Physical changes in the third month of pregnancy
In week 11 of pregnancy, your nausea should start to ease. You may still feel faint if you stand up too quickly. Your vaginal discharge will increase. The amount of blood circulating through your body will continue to increase. Hormonal changes will continue to make your gums prone to bleeding, so pay attention to your oral hygiene, avoid sugary foods, and have at least two dental check-ups while you are pregnant. Constipation may persist, and might be accompanied by hemorrhoids. Hemorrhoids are a form of varicose veins that appear around the anus, and they are uncomfortable, itchy, and sometimes painful. Make sure to eat plenty of fruit, vegetables, and high fibre foods to guard against constipation and hemorrhoids.
You may develop a backache, caused by leaning backward to compensate for the baby’s weight. To reduce backache, try to maintain good posture, avoid lifting heavy objects, lift with your knees bent, wear flat shoes, and sit with your back well-supported. You may also develop cramps in your legs and feet, especially at night. These sharp pains may be alleviated with adequate calcium intake, regular exercise, and massage therapy.
By week 12, your extreme fatigue should start to ease and you should have more energy. Your abdomen will continue to expand and your risk of miscarriage is now greatly reduced. Now is a good time to tell your employer and friends that you are pregnant.
Your nausea may be completely gone by week 13. Your uterus is enlarging at a regular and noticeable rate now, and your pregnant belly is now visible. By this time, your uterus is about the size of a grapefruit. Your nipples are darker and the blue veins in your breasts are very obvious. Your health care provider may be able to hear your baby’s heartbeat using a small handheld ultrasound device.
In week 14, you feel less tired, more fit and active. The dark area around your nipples, called the areola, will become darker and larger. Hormonal changes may cause a dark line to develop down the middle of your abdomen to your pubic bone.
You will probably gain about 0.5 kg to 1 kg (1 lb to 2 lbs) this month. Some women may lose a bit of weight if they have not been eating as well, which is fine. Your focus should be on maintaining good nutrition. Eat about 300 to 500 extra calories per day; you do not need more than that. Avoid junk food and eat lots of fruit, vegetables, and protein.
For more information on maintaining a healthy pregnancy diet, see "Nutrition."
Your medical visit in the third month of pregnancy
This month’s medical visit will not be as involved as last month’s. Your health care provider will check the following:
- weight
- blood pressure
- growth of the uterus
- the baby’s heartbeat
- urine tests
Screening tests this month
Nuchal translucency measurement test (10 to 14 weeks)
Some mothers, for example, those over 35 years of age, are at risk of having a baby with a chromosomal disorder such as Down syndrome. In these cases, a nuchal translucency measurement test can be given in weeks 10 to 14 of pregnancy to help estimate the risk that the baby has Down syndrome. This test uses ultrasound to measure the amount of fluid that has accumulated at the back of the fetus’ neck, between the skin and the underlying structures. When a fetus has a chromosomal disorder, the amount of fluid at the back of the fetus’ neck tends to be increased. If this screening test shows a high risk of Down syndrome, it can be followed by a diagnostic test such as chorionic villus sampling within the first three months of pregnancy, ideally at 10 to 12 weeks gestation, or amniocentesis after week 16.
First trimester combined screening (weeks 11 to 13)
First trimester combined screening (FTS) is done in weeks 11 to 13 and consists of a combination of the nuchal translucency ultrasound and a blood test, usually done on the same day. FTS is done to estimate the chances of having a chromosomal abnormality such as Down syndrome. FTS is followed by a blood test called alpha-fetoprotein (AFP) assay in week 16. This test checks the level of AFP in the blood. AFP is a substance produced by the unborn baby’s nervous system tissue. High levels of this protein could mean that the baby may have spina bifida. However, it could also mean that the pregnancy is farther along than originally thought or that the mother is carrying twins. A low level of AFP could mean that the baby has Down syndrome or simply that the pregnancy is not as far along as originally thought. Because this is a screening test, any abnormal results will be followed by a diagnostic test such as amniocentesis.
Integrated prenatal screening (weeks 11 to 13)
This is similar to FTS followed by AFP. Integrated prenatal screening is a combination of ultrasound, nuchal translucency measurement, and two blood tests to determine your risk of having a baby with a chromosomal abnormality or neural tube defect. The ultrasound is usually done between weeks 11 to 13 of pregnancy. The first blood test is also done between weeks 11 to 13, after the ultrasound. The second blood test is done between weeks 15 to 20, the earlier the better. About four of 100 women have a “positive” result on the integrated prenatal screening. This means that the chance of having a baby with a chromosomal abnormality or neural tube defect is higher than normal. However, most women with a positive result do not have a baby with any of these conditions. If you do have a positive result, you may choose to do a diagnostic test such as amniocentesis to determine if the baby really has one of these conditions. You may also be referred to a genetic counsellor.
Diagnostic tests this month
In week 11, if you are at significant risk of having a baby with Down syndrome or other chromosomal abnormalities, you may be offered a test called chorionic villus sampling (CVS). In this test, a fine tube is passed through the cervix into the uterus. Fetal cells in the tissue that is developing into the placenta are removed and tested. The advantage of CVS over amniocentesis is that the test can be done earlier and therefore the results are available earlier.
For more information about CVS and other tests, see "Prenatal Testing."
Emotional changes and depression in the first trimester of pregnancy
Usually, the first trimester of pregnancy is a time of great joy for the expectant mother. You will no doubt be excited and perhaps relieved when you discover you are pregnant. However, you may also have mixed feelings about your pregnancy. Unpleasant physical symptoms such as nausea or vomiting may make you feel resentful. You may feel frightened because of a bad experience with a previous pregnancy. You may be worried about the alcohol you drank before you knew you were pregnant, or whether you will be able to stick with your nutrition plan. You could be concerned about losing the baby. You might worry about whether you will be able to take care of a baby, or whether you can afford a child.
Self-esteem issues also come into play at this time. As your clothes become tighter, you might start to feel less attractive. If your professional activities are important to your self-esteem, you may feel isolated from peers and unable to meet the expectations of your superiors.
It is normal to have mood swings in response to all the changes you are going through in your pregnancy. These mood swings can range from elation to being upset, angry, or depressed. It is important to keep in mind that these feelings are normal during pregnancy. If you are getting into petty arguments with your spouse because of your mood swings, try to talk things over with him, to make sure the problems don’t escalate.
Some women may experience a depression that is so pronounced and continuous that it disrupts their normal functioning. This is called major depression, and it affects 4% to 12% of women during pregnancy. The incidence of major depression during pregnancy is not as high as during the postpartum period (12% to 28%). However, if you have depression during pregnancy, you are more likely to have postpartum depression. If you have any of the following symptoms of depression, check with your doctor:
- feeling out of control
- unpredictable tearfulness and spontaneous crying
- feelings of sadness, melancholy, weary anger, or general despair
- sleep disturbances
- a total loss of sexual desire
Overall, though, most women simply have an intense and romantic sense of excitement in the first trimester of pregnancy. There is a feeling of joy, and of being more special than anyone else in the world.