Your Pregnancy MD
Pregnancy Week Twenty Eight
Congratulations! At 28 weeks pregnant, you are into your third and final trimester of pregnancy. Your uterus climbs to about 3 inches above your navel. Your uterus should measure roughly 28 centimeters tall by this point. You’ll notice your weight gain may pick up a bit and remain fairly constant from this point on during pregnancy. Many women gain as much as a pound a week as they approach their third trimester.
As you get larger in your pregnancy, you may notice that you are having a hard time breathing, or feeling a little short of breath. This is a common pregnancy symptom, caused by your growing uterus compressing your diaphragm. You’re more likely to feel short of breath during pregnancy if you are carrying your baby high or if you are pregnant with twins or multiples.
Though shortness of breath is a bothersome sensation now, you will get relief in the final weeks of your pregnancy, when your baby drops into your pelvis (this is called “lightening“).
You may want to start counting your baby’s kicks. Although it’s not medically necessary for you to count fetal kicks (unless your midwife or doctor has advised you to), it’s a good way to feel more secure in knowing your baby is healthy.
The following are three ways to do baby kick counts that indicate the baby is doing well:
- At least 10 movements during 12 hours of normal maternal activity
- At least 10 movements over two hours when you are at rest and focused on counting
- At least 4 movements in one hour when you are at rest and focused on counting
Most women start seeing their doctors more frequently. You will probably start scheduling appointments once every two weeks until you are about 36 weeks along. Thereafter you will start seeing your doctor weekly until delivery. Your doctor will keep a close eye on you to monitor you for signs of labor during this time.
You are probably huge right now. Your pregnancy weight gain at 28 weeks pregnant is around 20 or 21 pounds. Can you believe it? Twenty one pounds! That’s like carrying a very heavy watermelon in your stomach. No wonder you are plagued with back pain in the second and third trimesters!
Most babies have less than 3 percent body fat by the time they reach the 28th week of pregnancy. Despite this you have probably gained up to 24 pounds already. Some women will have gained more and some women will have gained less. Remember that the weight you gain during pregnancy helps provide protection and comfort as well as nourishes your baby throughout your pregnancy.
During 28 weeks pregnant some women will receive a RhoGAM injection if they tested Rh-negative at the start of their pregnancy. This will prevent your body from becoming sensitized to your baby’s blood should it mix with yours during pregnancy. Fortunately one injection is all it takes to provide ample protection through delivery.
You may find a massage very helpful during pregnancy. A massage can help alleviate some of the lower back pain and leg cramps you may be experiencing due to your increasing girth. Other women start experiencing some mild swelling or itching around this time which surprisingly massage can also help.
If you haven’t had a baby shower yet now is the time to start planning. You may find several people offer to throw you a baby shower. You can always suggest that they get together to plan a single event. Many women delight in spoiling themselves a bit during the last few weeks of pregnancy. Why not, you deserve it!
Before you get too big and bulky you might start considering stocking up on some nursery supplies. Be sure you are armed with a steady supply of diapers, wipes and onesies before delivery. While you don’t actually have to set up your nursery, you will need to change and clothe your baby before delivery! Some women prefer to set up their nursery after their bundle of joy arrives. This can work to your benefit. When friends and family members ask what they can do to help after delivery you can suggest they get down to the nitty gritty and help decorate the baby’s nursery.
Your Baby at 28 Weeks of Pregnancy
By the end of pregnancy week 28 your baby may measure more than 14.8 inches long and weigh in at roughly 2.2 pounds.
Up until this point in time your baby’s brain resembled a smooth surface. By roughly this time in pregnancy your baby’s brain begins to mature, forming tiny grooves and canals that we typically associated with the human brain. Some baby hair will grow and lengthen starting now, though many babies will remain bald until weeks after birth. Some babies will be born with a full head of hair that not only falls out but also changes color shortly after delivery!
At this time your baby will be developing lovely eyelashes that will blink lovingly at you after birth.
Between 28 weeks pregnant and 32 weeks, the level of amniotic fluid in your womb will reach its maximum amount. After 32 weeks, the amount will remain constant until your baby is full term, when the level starts to decrease.
Many babies will move into the head-down position by now (the best position for an easier labor and delivery). However, it’s possible that these babies will continue doing somersaults for the next few weeks until they settle into their actual labor and delivery position.
Your baby is practicing breathing movements and your baby’s lungs are filled with amniotic fluid at this stage in your pregnancy. Up until this week, your baby’s breathing movements have been random. But now they are starting to reflect your baby’s sleep-wake patterns.
Your baby’s yawning patterns are more developed. Instead of an occasional yawn, yawns occur in succession, one after another in a repetitive pattern.
Pregnancy and Rh-Negative Blood
Rh is the protein, which is found on red blood cells. If you have this type of protein, you have Rh-positive blood type. If you don’t have this protein, you have Rh-negative blood type. Whether you are positive or negative doesn’t impact your health. However, there are some problems during pregnancy if a mom is Rh-negative and her baby has Rh-positive blood type.
The good news is there is medicine to help prevent most of the problems. A doctor will test your blood as part of your first prenatal visit and again at 28 weeks. This includes testing your blood type.
Problems with Rh-negative blood
There are certain problems that may develop when a mom has Rh-negative blood and her still unborn child has Rh-positive blood.
Usually, a mom and baby’s blood doesn’t mix during pregnancy, however if can right after delivery. If a small amount of your baby’s blood were to get in your blood vessels during delivery, your immune system would start making proteins called antibodies. In your next pregnancy, these antibodies run the risk of crossing the placenta and possibly damaging your future baby’s red blood cells. This could lead to anemia. That’s when someone doesn’t have enough red blood cells. When this happens, your child could make more red blood cells, but possibly not enough to help prevent anemia.
Knowing baby’s blood type
It’s sometimes difficult
to know your unborn child’s blood type. If you know the father’s blood type,
though, you might be able to figure it out. If both the mom and dad have
Rh-negative blood, your baby will also have Rh-negative blood.
If your baby’s father is Rh-positive, though, your baby could have either. In this case, your doctor will treat your child as if the child has Rh-positive blood. This way, they can help prevent any problems.
If you are Rh-negative, your doctor will want to do blood tests while you’re pregnant to check and see if you have antibodies in your blood. This blood test is usually done around 28 weeks of pregnancy. If you don’t have them, and your baby is likely Rh-positive, your doctor will want to give you medicine. This type of medicine keeps your body from making the antibodies that could potentially attack your child’s red blood cells. This can ward off anemia and other problems.
This type of medicine is
called anti-D immune globulin. The sample brand name is RhoGAM, and it’s
normally a shot that you get during your final trimester at 28 weeks. Once your
baby is delivered, your doctor will want to test your child’s blood type. If
your child is Rh-positive, he or she will give you a second dose of anti-D
immune globulin not long after delivery. If you’re Rh-negative, you won’t need
a second dose.
If you’re Rh-negative you may get the anti-D immune globulin at other times, though. This sometimes happens if a woman:
- Bleeds during her pregnancy
- Has an amniocentesis test or chorionic villus sampling (CVS)
- Has her pregnancy end with an abortion
- Has her pregnancy end in a miscarriage
- Has an ectopic pregnancy (grows in the wrong place)
Antibodies in your blood
If a woman already has
antibodies in her blood, anti-D immune globulin won’t help and your doctor
won’t give you this medicine.
You will have several kinds of tests to monitor your baby while you’re pregnant. If you develop anemia, or have other problems, you doctor will talk to you about the possible treatments.
If you do get pregnant again in the future, you’ll need the treatment again. Rh-negative women have to be treated with anti-D immune globulin each pregnancy, just so long as they don’t have antibodies in their blood.
Why do I get Shortness of Breath during My Pregnancy?
Shortness of Breath is Very Common in Pregnancy
Some women experience shortness of breath (S.O.B.) during
pregnancy. This is actually a common side effect of pregnancy.
Most women become more aware of their breathing during pregnancy, in part because of increasing demands carrying a baby places on the circulatory and respiratory systems. Rising levels of hormones can also stimulate the respiratory responses in the brain increasing your respiration rate and contributing to shortness of breath.
Shortness of breath during pregnancy may also result as your uterus expands and takes up much of the room you have available in your belly and diaphragm. Women who tend to carry high may notice this more as will women carrying multiples. Other women will experience shortness of breath while exercising or while attempting to climb the stairs. Both situations are usually normal.
Is Shortness of Breath During Pregnancy Safe?
Shortness of breath during pregnancy is usually not anything to
worry about. It may however serve as a gentle reminder that you should take
things easy during your pregnancy. Some women fear their shortness of breath
may reflect on their baby’s oxygen intake. This is not the case however.
Very rarely shortness of breath may suggest an underlying problem. This is more commonly the case if you have a health condition prior to pregnancy that contributes to respiratory illness or dysfunction. Common examples include asthma. Related information about asthma at 28 weeks pregnant.
In even more rare instances shortness of breath may be a sign of a pulmonary embolism. This is a blood clot that breaks free and travels to the lungs. Women are slightly more at risk for this condition during pregnancy due to blood clotting mechanisms in the body. If your shortness of breath comes on suddenly without provocation, you should contact your doctor or other healthcare provider.
Other reasons you should contact your doctor include:
- Shortness of breath accompanied by asthmatic symptoms.
- Shortness of breath accompanied by chest pain, fever and persistent coughing, which may signify a respiratory illness.
- Shortness of breath accompanied by heart palpitations or other cardiac symptoms.
- Bluish appearance of the appendages which may suggest inadequate oxygen intake.
Your doctor will undoubtedly request a complete physical to determine the exact cause of your medical problem.
Tips For Improving S.O.B. During Pregnancy
For ordinary shortness of breath, there are some simple strategies you can adopt to resolve the problem and fill your lungs with oxygen free air. Here are some ideas for improving your symptoms in the short term:
- Take time to expand your chest and breathe in slowly. When you breathe do so from your stomach. One way to enhance your breathing is by raising your arms above your head to open your rib cage.
- Take your time. Inhale by counting to three, then exhale and count to at least five to ten. Doing so will make you more conscious of your breathing patterns and encourage more fulfilling breathing.
- Consider a yoga class that focuses on breathing techniques.
- Take your time when climbing stairs or exercising and expect that you may be a little out of breath. Taking things too hard can result in dizziness or faintness. One thing you don’t want to do is faint at the gym!
Usually simple awareness of our breathing patterns helps alleviate shortness of breath during pregnancy. If you are having symptoms you may find as your baby drops in the last trimester your symptoms rapidly improve!
Pregnancy Weight Gain Guidelines by the ACOG
What is an Optimal Weight Gain for Pregnancy?
Your pre-pregnancy weight, pre-pregnancy body mass index (BMI), how fast you gain weight in pregnancy and your total pregnancy weight gain all determine the health of your pregnancy and baby. Although the importance of appropriate weight gain is well known, most women gain too little or too much weight during pregnancy.
The current guidelines for Gestational Weight Gain (GWG) is calculated from your pre-pregnant body mass index (BMI). Your body mass index is calculated by dividing your weight in kilograms by your height in meters squared. Don’t worry, just use all the tables found on-line or the table below. All you need is your current weight, your height and BMI table to find out your body mass index.
The American College of Obstetricians and Gynecologists provides the following guidelines for gestational weight gain using your pre-pregnancy BMI:
- Less than 18.5 BMI
- You should gain 28 to 40 total pounds
- BMI between 18.5 to 24.9
- You should gain 25 to 35 total pounds
- BMI between 25 to 29.9
- You should gain 15 to 25 total pounds
- BMI greater than 30
- You should gain 11 to 20 total pounds
Where does all this weight go?
• Baby – At birth your baby may weigh between 6-7.5 pounds.
• Uterus – The uterus expands during pregnancy and may weigh 2 pounds.
• Placenta – The placenta, vital for nourishing your baby, generally weighs 1.5 pounds.
• Breasts – Breast tissue often grows during pregnancy, and may weigh up to 1.5 to 2 pounds.
• Blood Volume – Your blood volume will increase during pregnancy up to 4 pounds.
• Fluid – Your body will retain some fluid during pregnancy, as much as 4 pounds!
• Amniotic Fluid – The fluid surrounding your baby will weigh approximately 2 pounds.
• Maternal Fat Stores and Nutrients – You will also gain about 7 pounds of weight that can be attributed to maternal fat and nutrient stores as well as muscle development.
Rate of Gestational Weight Gain
Your rate of gaining weight in pregnancy is also very important, as is the total amount of weight gained for a healthy pregnancy. You will gain most of your pregnancy weight in the second and third trimesters.
According to the new recommended Gestational Weight Gain Guideline values your rate of weight gain should be as follows:
• Normal Weight – you should gain (0.4 kg per week) in the second and third trimester.
• Underweight – you should gain, (0.5 kg per week) in the second and third trimester.
• Overweight – you should gain, (0.3kg per week) in the second and third trimester.
• Obese – you should gain, (0.2kg per week) in the second and third trimester.
Consequences of Greater than Normal Pregnancy Weight Gain for Mother and Child
If your weight gain
during pregnancy is greater than the recommended ranges, you will have an
increased risk for pregnancy complications. These complications include,
elevated blood pressure, gestational diabetes, complications during giving
birth, retaining weight after delivery (with subsequent obesity) as well as an
increased risk for unsuccessful breastfeeding.
There is a strong correlation between gestational weight gain and fetal growth. The more weight you gain, the larger your newborn baby will be. The lower the amount of weight gained, the smaller your baby will be at birth. Both of these scenarios can lead to complications for your newborn baby.
Safety of Intentional Weight Loss during Pregnancy
You should not lose weight during pregnancy, because the safety of intentional weight loss among obese women has not be determined. Instead of losing weight, all pregnant women should use the outlined guidelines for Gestational Weight Gain. By adhering to the guideline goals, you will reduce your pregnancy risks, weight retention after delivery, improve your long term health, normalize your baby’s birth weight and reduce childhood obesity for your newborn child.
You Can Increase the Likelihood of having a Healthy Pregnancy
First, you must conceive at a weight that is within the normal BMI recommended guidelines. Secondly and most importantly, you have to limit your weight gain during pregnancy to the range specified by the guidelines for your pre-pregnancy BMI. Meeting this first challenge requires preconception counseling and, for many women, some weight loss when planning the timing of your pregnancy. The second challenge requires you to educate yourself about the new Gestational Weight Gain Guidelines for pregnancy.
Pregnancy Skin Conditions
For many women, their hair, nails and skin all change during pregnancy. Some of the more common changes include:
- Melasma- patches of brown on the nose, forehead and around the cheeks
- Darks spots on the inner things, nipples or breasts
- Linea nigra- a dark line running from the navel to pubic hair
- Stretch marks
- Spider veins
- Changes in hair and nail growth
- Varicose veins
While some of these changes are due to changing hormone levels during pregnancy, doctors aren’t sure of the cause of most skin changes.
Dark patches and spots
Dark patches and spots are due to an increase in melanin. This is the natural substance, which provides color to your hair and skin. These dark spots and melisma will usually fade away once you have your child. In some women, though, the dark patches may last for several years. Be sure and wear a wide-brimmed hat and sunscreen when you are outside to help keep melisma from getting worse.
As your belly grows larger, your skin may get some reddish lines on it. These are called stretch marks. By the time you hit your last trimester, many women have stretch marks on their buttocks, thighs, breasts or abdomen. While a heavy moisturizer can help soften your skin, it won’t make stretch marks go away. Usually they fade after delivery, but may never go away.
Acne is fairly common in pregnant women. While some women notice the acne they already have worsens, sometimes women with clear skin suddenly develop acne.
You can treat acne by shampooing every day if you have oily skin, and trying to keep your hair off your face. You can also try washing your face twice a day with lukewarm water and a mild cleanser. You’ll also want to pick up some oil-free makeup. You don’t want to squeeze or pick acne, for it could cause scarring.
Over-the-counter acne products SAFE during pregnancy include:
• Azelaic acid
• Topical benzoyl peroxide
• Glycolic acid
• Topical salicylic acid
If you find an over-the-counter product with ingredients not on the list above, make sure you talk to your doctor.
• Isotretinoin – A form of vitamin A, this drug may cause birth defects including intellectual disabilities, potentially life-threatening brain and heart defects and other physical deformities.
• Hormonal therapy – While several medications blocking specific hormones can treat acne, there is a risk of birth defects during pregnancy.
• Topical retinoids – A form of vitamin A, these medications are similar to isotretinoin. Unlike it, though, you apply topical retinoids to the skin, and the amount your body absorbs is low. Despite this, doctors generally recommend against using these medications during pregnancy. While some retinoids are prescription only, you may also find them in certain over-the-counter products, so read those labels.
• Oral tetracyclines – If you take this after your fourth month of pregnancy, the antibiotic may discolor your child’s teeth. It can also affect how your baby’s bones are growing while you take it.
These tiny red veins may appear due to higher amounts of blood in your body, and hormonal changes during pregnancy. They often appear on a person’s arms, neck and face. Usually, the redness fades after delivery.
Your leg veins may become
sore, swollen and even blue due to the pressure and weight of your uterus
decreasing blood flow from your lower body. They may also appear in your vagina,
on your vulva and even your rectum, which is called hemorrhoids. Generally,
this a cosmetic problem which will fade away after you deliver.
Although there’s no way to prevent varicose veins, you can do certain things to try and ease the soreness and swelling of varicose veins, and even prevent them from worsening. These include:
- Not sitting with crossed legs for a long period of time
- Moving around occasionally if you have to stand or sit for long periods
- Exercising regularly, meaning riding an exercise bike, swimming or walking
- Propping your legs up on a footstool, chair or couch when possible
- Avoiding constipation by eating fiber-rich foods and lots of liquids
- Wearing support hose
Changes to hair
Because of the hormonal changes of pregnancy, your body and head hair may become thicker or grow faster. Some women find hair growing in places where it usually doesn’t, like their abdomen, chest, arms or face. This usually goes back to normal within about six months of delivery.
About three months after delivery, many women start noticing hair loss from their head. This is due to the hormones going back to normal levels, meaning your hair also goes back to its normal growth cycle. Expect that your hair grows completely back in about three to six months.
Changes to nails
Some women say their nails grow a lot faster while they’re pregnant. Others, meanwhile, deal with split nails that are easier to break. Just like your hair, the changes in your nails will let up after delivery.
Uncommon skin changes
There are some uncommon skin conditions during pregnancy, too. These may cause you to have itchy skin or bumps.
Pruritic urticarial papules and plaques of pregnancy (PUPPP)
With this condition, you’ll get hives and small red bumps during late pregnancy. These bumps can then turn into large, itchy patches. You’ll usually first notice the bumps on your abdomen before they spread to the breasts, buttocks and thighs. It’s not known exactly what causes PUPPP, but it usually goes away after delivery.
Prurigo of Pregnancy
With this condition, very small and itchy bumps can appear anywhere on your skin. They look like insect bites, usually starting with just a few that then increase very day. Doctors suggest they may be caused by changes in your immune system during pregnancy. Prurigo may last for several months, or even continue once your child is born.
This rare skin condition usually beings during either the second or the third trimester. It may also start right after delivery. With it, you get blisters on the abdomen. In more severe cases, those blisters may cover a large part of the body. Doctors think this is an autoimmune disorder. Possible pregnancy problems include a slight risk of a smaller-sized baby and preterm birth.
Intrahepatic cholestasis of pregnancy (ICP)
This is pregnancy’s most common liver condition. Severe itching occurs, but not a rash. You’ll usually experience this on the soles of your feet or the palms of your hand, but it can also spread to your trunk. Symptoms normally start during the final trimester, but usually go away just a few days after giving birth. ICP may raise the risk of preterm birth, as well as even fetal death.