancies, most health care providers approve flying until about 36 weeks of gestational age.[138] Most airlines allow pregnant women to fly short distances at less than 36 weeks, and long distances at less than 32 weeks.^[139] Many airlines require a doctor's note that approves flying, especially at over 28 weeks.^[139] During flights, the risk of deep vein thrombosis is decreased by getting up and walking occasionally, as well as by avoiding dehydration. The exposure to cosmic radiation is negligible for most travelers. For pregnant women, even the longest intercontinental fight would expose them less than 15% of both the NCRPM and ICRP limit.^[140][139] Full body scanners do not use ionizing radiation, and are safe in pregnancy.^[141]

Pregnancy classes and birth plan

To prepare for the birth of the baby, health care providers recommend that parents attend antenatal classes during the third trimester of pregnancy. Classes include information about the process of labor and birth and the various kinds of births, including both vaginal and

]

It is also suggested that a birth plan be written at this time. A birth plan is a written statement that outlines the desires of the mother during labor and delivery of the baby. Discussing the birth plan with the midwife or other care provider gives parents a chance to ask questions and learn more about the process of labour.[142]

In 1991 the

Complications

Each year, ill health as a result of pregnancy is experienced (sometimes permanently) by more than 20 million women around the world.

The following are some examples of pregnancy complications:

• Pregnancy induced hypertension
• Anemia^[145]
• Postpartum depression, a common but solvable complication following childbirth that may result from decreased hormonal levels.^[146]
• Postpartum psychosis
• Thromboembolic disorders, with an increased risk due to hypercoagulability in pregnancy. These are the leading cause of death in pregnant women in the US.^[147][148]
• Pruritic urticarial papules and plaques of pregnancy (PUPPP), a skin disease that develops around the 32nd week. Signs are red plaques, papules, and itchiness around the belly button that then spreads all over the body except for the inside of hands and face.
• Ectopic pregnancy, including abdominal pregnancy, implantation of the embryo outside the uterus
• Hyperemesis gravidarum, excessive nausea and vomiting that is more severe than normal morning sickness.
• Pulmonary embolism, a blood clot that forms in the legs and migrates to the lungs.^[148]
• Acute fatty liver of pregnancy is a rare complication thought to be brought about by a disruption in the metabolism of fatty acids by mitochondria.

There is also an increased susceptibility and severity of certain infections in pregnancy.

Miscarriage and stillbirth

Miscarriage is the most common complication of early pregnancy. It is defined as the loss of an embryo or fetus before it is able to survive independently. The most common symptom of miscarriage is vaginal bleeding with or without pain. The miscarriage may be evidenced by a clot-like material passing through and out of the vagina.^[149] About 80% of miscarriages occur in the first 12 weeks of pregnancy. The underlying cause in about half of cases involves chromosomal abnormalities.^[150]

Stillbirth is defined as fetal death after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. Each year about 21,000 babies are stillborn in the U.S.^[151] Sadness, anxiety, and guilt may occur after a miscarriage or a stillbirth. Emotional support may help with processing the loss.^[152] Fathers may experience grief over the loss as well. A large study found that there is a need to increase the accessibility of support services available for fathers.^[153]

Diseases in pregnancy

A pregnant woman may have a pre-existing disease, which is not directly caused by the pregnancy, but may cause complications to develop that include a potential risk to the pregnancy; or a disease may develop during pregnancy.

• diabetes mellitus (not restricted to gestational diabetes) and pregnancy. Risks for the child include miscarriage, growth restriction, growth acceleration, large for gestational age (macrosomia), polyhydramnios (too much amniotic fluid
  ), and birth defects.
• neurointellectual development
  in the early life of the child. Demand for thyroid hormones is increased during pregnancy, which may cause a previously unnoticed thyroid disorder to worsen.
• Untreated
  genetically susceptible women who are consuming gluten.^[156]
• neonatal lupus
  .
• postpartum bleeding.^[157] However, in combination with an underlying hypercoagulable state, the risk of thrombosis or embolism may become substantial.^[157]

Abortion

An abortion is the termination of an embryo or fetus via medical method. It is usually done within the first trimester, sometimes in the second, and rarely in the third. Reasons for pregnancies being undesired are broad,^[158] rape being the most legally accepted.^[159]

Birth control and education

Technologies and science

Assisted reproductive technology

Modern reproductive medicine offers many forms of assisted reproductive technology for couples who stay childless against their will, such as

.

Medical imaging

Epidemiology

About 213 million pregnancies occurred in 2012 of which 190 million were in the

Of pregnancies in 2012, 120 million occurred in Asia, 54 million in Africa, 19 million in Europe, 18 million in Latin America and the Caribbean, 7 million in North America, and 1 million in Oceania.^[11] Pregnancy rates are 140 per 1000 women of childbearing age in the developing world and 94 per 1000 in the developed world.^[11]

The rate of pregnancy, as well as the ages at which it occurs, differ by country and region. It is influenced by a number of factors, such as cultural, social and religious norms; access to contraception; and rates of education. The total fertility rate (TFR) in 2013 was estimated to be highest in Niger (7.03 children/woman) and lowest in Singapore (0.79 children/woman).^[162]

In Europe, the average childbearing age has been rising continuously for some time. In Western, Northern, and Southern Europe, first-time mothers are on average 26 to 29 years old, up from 23 to 25 years at the start of the 1970s. In a number of European countries (Spain), the mean age of women at first childbirth has crossed the 30-year threshold.

This process is not restricted to Europe. Asia, Japan and the United States are all seeing average age at first birth on the rise, and increasingly the process is spreading to countries in the developing world like China, Turkey and Iran. In the US, the average age of first childbirth was 25.4 in 2010.^[163]

In the United States and United Kingdom, 40% of pregnancies are

In the US, a woman's educational attainment and her marital status are correlated with childbearing: the percentage of women unmarried at the time of first birth drops with increasing educational level. In other words: among uneducated women, a large fraction (~80%) have their first child while they are unmarried. By contrast, few women with a bachelor's degree or higher (~25%) have their first child while unmarried. However, this phenomenon also has a strong generational component: in 1996, about 50% of women without a university degree had their first child being unmarried while that number increased to ~85% in 2018. Similarly, in 1996, only 4% of women with a BA degree or similar had their first child being unmarried. In 2018, that fraction increased to ~25%.[166]

Legal and social aspects

Legal protection

Many countries have various legal regulations in place to protect pregnant women and their children. Many countries have laws against pregnancy discrimination.^[167]

typically provides paid leave from work during roughly the last trimester of pregnancy and for some time after birth. Notable extreme cases include Norway (8 months with full pay) and the United States (no paid leave at all except in some states).

In the United States, some actions that result in miscarriage or stillbirth, such as beating a pregnant woman, are considered crimes. One law that does so is the federal Unborn Victims of Violence Act. In 2014, the American state of Tennessee passed a law which allows prosecutors to charge a woman with criminal assault if she uses illegal drugs during her pregnancy and her fetus or newborn is harmed as a result.^[168]

However, protections are not universal. In Singapore, the Employment of Foreign Manpower Act forbids current and former work permit holders from becoming pregnant or giving birth in Singapore without prior permission.^[169][170] Violation of the Act is punishable by a fine of up to S$10,000 (US$7300) and deportation,^[169][171] and until 2010, their employers would lose their $5,000 security bond.^[172]

Teenage pregnancy

Nurse-Family Partnership (NFP) is a non-profit organization operating in the United States and the UK designed to serve the needs of low income young mothers who may have special needs in their first pregnancy. Each mother served is partnered with a registered nurse early in her pregnancy and receives ongoing nurse home visits that continue through her child's second birthday. NFP intervention has been associated with improvements in maternal health, child health, and economic security.^[177][178]

Racial disparities

There are significant racial imbalances in pregnancy and neonatal care systems.

Midwifery care has been linked to better birth and postpartum outcomes for both mother and child. It caters to the needs of the woman and provides competent, sympathetic care, and is essential for maternal health improvement. The presence of a doula, or birth assistant, during labor and delivery, has also been associated with improved levels of satisfaction with medical birth care. Providers recognized their profession from a historical standpoint, a link to African origins, the diaspora, and prevailing African American struggles. Providers participated in both direct clinical experience and activist involvement. Advocacy efforts aimed to enhance the number of minority birth attendants and to promote the benefits of woman-centered birth care to neglected areas.^[180]

Transgender people

Transgender people have experienced significant advances in societal acceptance in recent years leaving many health professionals unprepared to provide quality care. A 2015 report suggests that "numbers of transgender individuals who are seeking family planning, fertility, and pregnancy services could certainly be quite large". Regardless of prior hormone replacement therapy treatments, the progression of pregnancy and birthing procedures for transgender people who carry pregnancies are typically the same as those of cisgender women^[181] however, they may be subjected to discrimination, which can include a variety of negative social, emotional, and medical experiences, as pregnancy is regarded as an exclusively female activity. According to a study by the American College of Obstetricians and Gynecologists, there is a lack of awareness, services, and medical assistance available to pregnant trans men.^[182]

Culture

In most cultures, pregnant women have a special status in society and receive particularly gentle care.^[183] At the same time, they are subject to expectations that may exert great psychological pressure, such as having to produce a son and heir. In many traditional societies, pregnancy must be preceded by marriage, on pain of ostracism of mother and (illegitimate) child.

Overall, pregnancy is accompanied by numerous customs that are often subject to ethnological research, often rooted in traditional medicine or religion. The baby shower is an example of a modern custom.

Pregnancy is an important topic in

. The parents' relationship and the relation between parents and their surroundings are also affected.

A belly cast may be made during pregnancy as a keepsake.

Arts

Images of pregnant women, especially small

. Identifying whether such figures are actually meant to show pregnancy is often a problem, as well as understanding their role in the culture concerned.

Among the oldest surviving examples of the depiction of pregnancy are prehistoric figurines found across much of

Venus figurines

. Some of these appear to be pregnant.

Due to the important role of the

The unhappy scene usually called Diana and Callisto, showing the moment of discovery of Callisto's forbidden pregnancy, is sometimes painted from the Renaissance onwards. Gradually, portraits of pregnant women began to appear, with a particular fashion for "pregnancy portraits" in elite portraiture of the years around 1600.

Pregnancy, and especially pregnancy of unmarried women, is also an important motif in literature. Notable examples include

.

See also

• Couvade syndrome
• Cryptic pregnancy
• False pregnancy
• Simulated pregnancy
• Pregnancy-related anxiety

References

Further reading

• "Nutrition for the First Trimester of Pregnancy". IDEA Health & Fitness Association. Retrieved 9 December 2013.
• Bothwell TH (July 2000). "Iron requirements in pregnancy and strategies to meet them". The American Journal of Clinical Nutrition. 72 (1 Suppl): 257S–264S.
  PMID 10871591
  .
• Stevens J (June 2005). "Pregnancy envy and the politics of compensatory masculinities".
  S2CID 39231847
  .

External links

Wikimedia Commons has media related to Human pregnancy.

Wikiquote has quotations related to Pregnancy.

• Pregnancy at
  Curlie
• Merck Manual Home Health Handbook – further details on the diseases, disorders, etc., which may complicate pregnancy.
• Pregnancy care – NHS guide to having a baby including preconception, pregnancy, labor, and birth.