Pregnancy 1771587 226141970 2008-07-17T00:30:59Z Atomaton 1217613 [[WP:UNDO|Undid]] revision 226129955 by [[Special:Contributions/72.205.235.62|72.205.235.62]] ([[User talk:72.205.235.62|talk]]) {{two other uses|pregnancy in female humans|pregnancy in other animals|Gestation|pregnancy in males|Male pregnancy}} [[Image:Expecting mother.jpg|thumb|A pregnant woman near the end of her term]] '''Pregnancy''' ([[latin]] ''graviditas'') is the carrying of one or more offspring, known as a [[fetus]] or [[embryo]], inside the [[uterus]] of a [[female]] [[human]]. In a pregnancy, there can be multiple [[gestation]]s, as in the case of [[twin]]s or [[Multiple birth|triplets]]. Human pregnancy is the most studied of all [[Pregnancy (mammals)|mammalian pregnancies]]. [[Obstetrics]] is the medical field that studies and treats pregnant patients. [[Childbirth]] usually occurs about 38 weeks from [[Human fertilisation|fertilization]], i.e., approximately 40 weeks from the start of the last [[menstruation]]. Thus, pregnancy lasts about nine months, although the exact definition of the English word “pregnancy” is a subject of [[Beginning of pregnancy controversy|controversy]]. ==Terminology== One scientific term for the state of pregnancy is ''gravid'', and a pregnant [[female]] is sometimes referred to as a ''[[Gravidity|gravida]]''.<ref>{{cite web |url=http://medical-dictionary.thefreedictionary.com/gravida |title=Definition of gravida |accessdate=2008-01-17 |work=The Free Dictionary/Medical Dictionary |publisher=Farlex, Inc}}</ref> Both words are rarely used in common speech. Similarly, the term "[[Parity (medicine)|parity]]" (abbreviated as "para") is used for the number of previous successful live births. Medically, women who have never been pregnant are referred to as "nulliparous" ("gravida 0, para 0"),<ref>{{cite web |url=http://www.medterms.com/script/main/art.asp?articlekey=15259 |title=Nulliparous Definition |accessdate=2008-01-17 |work=MedicineNet.com |publisher=MedicineNet, Inc}}</ref>, during a first pregnancy as a "primigravida" ("gravida 1, para 0") and in subsequent pregnancies as "multigravida" or "multiparous".<ref>{{cite web |url=http://www.thefreedictionary.com/gravida |title=Definition of gravida |accessdate=2008-01-17 |work=The Free Dictionary |publisher=Farlex, Inc}}</ref> Hence during a second pregnancy a woman would be described as "gravida 2, para 1" and upon delivery as "gravida 2, para 2". Incomplete pregnancies of abortions, miscarriages or stillbirths account for parity values being less than the gravida number, whereas a multiple birth will increase the parity value. The term ''embryo'' is used to describe the developing offspring during the first eight weeks following conception, and the term ''foetus'' is used from about two months of development until birth.<ref>{{cite web |url=http://www.medterms.com/script/main/art.asp?articlekey=3225 |title=Embryo Definition |accessdate=2008-01-17 |work=MedicineNet.com |publisher=MedicineNet, Inc}}</ref><ref>{{cite web |url=http://www.medterms.com/script/main/art.asp?articlekey=3424 |title=Fetus Definition |accessdate=2008-01-17 |work=MedicineNet.com |publisher=MedicineNet, Inc}}</ref> In many societies' medical and 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 foetus). During the second trimester, the development of the foetus can be more easily monitored and diagnosed. The beginning of the third trimester often approximates the point of [[Fetus#Viability|viability]], or the ability of the foetus to survive, with or without medical help, outside of the [[uterus]].<ref>{{cite web |url=http://www.medterms.com/script/main/art.asp?articlekey=11446 |title=Trimester Definition |accessdate=2008-01-17 |work=MedicineNet.com |publisher=MedicineNet, Inc}}</ref> <!-- make footer reference (Though this can be controversial, depending on the age of the foetus and the discussed context.) --> ==Characteristics== Pregnancy occurs as the result of the female gamete or [[oocyte]] ([[ovum|egg]]) being penetrated by the male gamete [[spermatozoon]] in a process referred to, in medicine, as "[[fertilization]]", or more commonly known as "conception". The fusion of male and female gametes usually occurs through the act of [[sexual intercourse]]. However, the advent of [[artificial insemination]] has also made achieving pregnancy possible in such cases where sexual intercourse is not potentially fertile (through choice or male/female infertility). A number of [[medical sign]]s are associated with pregnancy.<ref name="mayo symptoms">{{cite web | title = Early symptoms of pregnancy: What happens right away | url = http://www.mayoclinic.com/health/symptoms-of-pregnancy/PR00102 | publisher = [[Mayo Clinic]] | date = [[February 22]], [[2007]] | accessdate = 2007-08-22 }}</ref><ref name="titlePregnancy Symptoms - Early Signs of Pregnancy : American Pregnancy Association">{{cite web |url=http://www.americanpregnancy.org/gettingpregnant/earlypregnancysymptoms.html |title=Pregnancy Symptoms - Early Signs of Pregnancy : American Pregnancy Association |accessdate=2008-01-16 |format= |work=}}</ref> 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 cycle|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, [[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 [[Vaginal fornix]]), and [[Linea nigra]], (darkening of the skin in a vertical line on the [[abdomen]], caused by [[hyperpigmentation]] resulting from hormonal changes; it usually appears around the middle of pregnancy).<ref name="mayo symptoms"/><ref name="titlePregnancy Symptoms - Early Signs of Pregnancy : American Pregnancy Association"/> === Duration === Though pregnancy begins at conception, it is more convenient to date from the first day of a woman's last menstrual period (acronym = LMP), or from the date of conception (if known). Starting from one of these dates, the expected date of delivery (acronym = EDD) can be calculated. Counting from the LMP, pregnancy usually lasts between 37 and 42 weeks, with the EDD at 40 weeks,<ref name="UpToDate">{{cite web |url=http://patients.uptodate.com/topic.asp?file=pregnan/5708 |title=Patient information: Postterm pregnancy |accessdate=2008-01-16 |last=Norwitz, MD, PhD |first=Errol R |date=September 2007 |work=UpToDate |publisher=UpToDate, inc.}}</ref> 38 weeks after conception. 40 weeks is a little more than nine months and six days, which forms the basis of [[Naegele's rule]] for estimating date of delivery. 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 [[Premature birth|pre-term]]; from week 42 (294 days) events are considered [[Postmature birth|post-term]].<ref>{{cite web |url=http://www.preventioninstitute.sk.ca/home/Program_Areas/Maternal__Infant_Health/Definitions/ |title=Definitions |accessdate=2008-01-16 |work=Saskatchewan Prevention Institute. }}</ref> When a pregnancy exceeds 42 weeks (294 days), the risk of complications for mother and fetus increases significantly.<ref name="UpToDate" /><ref>{{cite web |url=http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZRDLPH97C&sub_cat=2005 |title=What To Expect After Your Due Date |accessdate=2008-01-16 |author=The American College of Obstetricians and Gynecologists |date=April 2006 |work=Medem |publisher=Medem, Inc.}}</ref> As such, obstetricians usually prefer to induce labour, in an uncomplicated pregnancy, at some stage between 41 and 42 weeks.<ref>{{cite web |url=http://www.rcog.org.uk/resources/public/pdf/rcog_induction_of_labour.pdf |title=Royal College of Obstetricians and Gynaecologists Induction of labour Evidence based Guideline |accessdate=2008-01-18 |author=Royal College of Obstetricians and Gynaecologists |date=2001 |work=Royal College of Obstetricians and Gynaecologists |publisher=Royal College of Obstetricians and Gynaecologists}}</ref><ref>{{cite web |url=http://www.durhamobgyn.com/viewArticle?ID=336380 |title=Postdate Pregnancy |accessdate=2008-01-18 |last=Stovall, M.D. |first=Thomas G. |date=2004-03-23 |work=Durham Obstetrics and Gynecology |publisher=Durham Obstetrics and Gynecology}}</ref> Recent medical literature prefers the terminology ''pre-term'' and ''post-term'' to ''premature'' and ''post-mature''. ''Pre-term'' 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.<ref>{{cite web |url=http://www.medterms.com/script/main/art.asp?articlekey=11895 |title=Definition of Premature birth |accessdate=2008-01-16 |work=Medicine.net}}</ref><ref>{{cite web |url=http://health.discovery.com/encyclopedias/illnesses.html?article=2728 |title=Premature Infant |accessdate=2008-01-16 |author=Lama Rimawi, MD |date=2006-09-22 |work=Disease & Conditions Encyclopedia |publisher=Discovery Communications, LLC.}}</ref> Though these are the averages, the actual length of pregnancy depends on various factors. For example, the first pregnancy tends to last longer than subsequent pregnancies. Fewer than 10% of births occur on the due date; 50% of births are within a week of the due date, and almost 90% within two weeks.<ref> Dr [[Sally Tracy]], ''Having a Great Birth in Australia'' ed. [[David Vernon]], [[Australian College of Midwives]], 2005, p22 </ref> Accurate dating of pregnancy is important, because it is used in calculating the results of various [[Prenatal diagnosis|prenatal tests]] (for example, in the [[triple test]]). A decision may be made to [[Induction (birth)|induce]] labour if a fetus is perceived to be overdue. Due dates are only a rough estimate, and the process of accurately dating a pregnancy using the LMP method is complicated by the fact that not all women have 28 day menstrual cycles, nor ovulate on the 14th day following their last menstrual period. ==Diagnosis== {{Main|Obstetrics}} The beginning of pregnancy may be detected in a number of ways, including various pregnancy tests which detect hormones generated by the newly-formed [[placenta]]. Clinical blood and urine tests can detect pregnancy soon after implantation, which is as early as 6-8 days after fertilization. Home [[pregnancy test]]s are personal [[urine]] tests, which normally cannot detect a pregnancy until at least 12-15 days after fertilization. Both clinical and home tests can only detect the state of pregnancy, and cannot detect its age. 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. An early [[medical ultrasonography|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 [[human sexual behavior|sexual activity]] has been limited, or she has been charting her cycles, or the conception is as the result of some types of fertility treatment (such as [[IUI]] or [[IVF]]) the exact date of fertilization is unknown. Absent symptoms such as [[morning sickness]], often the only visible sign of a pregnancy is an interruption of her 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 two 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.<ref>{{cite journal | title = Evaluation of ultrasound-estimated date of delivery in 17 450 spontaneous singleton births: do we need to modify Naegele's rule? | url = http://www.blackwell-synergy.com/doi/abs/10.1046/j.1469-0705.1999.14010023.x | journal = Ultrasound in Obstetrics and Gynecology | volume = 14 | issue = 1 | pages = 23–28 | last = Nguyen | first = T.H. | coauthors = ''et al.'' | date = 1999 | accessdate = 2007-08-18 | doi = 10.1046/j.1469-0705.1999.14010023.x | format = abstract }}</ref> The beginning of labour, 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.<ref>{{cite web | url = http://hygeia.org/poems23.htm | title = Post Term Pregnancy | last = Odutayo | first = Rotimi | coauthors = Odunsi, Kunle | date = n.d. | accessdate = 2007-08-18 }}</ref> 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. ==Physiology== :''The term '''trimester''' redirects here. For the term trimester used in academic settings, see [[Academic term]]'' 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=== [[Image:Pregnancy comparison.jpg|thumb|left|Comparison of growth of the abdomen between 26 weeks and 40 weeks gestation.]] 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 [[implantation|implanted]] into the [[endometrium|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 light 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. The outer layers of the embryo grow and form a [[placenta]], for the purpose of receiving essential [[nutrients]] through the [[uterine]] wall, or [[endometrium]]. The [[umbilical cord]] in a newborn child consists of the remnants of the connection to the placenta. The developing embryo undergoes tremendous growth and changes during the process of [[fetal development|foetal development]]. [[Morning sickness]] can occur in about seventy percent of all pregnant women and typically improves after the first trimester.<ref>[http://www.cnn.com/HEALTH/library/HQ/00451.html Early pregnancy: Morning sickness, fatigue and other common symptoms<!-- Bot generated title -->]</ref> Most [[miscarriage]]s occur during this period. <!-- ''The image below this hidden text has been approved by a majority of users after much discussion on the talk page. Please do not change or remove this picture without first discussing it in the talk page. If you do remove it, your edit will be reverted.'' --> [[Image:Pregnancy 26 weeks.jpg|thumb|right|A pregnant woman at 26 weeks]] ===Second trimester=== Months 4 through 6 of the pregnancy are called the second trimester. Most women feel more energized in this period, and begin to seriously put on weight as the symptoms of morning sickness subside and eventually fade away. Although the [[fetus]] begins moving 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 by the fourth month. The placenta is now fully functioning and the fetus is making insulin and urinating. The teeth are now formed inside the fetus's gums and the reproductive organs can be recognized, and can distinguish the fetus as male or female. ===Third trimester=== Final weight gain takes place, and the [[fetus]] begins to move regularly. 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 back-ache. 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. It is during this time that a baby born [[Premature birth|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.<ref name="Iams">{{cite journal |journal=Lancet |title=Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth |author=Iams JD |coauthors=Romero R, Culhane JF, Goldenberg RL |year=2008 |month=Jan |day=12 |volume=371 |issue=9607 |pages=164–75 |pmid=18191687 |doi=10.1016/S0140-6736(08)60108-7}}</ref> 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. ===Prenatal development and sonograph images=== {{seealso|Prenatal development}} Prenatal development is divided into two primary biological stages. The first is the [[embryo|embryonic stage]], which lasts for about two months. At this point, the [[fetus|fetal stage]] begins. At the beginning of the foetal stage, the risk of miscarriage decreases sharply,<ref>• [http://news.bbc.co.uk/2/hi/health/2176898.stm Q&A: Miscarriage]. (August 6 , 2002). ''BBC News.'' Retrieved [[2007-04-22]]: “The risk of miscarriage lessens as the pregnancy progresses. It decreases dramatically after the 8th week.”<br> • [[Lennart Nilsson]], A Child is Born 91 (1990): at eight weeks, "the danger of a miscarriage … diminishes sharply."<br> • “[http://www.womens-health.co.uk/miscarr.asp Women’s Health Information]”, Hearthstone Communications Limited: “The risk of miscarriage decreases dramatically after the 8th week as the weeks go by.” Retrieved [[2007-04-22]].</ref> 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.<ref name="Prechtl">Prechtl, Heinz. "[http://books.google.com/books?vid=ISBN0792369432&id=FzyPozUyKPkC&pg=RA1-PA416&lpg=RA1-PA416&dq=fetus+and+movement&num=100&sig=6_E9lwpo1KhTtwzIkTKh2difcbo#PRA1-PA415,M1 Prenatal and Early Postnatal Development of Human Motor Behavior]" in ''Handbook of brain and behaviour in human development'', Kalverboer and Gramsbergen eds., pp. 415-418 (2001 Kluwer Academic Publishers). Retrieved [[2007-03-04]].</ref> [[Brain stem]] activity has been detected as early as 54 days after conception,<ref name="Singer">Singer, Peter. ''[http://books.google.com/books?vid=ISBN0312144016&id=d5W1xE1GM2EC&pg=RA1-PA104&lpg=RA1-PA104&ots=kG4PXGCQDG&dq=%22human+life+must+be+protected+from+fifty-four+days%22&num=100&sig=PWH7KEPjVWhxAkFWTAwd3DWuyB0#PRA1-PA104,M1 Rethinking life & death: the collapse of our traditional ethics]'', page 104 (St. Martins Press 1996). Retrieved [[2007-03-04]].</ref> and the first measurable signs of [[Electroencephalography|EEG]] activity occur in the 12th week.<ref>Vogel, Friedrich. ''[http://books.google.com/books?vid=ISBN3540655735&id=r0lXOLhd-kAC&pg=PA13&lpg=PA13&dq=%22EEG+activity%22+and+fetus+and+brain&sig=6uMfRi6Ql5sW3jBLo6L05h0i1UI Genetics and the Electroencephalogram]'' (Springer 2000): "Slow EEG activity (0.5 – 2 c/s) can be demonstrated in the fetus even at the conceptual age of three months." Retrieved [[2007-07-24]].</ref> Some fingerprint formation occurs from the beginning of the fetal stage.<ref>Zabinski, Mark. Forensic Series Seminar, Pastore Chemical Laboratory, University of Rhode Island (February 2003) ([http://media.www.ramcigar.com/media/storage/paper366/news/2003/02/07/News/Blueprints.Of.Fingerprints-363370.shtml?sourcedomain=www.ramcigar.com&MIIHost=media.collegepublisher.com news report] retrieved [[2007-01-20]]).</ref> <center><gallery> Image:6 weeks pregnant.png|Embryo at 6 weeks after fertilization<ref>[http://www.3dpregnancy.com/static/pregnancy-week-6.html 3D Pregnancy] (Image from gestational age of 6 weeks). Retrieved [[2007-08-28]]. A rotatable 3D version of this photo is available [http://www.3dpregnancy.com/rotatable/6-weeks-pregnant.html here], and a sketch is available [http://www.3dpregnancy.com/pictures/pregnancy-week-6.html here].</ref> Image:10 weeks pregnant.png|Fetus at 8 weeks after fertilization<ref>[http://www.3dpregnancy.com/static/pregnancy-week-10.html 3D Pregnancy] (Image from gestational age of 10 weeks). Retrieved [[2007-08-28]]. A rotatable 3D version of this photo is available [http://www.3dpregnancy.com/rotatable/10-weeks-pregnant.html here], and a sketch is available [http://www.3dpregnancy.com/pictures/pregnancy-week-10.html here].</ref> Image:20 weeks pregnant.png|Fetus at 18 weeks after fertilization<ref>[http://www.3dpregnancy.com/static/pregnancy-week-20.html 3D Pregnancy] (Image from gestational age of 20 weeks). Retrieved [[2007-08-28]]. A rotatable 3D version of this photo is available [http://www.3dpregnancy.com/rotatable/20-weeks-pregnant.html here], and a sketch is available [http://www.3dpregnancy.com/pictures/pregnancy-week-20.html here].</ref> Image:40 weeks pregnant.png|Fetus at 38 weeks after fertilization<ref>[http://www.3dpregnancy.com/static/pregnancy-week-40.html 3D Pregnancy] (Image from gestational age of 40 weeks). Retrieved [[2007-08-28]]. A rotatable 3D version of this photo is available [http://www.3dpregnancy.com/rotatable/40-weeks-pregnant.html here], and a sketch is available [http://www.3dpregnancy.com/pictures/pregnancy-week-40.html here].</ref> Image:Month 1.svg|Relative size in 1st Month (simplified illustration) Image:Month 3.svg|Relative size in 3rd Month (simplified illustration) Image:Month 5.svg|Relative size in 5th Month (simplified illustration) Image:Month 9.svg|Relative size in 9th Month (simplified illustration) </gallery></center> 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.<ref name="pmid17469450">{{cite journal |author=Dimitrova V, Markov D, Dimitrov R |title=[3D and 4D ultrasonography in obstetrics] |language=Bulgarian |journal=Akush Ginekol (Sofiia) |volume=46 |issue=2 |pages=31–40 |year=2007 |pmid=17469450 |doi=}}</ref> Whilst 3D is popular with parents desiring a prenatal photograph as a keepsake,<ref name="pmid17265534">{{cite journal |author=Sheiner E, Hackmon R, Shoham-Vardi I, ''et al'' |title=A comparison between acoustic output indices in 2D and 3D/4D ultrasound in obstetrics |journal=Ultrasound Obstet Gynecol |volume=29 |issue=3 |pages=326–8 |year=2007 |pmid=17265534 |doi=10.1002/uog.3933}}</ref> both 2D and 3D are discouraged by the [[Food and Drug Administration|FDA]] for non-medical use,<ref>{{cite web |author=Rados C |title=FDA Cautions Against Ultrasound 'Keepsake' Images |url=http://www.fda.gov/FDAC/features/2004/104_images.html |publisher=FDA Consumer Magazine |date=January-February 2004}}</ref> but there are no definitive studies linking ultrasound to any adverse medical effects.<ref>{{cite newspaper |author=Kempley R |title=The Grin Before They Bear It; Peek-a-Boo: Prenatal Portraits for the Ultrasound Set |url=http://www.highbeam.com/doc/1P2-279063.html |publisher=Washington Post |date=[[2003-08-09]]}}</ref> The following 3D ultrasound images were taken at different stages of pregnancy: <center><gallery> Image:Baby-06.jpg|3-inch fetus (about 14 weeks [[gestational age]]) Image:Sucking his thumb and waving.jpg|Fetus at 17 weeks Image:3dultrasound 20 weeks.jpg|Fetus at 20 weeks </gallery></center> ==Physiological changes in pregnancy== 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. ===Hormonal changes=== Levels of progesterone and oestrogens rise continually throughout pregnancy, suppressing the hypothalamic axis and subsequently the menstrual cycle. The mother and the placenta also produces many hormones. [[Prolactin]] levels increase due to maternal [[Pituitary gland]] enlargement by 50%. This mediates a change in the structure of the [[Mammary gland]] from ductal to lobular-alveolar. [[Parathyroid hormone]] is increased due to increases of calcium uptake in the gut and reabsorption by the kidney. Adrenal hormones such as [[cortisol]] and [[aldosterone]] also increase. [[Placental lactogen]] is produced by the placenta and stimulates lipolysis and fatty acid metabolism by the mother, conserving blood glucose for use by the fetus. It also decreases maternal tissue sensitivity to insulin, resulting in [[gestational diabetes]]. ===Physical changes=== 12-15kgs (26-33lbs) are gained during pregnancy due to fat deposition, growth of the reproductive organs and fetal tissues. ===Cardiovascular changes=== Blood volume increases by 40% in the first two trimesters. This is due to an increase in plasma volume through increased aldosterone. Progesterone may also interact with the aldosterone receptor, thus leading to increased levels. Red blood cell numbers increase due to increased [[erythropoietin]] levels. Cardiac function is also modified, with increase heart rate and increased stroke volume. A decrease in vagal tone and increase in sympathetic tone is the cause. Blood volume increases act to increase stroke volume of the heart via [[Starling's law]]. After pregnancy the change in stroke volume is not reversed. Cardiac output rises from 4 to 7 litres in the 2nd trimester Blood pressure also fluctuates. In the first trimester it falls. Initially this is due to decreased sensitivity to [[angiotensin]] and vasodilation provoked by increased blood volume. Later however, it is caused by decreased resistance to the growing uteroplacental bed. ===Respiratory changes=== Decreased functional residual capacity is seen, typically falling from 1.7 to 1.35 litres, due to the compression of the diaphragm by the uterus. Tidal volume increases, from 0.45 to 0.65 litres, giving an increase in pulmonary ventilation. This is necessaary to meet the increased oxygen requirement of the body, which reaches 50ml/min - 20ml of which goes to reproductive tissues. Progesterone may act centrally on chemoreceptors to reset the [[set point]] to a lower partial pressure of carbon dioxide. This maintains an increased respiration rate even at a decreased level of carbon dioxide. ===Metabolic changes=== An increased requirement for nutrients is given by fetal growth and fat deposition. Changes are caused by steroid hormones, lactogen and cortisol. Maternal insulin resistance can lead to gestational diabetes. Increase liver metabolism is also seen, with increased gluconeogenesis to increase maternal glucose levels. ===Renal changes=== Renal plasma flow increases, as does aldosterone and erthropoietin production as discussed. The tubular maximum for glucose is reduced, which may precipitate [[gestational diabetes]]. == Management == [[Prenatal]] medical care is of recognized value throughout the developed world. Periconceptional [[Folic acid]] supplementation is the only type of supplementation of proven efficacy. ===Nutrition=== {{main|Nutrition and pregnancy}} A balanced, nutritious diet is an important aspect of a healthy pregnancy. If the woman is healthy, balancing [[carbohydrates]], [[fat]], and [[proteins]], and eating a variety of [[fruits]] and [[vegetables]] usually ensure 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. Adequate periconceptional [[folic acid]] (also called folate or Vitamin B9) 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 and this explains the necessity to guarantee adequate periconceptional folate intake.<ref name="pmid16303691">{{cite journal |author=Klusmann A, Heinrich B, Stöpler H, Gärtner J, Mayatepek E, Von Kries R |title=A decreasing rate of neural tube defects following the recommendations for periconceptional folic acid supplementation |journal=Acta Paediatr. |volume=94 |issue=11 |pages=1538–42 |year=2005 |pmid=16303691 |doi=10.1080/08035250500340396 |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0803-5253&date=2005&volume=94&issue=11&spage=1538 |accessdate=2008-01-20}}</ref><ref name="pmid11015508">{{cite journal |author=Stevenson RE, Allen WP, Pai GS, Best R, Seaver LH, Dean J, Thompson S |title=Decline in prevalence of neural tube defects in a high-risk region of the United States |journal=Pediatrics |volume=106 |issue=4 |pages=677–83 |year=2000 |pmid=11015508 |doi=10.1542/peds.106.4.677}}</ref> Folates (from ''folia'', leaf) are abundant in [[spinach]] (fresh, frozen or canned), and are also found in [[green vegetables]], salads, melon, [[hummus]], and [[Egg (food)|eggs]]. In the United States and Canada, most wheat products (flour, noodles) are fortified with folic acid.<ref name="pmid18185493">{{cite journal |author= |title=Use of supplements containing folic acid among women of childbearing age--United States, 2007 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=57 |issue=1 |pages=5–8 |year=2008 |pmid=18185493 |doi=}}</ref> Several [[micronutrients]] are important for the health of the developing fetus, especially in areas of the world where insufficient nutrition is prevalent.<ref name="pmid17054223">{{cite journal |author=Haider BA, Bhutta ZA |title=Multiple-micronutrient supplementation for women during pregnancy |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD004905 |year=2006 |pmid=17054223 |doi=10.1002/14651858.CD004905.pub2}}</ref> 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.<ref name="pmid17476978">{{cite journal |author=Theobald HE |title=Eating for pregnancy and breast-feeding |journal=J Fam Health Care |volume=17 |issue=2 |pages=45–9 |year=2007 |pmid=17476978 |doi=}}</ref><ref name="pmid17625571">{{cite journal |author=Basile LA, Taylor SN, Wagner CL, Quinones L, Hollis BW |title=Neonatal vitamin D status at birth at latitude 32 degrees 72': evidence of deficiency |journal=J Perinatol |volume=27 |issue=9 |pages=568–71 |year=2007 |pmid=17625571 |doi=10.1038/sj.jp.7211796}}</ref><ref name="pmid3488981">{{cite journal |author=Kuoppala T, Tuimala R, Parviainen M, Koskinen T, Ala-Houhala M |title=Serum levels of vitamin D metabolites, calcium, phosphorus, magnesium and alkaline phosphatase in Finnish women throughout pregnancy and in cord serum at delivery |journal=Hum Nutr Clin Nutr |volume=40 |issue=4 |pages=287–93 |year=1986 |pmid=3488981 |doi=}}</ref> There is some evidence that long-chain [[Omega-3 fatty acid|omega-3 (n-3) fatty acids]] have an effect on the developing fetus, but further research is required.<ref name="pmid17302536">{{cite journal |author=Hösli I, Zanetti-Daellenbach R, Holzgreve W, Lapaire O |title=Role of omega 3-fatty acids and multivitamins in gestation |journal=J Perinat Med |volume=35 Suppl 1 |issue= |pages=S19–24 |year=2007 |pmid=17302536 |doi=10.1515/JPM.2007.032 |url=http://www.extenza-eps.com/doi/abs/10.1515/JPM.2007.032 |accessdate=2008-01-20 |format=abstract}}</ref> At this time, supplementing the diet with foods rich in these fatty acids is not recommended, but is not harmful.<ref name="pmid17872742">{{cite journal |author=Dubnov-Raz G, Finkelstein Y, Koren G |title=Omega-3 fatty acid supplementation during pregnancy: for mother, baby, or neither? |journal=Can Fam Physician |volume=53 |issue=5 |pages=817–8 |year=2007 |pmid=17872742 |doi= |url=http://www.cfp.ca/cgi/pmidlookup?view=long&pmid=17872742 |accessdate=2008-01-20}}</ref> 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 catching [[salmonella]] infection from eggs and poultry, which should be thoroughly cooked. Practicing good hygiene in the kitchen can reduce these risks.<ref name="Tarlow">{{cite journal |journal=J Antimicrob Chemother |title=Epidemiology of neonatal infections |year=1994 |month=Aug |volume=34 |issue=Suppl A |pages=43–52 |author=Tarlow MJ |pmid=7844073 |doi=10.1093/jac/34.1.43}}</ref> ===Weight gain=== Caloric intake must be increased, to ensure proper development of the fetus. The amount of weight gained during pregnancy varies between women. The [[National Health Service]] recommends that overall weight gain during the 9 month period for women who start pregnancy with normal weight be 10 to 12 kilograms (22&ndash;26&nbsp;[[pound (mass)|lb]]).<ref>[http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=2311 How much weight will I put on during my pregnancy?]</ref> During pregnancy, insufficient weight gain can compromise the health of the fetus. Women with fears of weight gain or with [[eating disorder]]s may choose to work with a health professional, to ensure that pregnancy does not trigger disordered eating. Likewise, excessive weight gain can pose risks to the woman and the fetus. Women who are prone to being [[overweight]] may choose to plan a healthy diet and exercise plan to help moderate the amount of weight gained. ===Immunological tolerance=== {{main|Pre-eclampsia}} Research on the immunological basis for pre-eclampsia has indicated that continued exposure to a partner's semen has a strong protective effect against pre-eclampsia, largely due to the absorption of several immune modulating factors present in seminal fluid.<ref name="Robertson">{{cite web | author= Sarah Robertson| title=Research Goals | url=http://www.health.adelaide.edu.au/og/people/staff/robertsons.html}}</ref> Studies also showed that long periods of sexual cohabitation with the same partner fathering a woman's child significantly decreased her chances of suffering pre-eclampsia.<ref name=Einarsson>{{cite journal | author= Einarsson, Jon I. MD; Sangi-Haghpeykar, Haleh PhD; Gardner, Michael O. MD, MPH |title= Sperm exposure and development of preeclampsia | journal=Journal of Obstetrics and Gynecology | volume=188 | issue=5 | pages=1241–1243 | year=2003 |doi= 10.1067/mob.2003.401}}</ref> Several other studies have since investigated the strongly decreased incidence of pre-eclampsia in women who had received blood transfusions from their partner, those with long, preceding histories of sex without barrier contraceptives, and in women who had been regularly performing oral sex,<ref name="pmid10706945">{{cite journal |author=Koelman CA, Coumans AB, Nijman HW, Doxiadis II, Dekker GA, Claas FH |title=Correlation between oral sex and a low incidence of preeclampsia: a role for soluble HLA in seminal fluid? |journal=J. Reprod. Immunol. |volume=46 |issue=2 |pages=155–66 |year=2000 |pmid=10706945 |doi=10.1016/S0165-0378(99)00062-5}}</ref> with one study concluding that "induction of allogeneic tolerance to the paternal [[HLA]] molecules of the fetus may be crucial. Data collected strongly suggests that exposure, and especially oral exposure to soluble [[HLA]] from semen can lead to transplantation tolerance."<ref name="pmid10706945">{{cite journal |author=Koelman CA, Coumans AB, Nijman HW, Doxiadis II, Dekker GA, Claas FH |title=Correlation between oral sex and a low incidence of preeclampsia: a role for soluble HLA in seminal fluid? |journal=J. Reprod. Immunol. |volume=46 |issue=2 |pages=155–66 |year=2000 |pmid=10706945 |doi=10.1016/S0165-0378(99)00062-5}}</ref> Other studies have investigated the roles of semen in the female reproductive tracts of mice, showing that "insemination elicits inflammatory changes in female reproductive tissues,"<ref name="Johansson">{{cite journal |author=Martina Johansson, John J Bromfield, Melinda J Jasper, and Sarah A Robertson | title=Semen activates the female immune response during early pregnancy in mice | journal=Journal of Immunology | volume=112 |issue=2 |pages=290–300 |year=2004 | doi=10.1111/j.1365-2567.2004.01876.x}}</ref> concluding that the changes "likely lead to immunological priming to paternal antigens or influence pregnancy outcomes." A similar series of studies confirmed the importance of immune modulation in female mice through the absorption of specific immune factors in semen, including [[TGF-Beta]], lack of which is also being investigated as a cause of [[miscarriage]] in women and [[infertility]] in men. According to the theory, pre-eclampsia is frequently caused by a failure of the mother's immune system to accept the fetus and placenta, which both contain "foreign" proteins from paternal genes. Regular exposure to the father's semen causes her immune system to develop tolerance to the paternal [[antigens]], a process which is significantly supported by as many as 93 currently identified immune regulating factors in seminal fluid.<ref name="Burne">{{cite news | last=Burne | first=Jerome | title=Give Sperm a Fighting Chance | publisher=The Times | date=[[2006-01-30]] | accessdate=2007-11-16 | http://www.timesonline.co.uk/tol/life_and_style/health/our_experts/article721663.ece}}</ref><ref name="Sex Primes Women for Sperm">{{cite news | title=Sex Primes Women for Sperm | publisher=BBC News | date=[[2002-02-06]] | accessdate=2007-11-19 | http://news.bbc.co.uk/2/hi/health/1803978.stm}}</ref> Having already noted the importance of a woman's [[immunological tolerance]] to her baby's paternal genes, several Dutch reproductive biologists decided to take their research a step further. Consistent with the fact that human immune systems tolerate things better when they enter the body via the mouth, the Dutch researchers conducted a series of studies that confirmed a surprisingly strong correlation between a diminished incidence of pre-eclampsia and a woman's practice of oral sex, and noted that the protective effects were strongest if she swallowed her partner's semen.<ref name=NewScientist>{{cite news | last=Fox | first=Douglas | title=Gentle Persuasion | publisher=The New Scientist | date=2002-02-09 | accessdate=2007-06-17 | http://www.newscientist.com/article/mg17323294.200-gentle-persuasion.html}}</ref> The researchers concluded that while any exposure to a partner's semen during sexual activity appears to decrease a woman's chances for the various immunological disorders that can occur during pregnancy, [[immunological tolerance]] could be most quickly established through oral introduction and gastrointestinal absorption of semen.<ref name=NewScientist>{{cite news | last=Fox | first=Douglas | title=Gentle Persuasion | publisher=The New Scientist | date=2002-02-09 | accessdate=2007-06-17 | http://www.newscientist.com/article/mg17323294.200-gentle-persuasion.html}}</ref> Recognizing that some of the studies potentially included the presence of confounding factors, such as the likelihood that women who regularly perform oral sex and swallow semen{{Fact|date=February 2008}} engage in more frequent vaginal intercourse, the researchers also noted that, either way, the data still overwhelmingly supports the main theory behind all their studies--that repeated exposure to semen establishes the maternal [[immunological tolerance]] necessary for a safe and successful pregnancy.{{Fact|date=February 2008}} === Sexuality during pregnancy === Most pregnant women can enjoy [[sexual intercourse]] throughout gravidity. Most research suggests that, during pregnancy, both sexual desire and frequency of sexual relations decrease.<ref name="Bermudez">{{cite journal |title=Influence of the Gestation Period on Sexual Desire |journal=Psychology in Spain |year=2001 |author=M.P. Bermudez |coauthors=A.I. Sanchez, G. Buela-Casal |volume=5 |issue=1 |pages=14–16}}</ref><ref name="Fok">{{cite journal |title=Sexual behavior and activity in Chinese pregnant women |author=Wing Yee Fok |coauthors=Louis Yik-Si Chan, Pong Mo Yuen |journal=Acta Obstetricia et Gynecologica Scandinavica |volume=84 |issue=10 |pages=934–938 |year=2005 |month=10 |pmid= 16167907 |doi=10.1111/j.0001-6349.2005.00743.x}}</ref> In context of this overall decrease in desire, some studies indicate a second-trimester increase, preceding a decrease.<ref name="Reamy">{{cite journal |title=Sexuality and pregnancy. A prospective study |journal=J Reprod Med. |year=1982 |month=June |volume=27 |issue=6 |pages=321–7 |author=Reamy K |coauthors=White SE, Daniell WC, Le Vine ES |pmid=7120209}}</ref> However, these decreases are not universal: a significant number of women report greater sexual satisfaction throughout their pregnancies.<ref name=""Khamis">{{cite journal |title=Influence of gestational period on sexual behavior |journal= J Egypt Public Health Assoc. 2007 |year=2007 |volume=82 |issue=1-2 |pages=65–90 |author=Khamis MA |coauthors=Mustafa MF, Mohamed SN, Toson MM |pmid=18217325}}</ref> [[Sex]] during pregnancy is a low-risk behaviour except when the physician advises that sexual intercourse be avoided, which may, in some pregnancies, lead to serious pregnancy complications or health issues such as a high-risk for premature labour or a ruptured uterus. Such a decision may be based upon a history of difficulties in a previous childbirth. Some psychological research studies in the 1980s and '90s contend that it is useful for pregnant women to continue to have sexual activity, specifically noting that overall sexual satisfaction was correlated with feeling happy about being pregnant, feeling more attractive in late pregnancy than before pregnancy and experiencing orgasm.<ref name="Reamy" /> Sexual activity has also been suggested as a way to prepare for induced labour; some believe the natural prostaglandin content of seminal liquid can favour the maturation process of the cervix making it more flexible, allowing for easier and faster dilation and effacement of the cervix. However, the efficacy of using sexual intercourse as an induction agent "remains uncertain".<ref>[http://www.aafp.org/afp/20030515/2123.html Methods for Cervical Ripening and Induction of Labor - May 15, 2003 - American Family Physician<!-- Bot generated title -->]</ref> During pregnancy, the baby is protected from penetrative thrusting by the amniotic fluid in the womb and by the woman's abdomen.<ref>[http://www.marchofdimes.com/pnhec/159_516.asp The Joy of Sex During Pregnancy - March of Dimes<!-- Bot generated title -->]</ref> ===Abortion=== {{main|Abortion}} An [[abortion]] is the removal or expulsion of an embryo or fetus from the uterus, resulting in or caused by its death. This can occur spontaneously or accidentally as with a miscarriage, or be artificially induced by medical, surgical or other means. ==Progression== ===Complaints=== {{See also|Complications of pregnancy}} 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. *[[Constipation]]. A complaint that is caused by decreased bowel motility 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]]. 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) *[[Hemorrhoids|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]]. A common complaint is pain, instability or dysfunction of the symphysis pubis and/or sacroiliac joints resulting from either excess strain or injury (such as [[Diastasis symphysis pubis]]) during the course of the pregnancy or birthing process. *[[Increased urinary frequency]]. A common complaint referred by the gravida that is caused by increased intravascular volume, elevated GFR ([[glomerular filtration rate]]), and compression of the [[urinary bladder|bladder]] by the expanding uterus. *[[Varicose veins]]. Common complaint caused by relaxation of the venous [[smooth muscle]] and increased intravascular pressure. ===Childbirth=== {{main|Childbirth}} [[Childbirth]] is the process whereby an infant is born. It is considered by many to be the beginning of a person's life, and age is defined relative to this event in most cultures. A woman is considered to be in labour 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 labours, while others find that concentrating on the birth helps to quicken labour 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]]. ===Postnatal period=== {{main|Postnatal}} ==Context== There are fine distinctions between the concepts of fertilization and the actual state of pregnancy, which starts with implantation. In a normal pregnancy, the fertilization of the egg usually will have occurred in the [[Fallopian tube]]s or in the [[uterus]]. (Often, an egg may become fertilized yet fail to become implanted in the uterus.) If the pregnancy is the result of [[in-vitro fertilization]], the fertilization will have occurred in a [[Petri dish]], after which pregnancy begins when one or more zygotes implant after being transferred by a [[physician]] into the woman's uterus. In the context of political debates regarding a proper [[definition of life]], the terminology of pregnancy can be confusing. The medically and politically neutral term which remains is simply "pregnancy," though this can be problematic as it only refers indirectly to the embryo or fetus. De Crespigny observes that doctors' language has a powerful influence over the way patients think, and thus proposes that the best interests of patients are served by using language that both supports patient autonomy and is neutral.<ref name="de Crespigny">{{cite journal |title=Words matter: nomenclature and communication in perinatal medicine |journal=Clin Perinatol |author=de Crespigny L. |year=2003 |month=Mar |volume=30 |issue=1 |pages=17–25 |pmid=12696783 |doi=10.1016/S0095-5108(02)00088-X}}</ref> ==See also== {{col-begin}} {{col-1-of-3}} * [[Abortion]] * [[Anticoagulation in pregnancy]] * [[Birth control]] * [[Egg donation]] * [[Fertility]] * [[Fetal alcohol syndrome]] {{col-2-of-3}} * [[Maternal health]] * [[Nesting instinct]] * [[Parent]] * [[Postnatal depression]] * [[Pregnancy discrimination]] * [[Pregnancy fetishism]] {{col-3-of-3}} * [[Pregnancy over age 50]] * [[Pregnant patients' rights]] * [[Prenatal care]] * [[Simulated pregnancy]] * [[Teenage pregnancy]] |} ==References== {{reflist|2}} {{commonscat|Pregnancy}} {{wiktionarypar|pregnancy}} {{Reproductive physiology}} [[Category:Pregnancy|*]] [[Category:Birth control|*]] [[Category:Reproduction|*]] [[Category:Obstetrics]] [[Category:Family]] [[ar:حمل]] [[az:Hamiləlik]] [[bs:Trudnoća]] [[bg:Бременност]] [[ca:Embaràs]] [[cs:Těhotenství]] [[da:Graviditet]] [[de:Schwangerschaft]] [[et:Rasedus]] [[el:Εγκυμοσύνη]] [[es:Embarazo]] [[eo:Gravedeco]] [[eu:Haurdunaldi]] [[fr:Grossesse]] [[gd:Leatrom]] [[ko:임신]] [[hi:गर्भावस्था]] [[hr:Trudnoća]] [[id:Kehamilan]] [[is:Meðganga]] [[it:Gravidanza]] [[he:היריון]] [[pam:Pangabuktut]] [[lb:Schwangerschaft]] [[lt:Nėštumas]] [[nl:Zwangerschap]] [[ja:妊娠]] [[no:Svangerskap]] [[pl:Ciąża]] [[pt:Gravidez humana]] [[ro:Sarcină]] [[qu:Wiksayay]] [[ru:Беременность]] [[sq:Shtatzënia]] [[simple:Pregnancy]] [[sk:Tehotenstvo]] [[sl:Nosečnost]] [[sr:Трудноћа]] [[sh:Trudnoća]] [[fi:Raskaus]] [[sv:Graviditet]] [[th:การตั้งครรภ์]] [[tr:Gebelik]] [[uk:Вагітність]] [[wa:Pôzicion (comere)]] [[yi:שוואנגערן]] [[zh:妊娠]]