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Pregnancy Week by Week : Week 24 (part 1) - Depression

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1. How Big Is Your Baby?

By this week, baby weighs about 1¼ pounds (540g). Its crown-to-rump length is about 8½ inches (21cm).

2. How Big Are You?

Your uterus is now about 1½ to 2 inches (3.8 to 5.1cm) above the bellybutton. It measures almost 10 inches (24cm) above the pubic symphysis.

3. How Your Baby Is Growing and Developing

Your baby is filling out. Its face and body look more like that of an infant at the time of birth. Although it weighs a little over 1 pound at this point, it is still very tiny.

The baby grows in amniotic fluid inside the amniotic sac. Amniotic fluid has several important functions. It provides an environment in which the baby can move easily and cushions the fetus against injury. It regulates temperature. It also provides a way of assessing the health and maturity of the baby.

Amniotic fluid increases rapidly from an average volume of 1½ ounces (50ml) by 12 weeks of pregnancy to 12 ounces (400ml) at midpregnancy. The volume of amniotic fluid continues to increase as your due date approaches until a maximum of about 2 pints (1 liter) of fluid is reached at 36 to 38 weeks gestation.

Makeup of amniotic fluid changes during pregnancy. During the first half of pregnancy, it’s similar to the fluid in your blood without blood cells, except it has a much lower protein content. As baby grows, fetal urine adds to the amount of amniotic fluid present. Amniotic fluid also contains old fetal blood cells, lanugo hair and vernix.

The fetus swallows amniotic fluid during much of pregnancy. If it can’t swallow the fluid, you may develop a condition of excess amniotic fluid, called hydramnios or polyhydramnios. If the fetus swallows but doesn’t urinate (for example, if the baby lacks kidneys), the volume of amniotic fluid surrounding the fetus may be very small. This is called oligohydramnios.

4. Changes in You

Nasal Problems

Some women complain of stuffiness in their nose or frequent nosebleeds during pregnancy. Some experts believe these symptoms occur because of circulation changes caused by hormonal changes during pregnancy. Mucous membranes of your nose and nasal passageways swell and bleed more easily.

A few decongestants and nasal sprays can be used during pregnancy. Some brands to consider include chlorpheniramine (Chlor-Trimeton) decongestants and oxymetazoline (Afrin, Dristan Long-Lasting) nasal sprays. Before you begin using any product, discuss it with your healthcare provider.

It may also help to use a humidifier, particularly during winter months when heating may dry out the air. Some women get relief from increasing their fluid intake and/or using a gentle lubricant in their nose, such as petroleum jelly.

Depression

Depression can occur at any time during a person’s life. Many things can contribute to depression, including chemical imbalances in the body, stressful life events and situations that cause anxiety and tension. If you have a history of major depression, you’re at increased risk of depression occurring during pregnancy. In fact, between 3 and 5% of all women experience a major depression during pregnancy. It’s estimated another 15% have some degree of depression.

Image

The fetus doesn’t appear to have a great deal of
room to move in the uterus by the 24th week.
As the weeks pass, space gets even tight

If you’re being treated for depression when you get pregnant, it’s important to continue treatment. Treating depression is as important as treating any other problem.

If you take antidepressants, don’t stop unless advised by your healthcare provider to do so. Studies show up to 70% of women who stop taking antidepressants during pregnancy relapse into depression. Stopping your medication can raise stress hormones, which increases your risks of problems during pregnancy. The risks to you and your baby from depression may be greater than your risk of taking antidepressants. We know depression can be difficult to manage without using drug therapy.

There may be a very small increased risk of birth defects with some medicines used to treat depression when taken during the first trimester. It may help to switch to an antidepressant that is safer during pregnancy, including fluoxetine (Prozac), citalopram and escitalopram (Lexapro). Pregnancy may affect your body’s ability to use lithium. If you take an SSRI, the dose may need to be increased during the third trimester to maintain your normal mood. Talk to your healthcare provider as soon as you confirm your pregnancy.

There is continued concern about the safety of Paxil during pregnancy. Research suggests using the drug in the first trimester of pregnancy may be tied to an increased risk of heart problems in baby. However, do not stop taking your antidepressant medicine without first consulting your healthcare provider.

If you’re feeling depressed, your level of vitamin D may be low. Talk about it with your healthcare provider. Other suggestions for dealing with depression include getting some exercise and being sure you get enough B vitamins, folic acid and omega-3 fatty acids. Taking about 3.5g of omega-3 fatty acids every day has been shown to help fight depression.

Additional therapies include massage and reflexology. Another option is light therapy, similar to the type of treatment given to those who suffer from “seasonal affective disorder.”

Depression during Pregnancy. Depression during pregnancy does occur. Experts believe it’s one of the most common medical problems seen in pregnant women. Studies show up to 25% of all moms-to-be experience some degree of depression, and nearly 10% will experience a major depression. And if left untreated, 50% of women who are depressed during pregnancy will experience postpartum depression.

Treating depression during pregnancy is important for your health and baby’s health. This is one of the many reasons healthcare providers today make treating depression a priority.

Dad Tip

Now’s a good time to explore prenatal classes in your area. Encourage your partner to find out how many classes there are, when and where to register, and the registration cost. You may be able to take classes at the hospital or birthing center where your partner plans to deliver. Try to complete the classes at least 1 month before baby is due.

Depression is actually more common during pregnancy than after giving birth. If you have a family history of depression, you may be at higher risk during pregnancy. If you don’t have enough serotonin, researchers believe you may be at higher risk. If you’ve been struggling with infertility or miscarriage, you may also be more prone to depression.

If you’re depressed, you may not take good care of yourself. Babies born to depressed women may be smaller or born prematurely. Some women use alcohol, drugs and cigarettes in an attempt to ease their depression. You may also have trouble bonding with your baby after birth.

Consider the following to measure your risks of being depressed. You may be at higher risk if:

• you experienced mood changes when you took oral contraceptives

• your mother was depressed during pregnancy

• you have a history of depression

• you feel sad or depressed longer than 1 week

• you’re not getting enough sleep and rest

• you have bipolar disorder—pregnancy can trigger a relapse, especially if you stop taking your mood-stabilizing medications

Symptoms and Treatment. It may be hard to differentiate between some of the normal pregnancy changes and signs of depression. Many symptoms of depression are similar to those of pregnancy, including fatigue and sleeplessness. The difference is how intense the symptoms are and how long they last. Some common symptoms of depression include:

• overpowering sadness that lasts for days, without an obvious cause

• difficulty sleeping, or waking up very early

• wanting to sleep all the time or great fatigue (this can be normal early in pregnancy but usually gets better after a few weeks)

• no appetite (as distinguished from nausea and vomiting)

• lack of concentration

• thoughts of harming yourself

Women who are depressed are more likely to develop diabetes, and women who develop diabetes are more likely to be depressed. This is also true for pregnant women. If you have diabetes and untreated depression, then become pregnant, it can be serious if you don’t get help. You may have a difficult time caring for yourself. This could lead to difficulties in controlling weight and sugar levels. Your risk of addictive-substance abuse, such as alcohol use and cigarette smoking, may increase. And you may not be able to meet the nutritional demands of your pregnancy.

Research shows it’s better for baby if only one medicine is used during pregnancy to treat a woman’s depression.

Babies born to mothers with untreated depression can have many problems. They often cry a lot, have difficulty sleeping, are fussier and are difficult to soothe.

If you have symptoms and they don’t get better in a few weeks or every day seems to be bad, seek help as soon as you recognize you might be depressed. Call your healthcare provider, or bring it up at your next prenatal visit. There are steps to take to help you feel better again. It’s important to do it for yourself and your baby!

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