Monthly Archives: August 2017

Having a Baby: Stages of Pregnancy

For a pregnant woman, feeling a new life developing inside her body is an amazing experience, even though she may not always feel her best at some points along the way.

Pregnancy can be different from woman to woman, and even for the same mother from one pregnancy to the next. Some symptoms of pregnancy last for several weeks or months, while other discomforts are temporary or don’t affect all women.

“Pregnancy is a long, 10-month journey,” said Dr. Draion Burch, an obstetrician and gynecologist at Magee-Womens Hospital at the University of Pittsburgh Medical Center.

A normal pregnancy usually lasts about 40 weeks, counting from the first day of a woman’s last menstrual period, which is about two weeks before conception actually occurs.

Pregnancy is divided into three trimesters. Each of these periods lasts between 12 and 13 weeks.

During each trimester, changes take place in a pregnant woman’s body as well as in the developing fetus, and a summary of these changes will be described below.

About two weeks after a woman has her period, she ovulates and her ovaries release one mature egg. The egg can be fertilized for 12 to 24 hours after it’s released as it travels down the fallopian tube toward the uterus.

If an egg meets up with a sperm cell that has made its way into the fallopian tube, it combines into one cell, a process that’s known as fertilization or conception.

At fertilization, the sex of the fetus is already determined, depending on whether the egg receives an X or Y chromosome from a sperm cell. If the egg receives an X chromosome, the baby will be a girl; a Y chromosome means the baby will be a boy.

According to the Cleveland Clinic, it takes about three to four days for the fertilized egg (or embryo) to move to the lining of the uterus, where it attaches or implants to the uterine wall. Once the embryo is implanted, the cells start to grow, eventually becoming the fetus and the placenta, which is tissue that can transport oxygen, nutrients and hormones from the mother’s blood to the developing fetus throughout pregnancy.

A woman will experience a lot of symptoms during her first trimester as she adjusts to the hormonal changes of pregnancy. In the early weeks, the pregnancy may not be showing much on the outside of her body, but inside many changes are taking place.

For example, human chorionic gonadotrophin (hCG) is a hormone that will be present in a woman’s blood from the time conception occurs. Levels of hCG can be detected in a woman’s urine about a week after she has a missed period, and it is why a woman will have a positive result on a home pregnancy test.

Other hormonal changes can contribute to pregnancy symptoms: Rising levels of estrogen and hCG may be responsible for the waves of nausea and vomiting known as morning sickness that a woman typically feels during her first few months of pregnancy. Despite its name, morning sickness can occur any time of day.

A woman will also feel more tired than usual during the first trimester, a symptom that’s linked with rising levels of the hormone progesterone, which increases sleepiness. She may also need to urinate more frequently as her uterus grows and presses on her bladder.

Early in pregnancy, a woman’s breasts will feel more tender and swollen, another side effect of rising levels of pregnancy hormones. Her areolas, the skin around each nipple, will darken and enlarge.

A pregnant woman’s digestive system may slow down to increase the absorption of beneficial nutrients. But reduced mobility of the digestive system might also trigger such common complaints as heartburn, constipation, bloating and gas, according to the Office on Women’s Health (OWH).

Many parts of the body will work harder during pregnancy, including a woman’s heart. Her heartbeat will increase to pump more blood to the uterus, which will supply it to the fetus.

As more blood circulates to a woman’s face, it will give her skin a rosier complexion, described as a “pregnancy glow.”

Besides the physical changes in a woman’s body, she may also experience emotional highs and lows in the early months of her pregnancy and throughout it. These emotions may range from weepiness, mood swings and forgetfulness to fear, anxiety and excitement.

A developing baby is called an embryo from the moment conception takes place until the eighth week of pregnancy.

During the first month of pregnancy the heart and lungs begin to develop, and the arms, legs, brain, spinal cord and nerves begin to form, according to the American College of Obstetricians and Gynecologists (ACOG).

The embryo will be about the size of a pea around one month into a pregnancy, Burch said. Around the second month of pregnancy, the embryo has grown to the size of a kidney bean, he explained. In addition, the ankles, wrists, fingers and eyelids form, bones appear, and the genitals and inner ear begin to develop.

After the eighth week of pregnancy and until birth occurs, a developing baby is called a fetus.

By the end of the second month, eight to 10 of the fetus’ main organs will have formed, Burch said. At this stage of pregnancy, he stressed, it’s extremely important that pregnant women do not take harmful medications, such as illegal drugs. The first trimester is also the period when most miscarriages and birth defects occur.

During the third month of pregnancy, bones and muscles begin to grow, buds for future teeth appear, and fingers and toes grow. The intestines begin to form and the skin is almost transparent.

By the second trimester, some of the unpleasant effects of early pregnancy may lessen or disappear as a woman’s body adjusts to its changing hormone levels. Sleeping may get easier and energy levels may increase.

Nausea and vomiting usually get better and go away, Burch told Live Science. But other symptoms may crop up as the fetus continues its growth and development.

Women feel more pelvic pressure, Burch said, adding that the pelvis feels heavy like something is weighing it down.

A more visible baby bump appears as the uterus grows beyond a woman’s pelvis, and the skin on her expanding belly may itch as its stretches, according to the OWH.

As the fetus is getting bigger and a woman is gaining more pregnancy weight in the front of her body, she may also experience more back pain, Burch said.

Sometime between the 16th and 18th weeks of pregnancy, a first-time mother may feel the first fluttering movements of the fetus, known as quickening, Burch said. If a woman has had a baby before, she is likely to feel the fetus kicking, squirming or turning even sooner because she knows what to expect, he explained.

The 20th week usually marks the halfway point of a woman’s pregnancy.

Burch encourages his patients to take a “baby-moon” — a mini-vacation or weekend getaway — during the second trimester, and he said the best time to get away is around the 28th week of pregnancy. A woman is generally feeling pretty good at this point, there’s a lower risk of miscarriage and premature labor, and some health professionals may discourage airplane travel after the 36th week.

In the second trimester, the fetus is growing a lot and will be between 3 and 5 inches long, Burch said. Sometime between 18 and 22 weeks, an ultrasound may reveal the sex of the baby, if parents want to know this information in advance.

By the fourth month of pregnancy, eyebrows, eyelashes, fingernails and the neck all form, and the skin has a wrinkled appearance. In addition, during the fourth month the arms and legs can bend, the kidneys start working and can produce urine, and the fetus can swallow and hear, according to ACOG.

In the fifth month of pregnancy, the fetus is more active and a woman may be able to feel its movements. The fetus also sleeps and wakes on regular cycles. A fine hair (called lanugo) and a waxy coating (called vernix) cover and protect the thin fetal skin.

By the sixth month of pregnancy, hair begins to grow, the eyes begin to open and the brain is rapidly developing. Although the lungs are completely formed, they don’t yet function.

US Obesity Rates Start to Level Off

After years of soaring to new heights, obesity rates in the U.S. appear to be leveling off, according to a new report.

The report found that, from 2015 to 2016, adult obesity rates remained stable in 45 states. Rates increased in just four states — Colorado, Minnesota, Washington and West Virginia — and decreased in one state, Kansas.

This is a change from prior years, when many states saw increases in their obesity rates. For example, in 2006, obesity rates increased in 31 states, and in 2010, obesity rates increased in 16 states, according to the report, from the Trust for America’s Health, a nonprofit health advocacy organization, and the Robert Wood Johnson Foundation (RWJF), a philanthropic organization that funds health research. [13 Kitchen Changes That Can Help You Lose Weight]

The drop in Kansas’ obesity rate is also a break from previous trends — until last year, not one state had seen a decline in its obesity rate for at least a decade. (Last year, obesity rates declined in Minnesota, Montana, New York and Ohio.)

The new report shows progress in fighting the obesity epidemic, but experts caution that Americans cannot become complacent about obesity.

“Obesity rates are still far too high, but the progress we’ve seen in recent years is real and it’s encouraging,” Dr. Richard E. Besser, president and CEO of the Robert Wood Johnson Foundation, said in a statement. “That progress could be easily undermined if leaders and policymakers at all levels don’t continue to prioritize efforts that help all Americans lead healthier lives.” [See the Full List of Obesity Rates by State]

The report used information from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System survey, which tracks obesity rates in each state.

It found that, in 2016, five states had an obesity rate above 35 percent; 20 states had an obesity rate between 30 and 35 percent; 22 states had an obesity rate between 25 and 30 percent; and three states had an obesity rate between 22 and 25 percent. (Since 2010, no state has had an obesity rate below 20 percent.)

The obesity rate was highest in West Virginia, where 37.7 percent of the population is obese. Obesity rates also exceeded 35 percent in Mississippi, Alabama, Arkansas and Louisiana. Colorado had the lowest obesity rate, at 22.3 percent. Hawaii, Massachusetts and the District of Columbia also had relatively low obesity rates, between 22 and 24 percent.

Couple Sues Amazon Alleging Faulty Glasses

A couple in South Carolina has filed a lawsuit against Amazon, alleging that the company sold faulty solar eclipse glasses that did not adequately protect their eyes during last week’s eclipse.

The proposed class-action lawsuit was filed in a South Carolina federal court on Tuesday (Aug. 29), according to Reuters.

The lawsuit says that the couple — Corey Thomas Payne and Kayla Harris, of Charleston, South Carolina — purchased a three-pack of solar eclipse glasses on Amazon in early August. They used these glasses to view the solar eclipse on Monday, Aug. 21, which was visible across the United States.

They did not look at the sun without wearing the glasses, but soon after, they claim that they experienced a number of eye symptoms, including dark spots in their vision, blurriness and changes in perception of color, the lawsuit says. These are all symptoms of solar retinopathy, or damage to the eye’s retina that happens from looking directly at the sun. Often, symptoms of solar retinopathy are temporary, but sometimes they are permanent.

Prior to the eclipse, Amazon did issue a recall of some of the solar eclipse glasses sold on its site. In these cases, customers received an email from Amazon saying that the company could not verify that the purchased glasses were made by a recommended manufacturer. But Payne and Harris say that they never received the recall email.

The lawsuit is seeking to represent people who, like Payne and Harris, claim they experienced injuries after using solar eclipse glasses bought on Amazon.

PSA Screening May Reduce Prostate Cancer Deaths After All

For men approaching 50 years old, deciding whether or not to be screened for prostate cancer can be confusing: Information about a screening test — called the prostate-specific antigen (PSA) test — is riddled with conflicting advice.

The test measures the blood level of the protein PSA, which is produced by cells in the prostate gland. Abnormally high levels of PSA can mean that a man has prostate cancer, but not always. Some organizations, such as the U.S. Preventive Services Task Force (an expert panel that advises the government) do not recommend that men undergo routine screenings with the PSA test. But others, including the American Cancer Society, recommend that men discuss the test with their doctor.

Now, a new analysis of conflicting findings from two of the largest prostrate screening trials conducted suggests that PSA testing does lead to a lower risk of death from prostate cancer. These results should reduce uncertainty in an area of medicine where patients, doctors and policymakers have many questions, and could help raise awareness about who is best-suited for the blood test, said senior study author Ruth Etzioni, a biostatistician at the Fred Hutchinson Cancer Research Center in Seattle. [5 Things You Should Know About Prostate Cancer]

“They’ll feel more confident that this is a beneficial test with the caveat that a beneficial test doesn’t save everybody. Screening is only one of our tools to save lives with cancer,” Etzioni told Live Science

The analysis was published yesterday (Sept. 4) in thejournal Annals of Internal Medicine.

In the new analysis, the investigators found no evidence that results of PSA screening differed between the two clinical trials, but found strong evidence that getting screened lowered the risk of dying from cancer up to 32 percent, compared with not getting screened.

“The trials aren’t as different as they appear,” Etzioni said.

The two trials in question are the European Randomized Study of Screening for Prostate Cancer (ERSPC), which was conducted in the Netherlands, Belgium, Sweden, Finand, Italy, Spain and Switzerland, and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), which was conducted in the United States. The ERSPC trial found PSA screening was associated with a 21 percent lower risk of dying from prostate cancer. The PLCO trial, however, found no link between PSA screening and the reduced risk of death from prostate cancer.

But the different results may stem from the different ways and the different countries in which the two trials were conducted, the researchers said. For example, men in the two trials were screened at different frequencies (annually versus every two to four years). They were also told to get a biopsy when their PSA level reached different thresholds (4.0 micrograms per liter [μg/L] versus 3.0 μg/L). And screening was stopped at different times. [5 Myths About the Male Body]

In the PLCO trial, only 40 percent of those recommended for a biopsy actually had one within one year, Etzioni added.

Both PSA trials had two main groups, or “arms,” being studied — an arm receiving PSA testing and a control arm that was not receiving PSA testing. But in the PLCO trial, more than three-fourths of the control group had at least one screening test during the trial, the authors said.

“It’s called ‘contamination,’ and there were very high levels in the U.S. study,” said Andrew Vickers, an attending research methodologist at Memorial Sloan Kettering Cancer Center in New York City. Vickers was not involved in the new analysis, but wrote an editorial that was published alongside the new analysis in the Annals of Internal Medicine.

Adding to the contradictory results of these trials are medical considerations around prostate cancer that can muddy a decision about whether to have the test. For instance, a test can help detect cancer early, but prostate cancers are generally slow-growing and many never spread. This means the test may not well serve men over age 70, who may die from other causes long before their prostate cancer becomes dangerous, Vickers told Live Science.

Prostate cancer is easy to treat, according to the Mayo Clinic, but the treatment can produce side effects, such as urinary incontinence, erectile dysfunction or bowel dysfunction. PSA tests aren’t perfect. Protein levels can be elevated even if there’s an infection and cancer isn’t present. As a result, tests can produce unnecessary anxiety and fear.

“The question is, Does it do more good than harm,” Vickers said.

To get a better idea of whether early detection itself is effective, Etzioni and her team used computer modeling to summarize the different factors that impacted the amount of early detection on each arm of the two trials and put them on an even playing field. Then, they compared each of the four arms to a historical population of men that had never undergone PSA screening to create a score that represented the amount of early detection of prostate cancer. [10 Do’s and Don’ts to Reduce Your Risk of Cancer]

“It takes all of the influences and turns it into one score that means the same thing for the four different arms,” Etzioni said.

Next, they correlated the four scores with the number of men who died of prostate cancer in each arm. They found a strong correlation, and no evidence of differences in screening benefit between the trials after accounting for the scores, Etzioni said.

“The modeling study essentially shows is that if the rates of screening in the US trials had been similar to the European studies, they would have had similar results,” Vickers said.

Although mathematical models are standard in medicine, when it comes to deciding whether a cancer-screening test is effective or not, they all depend on a huge number of assumptions, Vickers said. Ideally, large clinical trials would be done in ways that are identical to each other, but this is virtually impossible.

Vickers also said that other, smaller studies have shown that PSA testing was effective at finding prostate cancer.

“If [Etzioni’s study] was just one modeling study, that would not be very good evidence,” he said. “But the fact that this is congruent with other evidence … makes it a compelling study.”

Etzioninoted that getting screened won’t guarantee that every person’s cancer will be discovered, nor does it suggest that all men should have such a test. But now people may have less uncertainty about whether such a test is beneficial, she said.