What is Pregnancy?

First trimester - Weeks 1 to 12:
The most significant development occurs during the 1st trimester as the fertilized egg implants in the uterus, the baby’s organs begin to form and the embryo becomes a fetus. Morning sickness, fatigue, and frequent urination are common symptoms during the first trimester of pregnancy. The risk of miscarriage is highest during this trimester.

Second Trimester - Weeks 13 to 27:
This trimester is also referred to as the golden trimester and is marked by a visible baby bump. Morning sickness tends to reduce during this period. The fetus grows rapidly during this trimester and movements of the fetus may be felt by the mother. Routine prenatal checkups and ultrasounds are scheduled to monitor the baby's development.

Third Trimester - Weeks 28 to 40:
The baby gains weight and develops vital organs. The mother may experience increased discomfort due to the baby's size and increased pressure.

Pre-pregnancy checkups
It’s important to book a checkup with your doctor. You should be prepared to talk about your family medical history and that of your partner, as well as your medical history, medications you’re currently taking and your lifestyle. This can help your doctor assess which tests may be needed.

Prenatal vaccinations
Your immune function is somewhat lower during pregnancy, making expectant moms more susceptible to infections and complications. Vaccinations can go a long way to preventing or reducing the severity of illnesses that can make you sick or harm your baby during pregnancy.

The flu shot is always recommended for women who are pregnant during flu season, so it’s a good idea to get it if you’re trying to conceive to protect you in those early weeks when you may not know that you’re pregnant yet. (The flu shot is also safe for pregnant women.)

Live vaccines like varicella (chicken pox) and rubella (German measles) are out of the question during pregnancy, so it’s recommended that you get tested for immunity and, if necessary, get vaccinated before trying to get pregnant. It’s important to keep in mind that you’ll need to wait at least a month after a live vaccination before trying to get pregnant

Chickenpox may not seem like a big deal, but pregnant women have an increased risk of developing pneumonia as a complication. If a pregnant woman gets chicken pox between eight and 20 weeks gestation, the baby will have a slight risk of developing congenital varicella syndrome, which can cause skin scarring, underdeveloped arms and legs, eye inflammation and problems with brain development.

Rubella can have more serious consequences: There’s an increased risk of miscarriage, stillbirth and premature birth and, if rubella is passed on to the fetus, there is a small risk that the baby could be born with a range of problems, including vision and hearing issues, heart damage, microcephaly and liver and spleen damage.

So what do you do if you find out that you’re not immune to rubella or varicella during your pregnancy?

“Women should avoid children or patients with rubella until they give birth and Mom can be vaccinated after delivery.

Sexually transmitted infections:

There are a number of sexually transmitted infections (STIs) that can lead to infertility or affect your health or your baby’s health during pregnancy, so if you are at high risk, you might be tested for STIs before trying to get pregnant and again early on in pregnancy.

Both chlamydia and gonorrhea often go undiagnosed because many people who have these STIs don’t have any symptoms. Both infections can damage the Fallopian tubes and lead to pelvic inflammatory disease, which can cause infertility. These STIs can also affect your pregnancy and your baby.

Chlamydia can cause premature delivery and, if the infection passes to your baby during birth, your newborn could develop an eye infection or pneumonia. Gonorrhea can lead to miscarriage, premature rupture of membranes and premature birth and, if it passes to your newborn during delivery, can lead to eye, joint or life-threatening blood infections in your baby.

While chlamydia and gonorrhea can be cured with antibiotics, treatment can’t undo any damage that’s already been done.

Syphilis can also have serious health effects during your pregnancy. If diagnosed after 20 weeks, there’s an increased risk of preterm labor and fetal distress, and babies born with syphilis may develop serious health problems, such as brain damage and hearing and vision loss. But if you receive treatment before 20 weeks, there’s a good chance that the infection won’t be passed on to your baby. As with chlamydia and gonorrhea, syphilis can be treated with antibiotics.

Similarly, HIV can be passed along to your baby, though the transmission can occur during any stage of pregnancy, labor and delivery, as well as during breastfeeding. Early diagnosis and treatment can help reduce the risk of mother-to-baby transmission. Combined with treatment of the baby during the first four to six weeks of life, the risk is as low as one percent.

Lastly, you may be tested for hepatitis B before trying to get pregnant, as it can also be passed on to your baby during delivery. Babies who are infected at birth can develop chronic hepatitis B infection, which can cause lifelong health problems, but this can be prevented if the baby is treated with a series of vaccinations and a hepatitis B immune globulin shot at birth. If you haven’t been vaccinated for hepatitis B, talk to your doctor about getting the shot—you can safely get it at any point before or during your pregnancy.

Common tests during pregnancy:

The best pregnancy test and the most preferred test to confirm pregnancy is a urine or blood test to detect the presence of human chorionic gonadotropin (hCG), a hormone produced during pregnancy.

Apart from the tests to confirm pregnancy, there are several other tests that are performed during pregnancy to monitor the health and development of both the mother and the fetus. These tests play a crucial role in ensuring the well-being of both the mother and the fetus during pregnancy.

Maternal marker screening:

Maternal serum screening (MSS) is a set of tests that helps pregnant women identify if their pregnancy has an increased risk of genetic disorders, birth defects, and pregnancy complications. The tests can be taken during the first trimester between 11 – 13 weeks 6 days and during the second trimester between 14 – 20 weeks 6 days.

First Trimester Screening Tests:
Double marker test
A double marker test is a screening test that is used to assess the risk of certain chromosomal abnormalities and birth defects in a developing fetus. The test is typically performed during the first trimester of pregnancy, and it measures the levels of two specific proteins in the mother’s blood: Beta human chorionic gonadotropin hormone (Beta-hCG) and pregnancy- associated plasma protein – A (PAPP-A). The levels of hCG and PAPP- A can be used to estimate the risk of certain chromosomal abnormalities such as Down Syndrome, Edward syndrome and Patau syndrome.

Extended double marker test
This test, which includes PAPP-A, free Beta hCG, PlGF and AFP is the first biochemistry- only screening protocol for Down syndrome in the first trimester with 95% detection rate along with ultrasound scan

Advantages

• Provides a high detection rate for Down syndrome.
• Provides a high detection rate for Down syndrome.

Second Trimester Screening Tests

Triple Marker Test:
A triple marker test is a screening test that is used to assess the risk of certain chromosomal abnormalities and birth defects in a developing fetus. The test is typically performed during the second trimester of pregnancy and it measures the level of three specific substances in the mother’s blood: alpha-feto protein (AFP) + Beta hCG + Unconjugated Estriol (UE3). The level of AFP, hCG and UE3 can be used to estimate the risk of chromosomal abnormalities.

Quadruple Marker Test:
A Quadruple marker test is a screening test that is used to assess the risk of certain chromosomal abnormalities and birth defects in a developing fetus. The test is typically performed during the second trimester of pregnancy and it measures the level of four specific substances in the mother’s blood: alpha-feto protein (AFP) + Beta hCG + Unconjugated Estriol (UE3) and Inhibin A. The level of AFP, hCG, UE3 and Inhibin A can be used to estimate the risk of certain chromosomal abnormalities.

Pre eclampsia screening test

Tests include: PAPP-A + PLGF – Can be done during any trimester

Pre-eclampsia:
A pregnancy complication characterized by high blood pressure and signs of damage to another organ system, (liver and kidney), usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal. Symptoms: Weight gain , Edema , Hypertension.

Genetic screening:

Genetic screening as part of pre-pregnancy check-ups is becoming increasingly recognized and recommended, especially in cases where there is a family history of genetic disorders or specific ethnic considerations.

Carrier Screening:Carrier screening is often recommended to individuals or couples who are planning a pregnancy, especially if there is a known family history of genetic disorders prevalent in specific ethnic or regional populations. Common genetic disorders screened for in India include thalassemia, sickle cell anemia, cystic fibrosis, and hemophilia, among others.

Consanguineous Marriages:In regions where consanguineous marriages (marriages between blood relatives) are more common, the risk of certain autosomal recessive genetic disorders is higher. Genetic counseling and screening may be recommended to individuals or couples in such situations to assess their risk and make informed decisions about family planning.

Advanced Maternal Age:Advanced maternal age is associated with an increased risk of chromosomal abnormalities such as Down syndrome. Genetic counseling and prenatal screening tests, such as non-invasive prenatal testing (NIPT), may be recommended to women over a certain age (usually 35 years and older) during pre-pregnancy check-ups.

Other Diagnostic tests in pregnancy

- Chorionic villus sampling (CVS):A thin needle is inserted through the vagina or abdomen to collect a small sample of the placenta. This test is done between 10 and 13 weeks of pregnancy and it gives insights about the genetic makeup of the fetus.

- Amniocentesis:Amniocentesis is usually done between 15 and 20 weeks of pregnancy. It involves inserting a thin needle through the abdomen to withdraw a small amount of amniotic fluid surrounding the fetus. The fetal cells in the amniotic fluid can be analyzed for genetic abnormalities.

Some of the other common tests in pregnancy are:

- Ultrasound: Sound waves are used to create images of the uterus and fetus. It aids doctors to determine the gestational age, monitor fetal development and detect abnormalities

- Oral Glucose Tolerance Test (OGTT): It is often used to screen for gestational diabetes.

- Group B strep screening: It is used to check for the presence of group B streptococcus bacteria in the vagina and rectum of the mother as the bacteria can be passed on to the baby during childbirth, causing serious infections.

- Doppler ultrasound: It is used to measure blood flow in the umbilical cord and fetal blood vessels and assess the well-being of the fetus or look for signs of fetal distress.

- Noninvasive prenatal testing (NIPT): It is used to analyze fetal DNA in the mother's blood to screen for chromosomal abnormalities like Down syndrome.

- Nonstress test (NST): It is performed during the third trimester to monitor the fetus' heart rate in response to its movements and assess its well being.

- Biophysical profile (BPP): This test combines Non Stress Test with ultrasound to assess fetal movements, muscle tone, breathing, and amniotic fluid levels. It is usually performed during the third semester.

Some additional blood tests may also be performed to screen for conditions such as anemia, infections and genetic disorders.

Tips for a healthy pregnancy

• Plan ahead and schedule regular appointments with your doctor to monitor your health and your baby's development.
• Engage in regular exercise. Aim for at least 150 minutes of moderate-intensity aerobic activity every week to stay physically active. Consult your doctor to understand what type of exercise is best and safe for you.
• Take prenatal vitamins and other essential nutrients such as folic acid and iron to aid your baby's development.
• Stay up to date on immunizations like flu shots and vaccinations.
• Consume nutrient-rich foods such as whole fruits, vegetables and fiber rich food. Have breakfast daily and stay hydrated to prevent constipation. Avoid consuming undercook meat, fish and soft cheeses
• Maintain a healthy weight throughout pregnancy.
• Try to get 7-8 hours of undisturbed sleep every night.
• Find healthy ways to manage stress, such as meditation, yoga, or spending time in nature.
• Refrain from smoking, consuming alcohol and using certain medications. Consult your doctor to understand which medications or drugs you can consume during pregnancy
• Minimize exposure to toxic substances and environmental pollutants.

Consult your doctor or OBGyn for personalized pregnancy health tips.

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Frequently Asked Questions

1. What is the accuracy of the maternal marker screening test?

Ans - The results of double/triple/quadruple marker tests are typically reported as risk ratio which compares the level of the markers in the mother’s blood to the levels typically seen in a normal pregnancy. If the risk ratio is higher than expected, it may indicate an increased risk of chromosomal abnormality or birth defect. If the risk ratio is lower than expected, it may indicate decreased risk of a chromosomal abnormality or birth defect.

2. Are double, triple and quadruple marker tests recommended for all pregnant women?

Ans - All pregnant women are screened for chromosomal abnormalities regardless of their age or risk factors. However, the double marker test is typically recommended for women who are at an increased risk of having a baby with chromosomal abnormalities, such as:

1. Women who are above 35 years of age or older during pregnancy.

2. Women with a personal or family history of chromosomal abnormalities

3. Women who have had previous pregnancy with chromosomal abnormalities

4. Women with certain medical conditions like Diabetes, Thyroid or epilepsy

3. What should I avoid during pregnancy?

Ans - This may vary from person to person and it is advisable to talk to your doctor for personalized advice. Having said that, it is generally advisable to:

- Avoid harmful substances like alcohol, smoking and certain medications

- Avoid strenuous activities, lifting heavy objects, and contact sports

- Avoid overheating or exposure to X-rays as it may harm the baby’s growth and development

- Avoid Stress

- Avoid certain types of foods including unpasteurized dairy, processed foods, food items with excessive sugar, raw meat/fish/eggs, high-mercury fish and excessive caffeine.

4. What prenatal vitamins should I take?

Ans - Consult your doctor to understand the best prenatal vitamins for your individual needs and deficiencies (if any). Common prenatal vitamins contain folic acid, iron, calcium, and other essential nutrients.

5. How much weight should I gain during pregnancy?

Ans - The recommended weight gain depends on your pre-pregnancy weight and BMI. Consult your doctor for a personalized target weight range.

6. What exercises are safe during pregnancy?

Ans - Moderate intensity aerobic exercises such as Walking, swimming, prenatal yoga, low- impact cardio and strength training can be beneficial to pregnant women. Always consult your doctor before starting any exercise program to understand if it’s safe and beneficial for you.

7. How often should I see my doctor during pregnancy?

Ans - Most pregnant women would be expected to visit the doctor every 4 weeks in the first trimester, every 3 weeks in the second trimester, and every 2 weeks in the third trimester. However, your doctor may adjust this schedule to best suit your individual needs and health conditions.