Dealing with gestational diabetes

GDM is the most common disorder affecting pregnant women, seen in anywhere from 2% to 10% of pregnancies in the U.S. every year. It can damage the organs in both the fetus and in the mother. During pregnancy, it can cause birth defects, high blood pressure, preeclampsia, babies with large birth weight, preterm birth, or the likelihood of needing a C-section.

As it stands, pregnant people are screened for GDM between 24 and 28 weeks. The glucose challenge test, or one-hour glucose tolerance test, involves drinking a sugary substance and having blood drawn about an hour later. If diagnosed, you need to closely monitor your diet, exercise, and blood sugar. Half of all women with GDM go on to develop type 2 diabetes later in life, the Centers for Disease Control and Prevention reports. They are also at a higher risk for cardiovascular disease.

Related: It’s science: The glucose test is safe for pregnant women: But there are alternatives if you want them

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Spotting GDM sooner

A team from UCLA pinpointed biomarkers that they believe may be indicators of GDM early in pregnancy. Their study appeared in PLOS ONE.

Researchers collected blood samples from 24 women during each trimester and at delivery. Then they looked at extracellular vesicles (EVs) that are secreted from the placenta (this starts at about 6 weeks into pregnancy). The EVs transport microRNA genes (miRNAs) in the mother’s blood. 

The researchers noticed a unique expression of miRNA in EVs from the first trimester in women who went on to develop GDM. The expression of miRNA differed compared to women who did not have GDM later in pregnancy.

The UCLA team also took blood from three healthy women who were not pregnant for control purposes.

The changes in miRNA suggests the miRNAs had a role in the development of the disease instead of factors secondary to the condition itself (or treatments like insulin, which can impact the miRNA content of circulating EVs).

“As pregnancy complications continue to rise worldwide, there have been increasing efforts to study with urgency the first-trimester as a window of opportunity for early identification and prediction of GDM, and the optimal point to take action to prevent maternal disease,” Dr. Sherin Devaskar, lead author of the study and physician-in-chief of UCLA Mattel Children’s Hospital, says in a statement.

Related: Gestational diabetes may not be linked to pregnancy weight gain, study says

The findings also imply that the miRNA may be communicating with other maternal organs and cell types, and interacting with signaling pathways involved in metabolism and inflammation. This could impact the maternal metabolic adaptations that have been seen in women with GDM, the researchers say, providing a possible clue as to the higher risk for type 2 diabetes or cardiovascular disease seen down the line.

Devaskar says the findings are “promising” but notes that more research is needed. (After all, it was a relatively small study.)

But the findings provide more evidence that GDM starts earlier in pregnancy than the time when it is routinely diagnosed at the end of the second trimester. 

If women knew earlier on that they have GDM, that knowledge may help them and their healthcare providers better manage the condition. It also may help pregnant women avoid birth complications that are otherwise not reversible—and reduce their risk of chronic disease later in life.

Sources

KC K, Shakya S, Zhang H. Gestational Diabetes Mellitus and Macrosomia: A Literature Review. Ann Nutr Metab 2015;66(suppl 2):14-20. doi: 10.1159/000371628

Thamotharan S, Ghosh S, James-Allan L, Lei MYY, Janzen C, Devaskar SU. Circulating extracellular vesicles exhibit a differential miRNA profile in gestational diabetes mellitus pregnancies. 2022. PLoS ONE 17(5): e0267564. doi:10.1371/journal.pone.0267564

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I had always wanted to have a daughter. I have a close relationship with my own mom and I hoped for the same with a daughter. I wanted to teach her about what it means to be a women in this world. And yes, as regretful as it is to admit, I suppose I also wanted to do the stereotypical “girl” things with a daughter—get pedicures, go shopping together, share makeup. I know, I know.

But just because my feelings of disappointment were fleeting, that doesn’t mean they weren’t valid. 

Fifteen years and two boys later, I can say emphatically that all of those feelings were very fleeting. I don’t miss having a daughter at all. I absolutely adore having sons. I adore my sons. And I am sometimes shocked at how much I love raising boys. 

But just because my feelings of disappointment were fleeting, that doesn’t mean they weren’t valid. 

Often referred to as “gender disappointment,” what we’re actually referring to is the baby’s sex and not their gender. Very important note: gender is an identity that isn’t known until a child is old enough to identify with a gender so parents typically assume that a baby’s gender matches their sex assigned at birth. 

Related: Dear daughter, when I fail at being your role model

Acknowledging disappointment about your baby’s sex is still pretty taboo in parenting circles. We are supposed to love our child unconditionally. And we do. But we are also complicated people with a multitude of emotions. It should go without saying, but it’s possible to feel disappointment and also feel grateful and in love with your baby. We can feel more than one emotion at the same time. Humans are amazing like that. 

I loved my baby boy instantly, but it took a while to settle into being the mother of a son. But three years later, when we learned we were having another boy, I was thrilled to be having another boy. 

You won’t—and don’t—love your child less than or differently. You just need some time to adjust the image of motherhood you had in your mind and settle into the reality.

A decade and a half after that very confusing ultrasound appointment, I am so glad that I have two sons. (To confirm, so far, their gender identity matches the sex they were assigned at birth.) I take my role as a mother to sons very seriously. I talk to them about menstruation, sex, and the patriarchy. I don’t push any of that “man up” or “boys will be boys” nonsense. I acknowledge their emotions and hold them when they cry. (Anyone who tells you that boys are less emotional than girls is lying to you.) And I parent them with a certain softness while also trying to not tame out all of their wildness (which is more attributed to who they are than their gender). I’ve learned to deal with a toilet seat that’s always up. I’ve gotten used to the noise. I am, dare I say, a pretty good mom to sons.

I’ve talked to several other parents who had complicated emotions when they found out the sex of their baby too. “I cried,” I’ve heard more than one mom sheepishly admit. This is normal and not uncommon.

But while all feelings are valid, not all behaviors are appropriate. Your feelings aren’t a free pass to act like a brat or hurt others. Crying is normal, but hold off on the tantrum (like the dad in a viral TikTok video) and sexist jokes are also a no-no. It’s not okay to tell your child you wish they were someone different than who they are. And it’s not cool to ask other parents if they are “trying for a girl/boy” when all of their other children are the opposite sex. 

If you felt or feel disappointed by the sex of your baby, you aren’t alone. There is nothing wrong with you. If you’re wondering how to deal with gender disappointment, start by acknowledging your feelings. And remember that, while valid, this feeling is also fleeting. It will pass. 

Related: How becoming a boy mom transformed the way I see men 

You won’t—and don’t—love your child less than or differently. You just need some time to adjust the image of motherhood you had in your mind and settle into the reality.

Because here’s the thing: no matter the sex of your baby at birth, your child will be the unique and beautiful person they are meant to be. They will surprise you and impress you and challenge you. After all, nothing shatters our expectations of motherhood like the realities of motherhood, whatever sex or gender they are. But equally true? No one is better able to mother the child you have than you are. 

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Getting the Covid vaccine or booster shot in pregnancy is one of the most important steps you can take to protect your baby and yourself from serious illness. That’s for a couple reasons: Pregnancy is considered a high-risk state for Covid infection; and there is no plan to create a vaccine for infants under 6 months of age. (And, at the time of writing, the vaccine authorization for kids ages 6 months to 4 years has been delayed yet again.) 

Vaccination in pregnancy can offer protection against Covid for both mother and baby—no matter when it’s received. Both the Centers for Disease Control and Prevention (CDC) and The American College of Obstetricians and Gynecologists (ACOG) stress that pregnant women get vaccinated as soon as possible, i.e., right now. 

Research has shown that the mRNA vaccines are safe and effective for pregnant people, and yet just 67% of pregnant people in the U.S. have gotten the shots, according to CDC data.

But new research may provide more information on when the placenta most efficiently transfers vaccine-provided antibody protection to the developing baby.

Research shows vaccination in pregnancy leads to strong antibody protection in babies

A recent study published in The Journal of the American Medical Association (JAMA) showed that vaccination with two doses of an mRNA vaccine during pregnancy resulted in antibody levels in infants that lasted until they were 6 months old at much higher rates than in babies born to unvaccinated, Covid-infected mothers.

The study, from Massachusetts General Hospital (MGH), looked at women who were either vaccinated with two doses of an mRNA vaccine or infected with the virus between week 20 to 32 of pregnancy. 

They found that antibody levels (titers) were higher in the cord blood of vaccinated mothers at delivery. At 2 months of age, 98% of the infants born had detectable IgG antibody levels in their blood. At 6 months, 57% of the infants still had detectable levels of IgG, as compared with just 8% of infants born to unvaccinated, infected mothers.

A recent CDC study found that babies under 6 months old born to mothers who had received two doses of an mRNA vaccine during pregnancy were 61% less likely to be hospitalized due to Covid infection than those born to mothers who were not vaccinated.

“While it’s still unclear just how high the titer needs to be to completely protect an infant from COVID, we know anti-spike IgG levels correlate with protection from serious illness,” says Andrea Edlow, MD, MSc, a Maternal-Fetal Medicine specialist at MGH, director of the Edlow Lab in the Vincent Center for Reproductive Biology and co-senior author of the JAMA study, to ScienceDaily. “The durability of the antibody response here shows vaccination not only provides lasting protection for mothers but also antibodies that persist in a majority of infants to at least six months of age.” 

But when those vaccinations were administered also matters.

When should you get the Covid vaccine or booster in pregnancy?

A 2021 study published in Obstetrics and Gynecology on 1,359 vaccinated pregnant women found that while antibody levels were detected at delivery regardless of vaccination timing, those vaccinated in the early third trimester had slightly higher antibody levels both in maternal blood and umbilical cord blood. Those who had only received one shot before delivery had the lowest levels of antibodies—though they did still have detectable levels.

Completing a full round of vaccination at any time during pregnancy before giving birth is the most important factor. But if you’re already fully vaccinated before becoming pregnant and looking to time your Covid booster shot in pregnancy to offer the most benefits to your infant once born, it seems that weeks 20 to 32 of pregnancy are when Shook, et al. (2022) pinpoint as an optimal time to receive the vaccine in pregnancy. 

That equates to between the end of the second trimester and the beginning of the third trimester. In that window, antibody transfer via the placenta seems to reach peak levels.

“Individuals vaccinated or infected at 20 to 32 weeks’ gestation were enrolled because previous studies have demonstrated superior transplacental transfer of antibodies during this window compared with vaccination closer to delivery,” Shook, et al. (2022) write. 

What if you’re pregnant and already had Covid?

Previous Covid infection conferred some benefit when combined with vaccination. Yang, et al. (2021) showed that antibody levels in women who had recovered from a previous Covid infection and had been vaccinated in early pregnancy were comparable to those who were uninfected but received the vaccine in the early third trimester. 

Those who were eligible for a booster and received one in the third trimester had the highest antibody levels of all groups. 

A note from Motherly

The bottom line? It’s important to receive both doses of the mRNA vaccine in pregnancy before giving birth in order to pass on antibody protection to your infant, and it’s best to do so sooner than later. If you have the option to time your booster dose, try to do so between weeks 20 to 32, when placental transfer is most effective. 

“Pregnant women are at extremely high risk for serious complications from COVID,” says Galit Alter, PhD, core member of the Ragon Institute of MGH, MIT and Harvard, and co-senior author of the JAMA study, to ScienceDaily. “And given the lag in development of COVID-19 vaccines for infants, these data should motivate mothers to get vaccinated and even boosted during pregnancy to empower their babies’ defenses against COVID.” 

Sources

Shook LL, Atyeo CG, Yonker LM, et al. Durability of Anti-Spike Antibodies in Infants After Maternal COVID-19 Vaccination or Natural Infection. JAMA. Published online February 07, 2022. doi:10.1001/jama.2022.1206

Yang YJ, Murphy EA, Singh S, Sukhu AC, Wolfe I, Adurty S, Eng D, Yee J, Mohammed I, Zhao Z, Riley LE. Association of Gestational Age at Coronavirus Disease 2019 (COVID-19) Vaccination, History of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection, and a Vaccine Booster Dose With Maternal and Umbilical Cord Antibody Levels at Delivery. Obstetrics & Gynecology. 2021 Dec 28:10-97.

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The second time around, I know more about the work that is motherhood, which means I’m much more aware of the impact that a child has on life. This pregnancy was planned, but I’m still very anxious about the upcoming changes in my family.

And though I know all of that is healthy and normal, there is pressure—spoken, unspoken, imagined, obvious—that suggests any feeling about pregnancy other than excitement is synonymous with ingratitude. 

We often hear people wonder about the possibility of regretting not expanding their family—the guilt about being ‘one and done’. But what happens when you do decide to have more children and the anxiety and overwhelm start to trickle in? When you’re haunted by questioning statements such as, Am I making a huge mistake? Or…

My marriage already feels so strained since having a child, is having two going to make it worse?

Where am I going to find the time or energy for another child?

Will I ever be able to focus at work?

How will I divide my energy fairly?

Why am I fixing something that isn’t broken? One child is finally feeling manageable. 

Anticipating the challenges of balancing two children, work, marriage, household responsibilities and well, life—I often spend hours awake at night wondering how and when this is all supposed to happen.

What is pregnancy ambivalence?

Though it might be taboo to discuss, ambivalence in pregnancy is very common. Studies looking at pregnancy ambivalence, though limited, suggest that we don’t typically subscribe to one reaction in pregnancy or the other—but that our feelings towards pregnancy oscillate at any given moment. 

Ambivalence in pregnancy can be understood through a variety of measures, but I think a helpful way to understand it was described through one study as “going back and forth” between strongly positive and strongly negative reactions to pregnancy. It couldn’t be further from a lack of emotions—instead, it feels more like a rollercoaster of negative and positive emotions.

This is consistent with the concept that “two things can be true.” We hold both positive feelings and negative feelings toward pregnancy, without having one feeling be “truer” or more consistent than the other. Sometimes there are days where my emotions are positive and excited, other days, when parenting a toddler feels challenging, I am filled with dread and insecurity about what is to come.

In my personal experience, this has certainly been the case over the past months of my second pregnancy. Knowing what I know now about parenthood, I certainly have my fears—specifically around sleep loss, identity loss, financial impact, fears about the impact of parenthood on work, and of course, concerns about how a new family member will shift our current family dynamic. 

What the research shows about family expansion

In examining all of this, I wasn’t only interested in researching pregnancy ambivalence but also the reality of how it feels once you’re on the other side—once your family has expanded. Are bigger families happier? When I took some time to look at the data behind family expansion and happiness, the findings were all over the place; often conflicting. There is data that supports the idea that women are not more satisfied with more than one child versus one. Some analysis suggests that happiness rates are lowest among parents of preschool-aged children, but improves over time.

Another study shows that some men are happier with more than one child, while women are happiest with one and progressively unhappier with more. 

Perhaps the most disheartening analysis of existing data suggests a decline in marital health which worsens with each additional child, suggesting that the time and freedom it takes to account for the new addition is likely withdrawn from the couples’ alone time. 

And yet, I feel this biological pull toward expanding our family—even though I know logically, practically and emotionally it is going to be difficult. I know in my heart it is right for my family, but my mind is just trying to solve for practicality. 

How to cope with pregnancy ambivalence

In moments of doubt, I always turn to other mothers. In particular, I spoke with several mothers who experienced this transition from one to two children recently and are still in the adjustment phase. Here are some of the most common anecdotal experiences they shared, especially as it relates to the first few months.

1. Don’t be surprised by feeling rage or resentment toward your toddler when the baby is born. 

This may happen for reasons which are largely biologically based, like wanting and needing to protect a newborn. I’ve been told that the intensity of these feelings dissipates after a few months, but that the guilt for having those feelings at all is hard to manage. 

2. Don’t be surprised if you resent the impact of the baby on your relationships.

Contrary (or perhaps in addition to point number one), there is a longing for one-on-one time with your toddler and the ability to be present. It can often feel like the baby is the source of conflict between you and your toddler, and it’s hard not to feel like things were easier before the baby joined the family.

3. Don’t be surprised if you really resent your partner. 

This one came as no surprise to me after my experience with baby number one, but the mental load of managing two or more children takes some serious getting used to. It also takes frequent communication, delegation and reorganization.

4. Your patience will feel limited in the beginning. 

I heard from almost everyone I spoke with that they felt an intense lack of patience and warmth in the early months, due to overall exhaustion. I was reassured that over time, as sleep restores some semblance of normalcy and routines start to settle, patience starts to feel progressively more attainable. 

5. The guilt is real—and challenging. 

It’s hard to hear that I should prepare for a level of guilt that I may have never previously experienced, but it’s also comforting to know that it feels like a universal, or at least, very common experience. One common example of guilt during this adjustment is feeling like neither child is getting good or sufficient attention. Hearing that this experience was very common across the board is a good reminder that these feelings are normal, but that doesn’t make them true. 

I feel compelled to add that almost all of these experiences were followed by “but it gets better”. Plus, plenty of reminders that seeing the children together brings an overwhelming feeling of love. 

Big change takes time to process

Sometimes when ambivalence arises, the most comforting thought is knowing that having doubts is a completely healthy and appropriate way of processing and planning for change that is inevitable.

For now, I am trying to enjoy the months I have left with my son as my only child, and really savor the long stretches of sleep which will be (temporarily) compromised. Becoming a parent was the most difficult challenge of my life so far, but I am stronger for it. I am looking forward to seeing the ways that I grow emotionally as my family expands. 

So mama, if you’re reading this and you’re nervous, scared or ambivalent, just know you’re not alone. Know that it doesn’t mean you’re not equipped to handle this challenge. There are certainly parenting seasons that are more challenging than others, but we’ll get the hang of it. We always do. 

Sources

Balbo N, Arpino B. The Role of Family Orientations in Shaping the Effect of Fertility on Subjective Well-being: A Propensity Score Matching Approach. Demography. 2016;53(4):955-978. doi:10.1007/s13524-016-0480-z 

McFall SL, Garrington C (Eds.). Early findings from the first wave of the UK’s household longitudinal study. 2011. Colchester: Institute for Social and Economic Research, University of Essex.

Miller WB, Barber JS, Gatny HH. The effects of ambivalent fertility desires on pregnancy risk in young women in the USA. Popul Stud (Camb). 2013;67(1):25-38. doi:10.1080/00324728.2012.738823

​​Twenge JM, Campbell WK, Foster CA. Parenthood and marital satisfaction: a meta‐analytic review. Journal of marriage and family. 2003 Aug;65(3):574-83. doi:10.1111/j.1741-3737.2003.00574.x

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Did you know that the moment a fertilized egg implants into your uterus and establishes a pregnancy, you are actually already considered 2 weeks into your 40-week pregnancy? 

You may consider that good news, because it means that by the time of your missed period, you are likely about 4 to 5 weeks into the countdown, which means you’re that much closer to meeting your baby. But the less-great news? That fact doesn’t necessarily mean you get to skip some or all of those un-fun early pregnancy symptoms (morning sickness, we’re looking at you). Luckily, things start improving in the second trimester. 

Surprising facts about the first trimester of pregnancy

1. The nose knows: You’re now a super-smeller: You might now find the scent of your favorite lotion nauseating, or decide you need to throw away your dryer sheets because you can no longer stand the smell. Biologically speaking, this change is believed to be a way for pregnant people to avoid ingesting potentially unsafe foods and as a motivator for them to seek out a clean, safe environment. 

2. Waving hello: By the end of the first trimester (or first 12 weeks) of pregnancy, your baby is still teeny (about 3 inches long), but their fingers and toes have already formed.  

3. Show and tell: In the first trimester, you may look pregnant at night, then wake up looking like your pre-pregnancy self again. Hormonal changes during pregnancy slow digestion, often leading to gas and bloating. That bloating is responsible for the protruding lower belly that many pregnant people have toward the evening of each day during the first trimester. It can trick us into thinking we may be starting to show.  Alas, it’s probably just gas, my friends. Those darn hormones are always messing with us!

Weird facts about the second trimester of pregnancy

1. Smooth moves: OK, friends. What is an article talking about interesting pregnancy facts if we don’t talk about poop?! By the end of the second trimester, your baby’s first bowel movement, called meconium, will have formed in its intestines, where it will patiently wait to be passed until the first 24 to 48 hours after birth. 

2. Go with the flow: I guess if we talked about poop, we should also talk about pee. Although baby’s first urine production happens in the first trimester, it’s early in the second trimester that urine production increases quite a bit. The weird (and maybe a bit gross?) part is that the fluid inside the womb that surrounds the baby, called the amniotic fluid, is almost entirely made of urine by about the 20th week of pregnancy. (Yeah, we didn’t know either.) The baby proceeds to swallow and then pee out that fluid in a continuous cycle until they are born. 

3. The sound of music: You’ve likely heard that fetuses can hear from inside of the womb. And by the late second trimester of pregnancy, babies can actually respond to sound and voices. Studies involving introducing sound to fetuses in the womb and observing their reaction with ultrasound have actually shown that fetuses can cry in response to those sounds during the second trimester. While they don’t make noise, babies perform the other physical facial behaviors observed during crying.  

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Fun facts about the third trimester of pregnancy

1. Milk mama: Your breasts may begin leaking milk! Yes, you read that correctly. A special type of early milk known as colostrum may begin coming out of your breasts before your baby is even born. Your body is forming the pathways needed to start creating milk for your infant once born. 

2. Baby bubbles: Babies can get the hiccups during the third trimester of pregnancy. Hiccups are related to the movement of the diaphragm, which is also largely responsible for humans’ ability to breathe. During the 3rd trimester, fetuses start to practice breathing by moving their diaphragm, so their ability to have hiccups naturally follows. It’s pretty cute to imagine your little one hanging out in your uterus with the hiccups, right? You may feel their hiccups as rhythmic little bumps against your belly in a predictable, consistent pattern.  

3. Size up: By the end of your 3rd trimester, your feet may have grown an entire shoe size. What’s even more wild is that your feet may be permanently changed by the end of your first pregnancy. The increase in shoe size is thought to be related to the hormone relaxin, produced by the pregnant body to help facilitate the birth process. Since relaxin does not discriminate, it affects ligaments all over the body, including those in the foot arch. As these ligaments relax, the arch may flatten and the foot may gain length, resulting in a likely permanent change to shoe size.  

Bonus round: Wild facts about the fourth trimester

In the first three months after your baby is born, known as the fourth trimester, some pretty wild happenings also take place as your body heals after birth and adjusts to caring for a newborn.

1. Growing pains: You will probably experience significant cramping while you are breastfeeding your infant. Breastfeeding is often depicted as a beautiful, peaceful, effortless process that occurs seamlessly after the birth of a baby. While that can be true for some, it’s also true that breastfeeding is work—and can be painful. In the early days, one challenging aspect is the uterine cramping that occurs after birth to help the uterus shrink down to its pre-pregnancy size. This painful cramping is a result of the release of oxytocin when an infant latches to the breast. 

2. Snuggle up: Skin-to-skin contact isn’t all about your baby. The practice of holding your naked (or diaper-clad) baby against your bare chest is incredibly beneficial for babies. But the mother’s response to holding her baby skin-to-skin is pretty amazing on a sciency-level (yes, that’s a technical term). The oxytocin released by your body in response to that physical, skin-to-skin contact is what allows mothers and babies to recognize each other’s unique scents. Of course, baby gains tons of benefits from this type of contact as well. For example, mother’s breasts have been shown to change in temperature based on the infant’s temperature needs, and skin-to-skin can help regulate an infant’s heart rate, breathing rate, and blood sugar levels. 

3. Chain reaction: After your baby is born, you could develop an allergy to them! Well, sort of… Let’s clarify. There is a small protein that some people carry on their red blood cells, while others do not. This is called the Rh factor. If a person without Rh factor carries a baby who does have Rh, the pregnant person can develop an immune response against Rh. What does this mean? Although a mismatch in Rh between mother and baby is unlikely to affect a person’s first pregnancy in which the incompatibility exists, your postpartum body will be busy developing an immune response to what it perceived as a foreign invader, so the next time you are pregnant with an Rh-positive baby could cause problems. Luckily, with appropriate prenatal care, these issues are easily foreseen and can be addressed accordingly to keep mother and subsequent baby healthy. 

Pregnancy is a wild and wonderful ride. If you have questions or concerns about any of the changes your body is going through, or if something seems not normal, talk to your care provider.

Sources:

Costumbrado J, Mansour T, Ghassemzadeh S. Rh Incompatibility. Updated 2021 Aug 27. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 

Department of Health and Human Services. Office on Women’s Health. Recovering from birth. 2018.

Dikici O, Muluk NB, Şahin E, Altintoprak N. Effects of pregnancy on olfaction. ENT Updates. 2017 Aug 1;7(2):104-7. doi:10.2399/jmu.2017002009

Reissland N, Francis B, Mason J, Lincoln K. Do facial expressions develop before birth?. PLoS One. 2011 Aug 31;6(8):e24081. doi:10.1371/journal.pone.0024081

Segal NA, Boyer ER, Teran-Yengle P, Glass NA, Hillstrom HJ, Yack HJ. Pregnancy leads to lasting changes in foot structure. Am J Phys Med Rehabil. 2013;92(3):232-240. doi:10.1097/PHM.0b013e31827443a9

Underwood M, Gilbert W & Sherman M. Amniotic Fluid: Not Just Fetal Urine Anymore. J Perinatol 25, 341–348 (2005). doi:10.1038/sj.jp.7211290

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Here’s what you need to know about pregnancy classes to support you + your baby during the second trimester:

What should I expect during the second trimester of pregnancy?

Stretching from Week 13 through Week 27 of pregnancy, a lot happens during the second trimester. The nausea and exhaustion common during the first trimester often dissipates, but your growing belly is all the reminder you need that you’re pregnant—and just wait until you start feeling baby kicks and flips!

During the second trimester, you will continue on with regular appointments with a doctor or midwife. It also isn’t too soon to start thinking about a birth plan. With the tools, explanations and resources, Motherly’s digital Second Trimester classes are designed to help you feel empowered as you get closer and closer to *birth day.*

What should I learn about during the second trimester of pregnancy?

1.) Common physical symptoms during the second trimester

Out with many unpleasant symptoms, in with… some new changes to your body. In Motherly’s Preparing for Your Second Trimester Class, Pediatric Nurse and Certified Doula Diana Spalding covers what to know about changes to your body and upcoming doctors appointments.

2.) What to know about Gestational Diabetes

Between weeks 24 and 28, your health care provider will likely request you get a Gestational Diabetes test. (If you are at higher risk, you might do the test sooner.) In Motherly’s Preparing for Your Second Trimester Class, Diana comprehensively explains what to know about the screening and Gestational Diabetes.

3.) What to know about pregnancy sex

As your body changes through pregnancy, there can be some new questions and concerns about intimacy. Although every person and every couple’s experiences will vary during pregnancy, this can be a very sensuous time. In Motherly’s Sex + Relationships During Pregnancy Class, you will get insight and support for your love life. 

4.) What is coming next

As you look toward the home stretch, it’s time to start thinking about your birth plan. Part of that is considering common possibilities, such as a cesarean birth. In Motherly’s Cesearan Births Class, Diana Spalding is joined by Ob-Gyn and Reproductive Endocrinologist Dr. Aimee Evyazzadeh to discuss c-sections.

What should I know about online pregnancy classes from Motherly?

The classes are self-paced

When you purchase a digital class from Motherly, it’s yours to watch, pause, rewind and rewatch as many times as you want. By having the freedom to use these classes on your own terms and own time, you can maximize what you learn—and feel more empowered in the process.

The content comes directly from experts

Our expert-driven, woman-centered classes allow you to learn from leading health, fitness and wellness professionals—no matter where you are located. 

You can discover what works for you

Every pregnancy experience is different. With a selection of classes to suit your goals and lifestyle, you can feel empowered to make the decisions that are right for you. Our classes provide expert guidance and support to help you feel confident.

We independently select and share the products we love—and may receive a commission if you choose to buy. You’ve got this.

But new research challenges this long-held belief. In a study of 8,352 pregnant women published in the Journal of Diabetes Investigation, results indicate that excessive weight gain during pregnancy is not a significant risk factor for developing gestational diabetes, regardless of your pre-pregnancy body mass index (BMI). 

This study took a unique perspective in that it looked at weight gain up until pregnant women took the oral glucose test used to screen for gestational diabetes. In previous studies examining the relationship between gestational diabetes and pregnancy weight gain, researchers typically looked at overall weight gain over the entire pregnancy—which may have contributed to a skewed picture of the cause-and-effect relationship. 

What is diabetes?

Diabetes is a condition in which your body can’t make enough insulin or use it effectively. Insulin is a hormone that helps sugar (glucose) in your blood enter your body’s cells so that it can be used as energy. When glucose cannot enter your cells, it builds up in your blood, leading to high blood sugar. 

While type 1 diabetes is an autoimmune disorder where you don’t make enough insulin, type 2 diabetes may occur when your cells stop responding to insulin, which results in insulin resistance and chronically elevated blood sugar levels.

What is gestational diabetes?

Gestational diabetes can develop in pregnancy in women who did not already have diabetes before becoming pregnant. It’s a condition in which your body can’t make enough insulin to meet your needs. 

When you’re pregnant, glucose becomes the baby’s primary source of food, which alters how your body handles both glucose and insulin. As the placenta grows, it creates more hormones to support the pregnancy—but these hormones also have a simultaneous anti-insulin effect. All pregnant women have some level of insulin resistance in late pregnancy, and some women may already have diabetes or be mildly insulin resistant before getting pregnant. 

Diabetes of any type can damage your blood vessels, nerves, eyes, kidneys, and heart. When you are pregnant, gestational diabetes can also cause high blood pressure, preeclampsia, birth defects, babies with large birth weight and complications that can result in preterm birth, or the likelihood of needing a C-section.

The relationship between gestational diabetes and pregnancy weight gain

For decades, experts pointed to a correlation between excessive weight gain in pregnancy and the onset of gestational diabetes, but this retrospective study may suggest otherwise.

For the purposes of the study, excessive weight gain is defined as weight gain above the 90th percentile of women in the same BMI category before and during pregnancy, or exceeding the upper range of the pregnancy weight gain guidelines from the Institute of Medicine.

The study’s authors found that the 1,129 women in the study who did develop gestational diabetes gained less weight than women who did not develop diabetes, even when they started out with a higher prepregnancy BMI. Additionally, there were no differences in weight gain during their first trimester and before their gestational diabetes screening. 

“The amount of gestational weight gain in the first trimester and before gestational diabetes screening did not change the risk of developing gestational diabetes,” wrote Tai-Ho Hung, MD, PhD, director of maternal fetal medicine in the department of obstetrics and gynecology at Taipei Chang Gung Memorial Hospital and colleagues in the study. However, the researchers state that excessive gestational weight gain may still be correlated with other pregnancy complications, such as pre-eclampsia.

The researchers also stated that further studies of gestational diabetes are needed to confirm their findings.

Gaining weight during pregnancy is healthy and normal

Gaining weight during pregnancy—even a significant amount of weight—is a normal and healthy part of the process.

Factors that may contribute to pregnancy weight gain include:

• The development of the baby and the placenta
• An increase in maternal blood volume and extracellular fluid
• Growth of the pregnant uterus 
• Enlargement of the mother’s breasts  
• An increase in maternal fat stores 

As always, it is best to follow through with your healthcare provider’s recommendations and to get regular physicals, even after pregnancy.

Between 2% and 10% of mothers develop gestational diabetes during pregnancy. A mama with gestational diabetes during one pregnancy is more likely to have it again during a future pregnancy—or go on to develop another type of diabetes after pregnancy. The American Diabetes Association recommends that women with a history of gestational diabetes should have lifelong screening for the development of type 1 and type 2 at least every 3 years. 

Kaisu Luiro-Helve, MD, PhD, at the University of Helsinki in Finland explained at the European Congress of Endocrinology that, “Type 1 diabetes is not just a disease of the young. Type 1 usually occurs within 10 years of gestational diabetes, and that is the time when we need to stay alert and perhaps conduct another oral glucose tolerance test. Do not forget about these women after delivery.”

Sources:

Chuang YC, et al. The association between weight gain at different stages of pregnancy and risk of gestational diabetes mellitus. Journal of Diabetes Investigation. 20 Aug 2021; doi:10.1111/jdi.13648

Luiro-Helve K, et al. Abstract #1479. Presented at European Congress of Endocrinology; May 22-26, 2021 (virtual meeting).

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It turns out that in addition to being a cute little “hello!” from your little one, baby kicks serve a very important purpose in fetal development.

The fascinating science behind those adorable baby kicks

Researchers have proven you aren’t just unsteady on your feet: Those little baby kicks really are incredibly forceful.

According to a report published in the Journal of the Royal Society Interface, researchers from the Imperial College London were able to determine how strong fetus’ kicks are by modeling the movements captured with imaging technology.

Using this original process, they found fetuses kick with up to 6.5 lbs. of force at just 20 weeks gestation—meaning those little legs you see on the anatomy ultrasound are strong enough to give a ball a good kick!

10 weeks later, the babies hit their peak gestational fitness with up to 10.5 lbs. of force in their leg movements. Although babies do keep getting stronger from there, they start running out of space. By 35 weeks, the force drops off again to 3.8 lbs.

“This increasing trend with gestational age is important because changes in fetal movement patterns in late pregnancy have been linked to poor fetal outcomes and musculoskeletal malformations,” the researchers say in their conclusion, adding they hope that confirming this link will inspire “future research in tissue engineering and mechanobiology.”

Not only are those kicks strong, but they are purposeful: Those little exercises are helping babies develop their neuromuscular systems to prepare them for the outside world. (Even if they can’t hold their head up at birth.)

In the earlier days of moving and grooving, Niamh Nowlan, a bioengineer at Imperial College London, says the movements are likely just reflexes rather than actions ordered by the baby’s brain. But as the weeks go on, babies begin to get deliberate about when, why and how they move.

“The baby needs to move [in the womb] to be healthy after birth, particularly for their bones and joints,” Nowlan tells Live Science, explaining fetal movement is linked to lower rates of congenital disorders such as shortened joints and thin bones.

Fetal kicks are a sign of health

On your end, the kicks and jabs are also good signs that the baby is doing well in there, which is why many prenatal health practitioners recommend tracking your baby’s kicks once a day. However, from her experience with her own two babies, Nowlan says the actual sensation of a baby kicking can differ from pregnancy to pregnancy.

“I could always tell where my son’s feet were, whereas that wasn’t really the case for my first,” she explains. Because the feeling can vary for a variety of reasons, Nowlan and her team are conducting research on a wearable fetal movement monitor that they developed, which could bring peace of mind to expectant parents.

Today those not-so-little kicks may be keeping you up at night, but soon enough they will be supporting a crawling, walking and running kiddo—so that pre-season training goes a long way.

This post was originally published on February 15, 2018. It has been updated.

Getting ready for your little one’s big debut? Check out some of our favorite new mama must-haves in the Motherly Shop!

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Fast-forward a few years to when I created a baby registry before the birth of my first child—and I found the experience to have a much steeper learning curve. Unlike those sheets, it felt like a bad swaddle or bassinet selection would be catastrophic. Unsure of what to expect from motherhood or my baby, I leaned heavily on advice from friends who already ventured into parenthood. (Starting with their reminders to take deep breaths!)

Now a mom of three little ones under the age of four, I’m happy to be in a position to pass along some wisdom (and products to go along with it) to help other mamas-to-be crack the code of what to put on a baby registry.

Go shopping with a veteran parent

My husband and I barely knew the difference between a bouncer and a swing as first-time parents, let alone what specific features we would want. So when a mom friend recommended we head to Target to build my registry together—because she found them to carry the trendy brands she loved AND make registering a breeze during her pregnancy—I leaped at the chance.

By walking through the aisles together and actually getting to see the products, I was much more confident in my registry selections. Thanks to that quick, in-store tutorial from my friend, I understood exactly how to match a perfect infant car seat with a base and stroller—which is something I would have been clueless about on my own. (Another great option is signing up with a service like Babylist, so you can add products from any store—even Etsy!)

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1. Chicco Bravo Trio travel system

It’s easy to plunk down some serious cash on the essentials—but you don’t necessarily have to. Chicco’s best-selling travel system, the Bravo Trio (which includes the #1-rated Chicco KeyFit 30 infant car seat) has all the features you need, like a smart fold close, easy-to-install base and UPF protection, at a really reasonable price.

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Include items at a variety of price points

When it comes down to it, a registry is really a wish list. So, while I had a personal budget for a stroller if it had to come out of my own pocket, this was an opportunity for me to ask for the stroller of my dreams. And, wouldn’t you know it? A few family members went in on it together, which made a bigger price tag much more manageable.

At the same time, it’s nice to include some of the smaller ticket items that are absolutely essential. I can’t even begin to tell you how grateful I was to skip buying my own diapers for those first few weeks. (With super cute patterns, these are also surprisingly fun to give, too!)

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1. Joolz Hub+ stroller

When it comes to dream strollers, this one is a worthy consideration. Slim and agile without compromising your little one’s comfort, the Joolz Hub+ stroller was designed with city living in mind. It features a one-hand steering function so you can maneuver through everything from narrow bodega aisles to busy streets and folds compact for easy storage. Added features you’ll love include an easy-to-use 5-point buckle, rotatable bumper bar and oversized shopping basket for those errands.

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4. Babyganics essentials gift set

Baby care products are another great low price point inclusion. This gift set from tried-and-true favorites, Babyganics, includes all the (organic!) essentials for keeping your little one fresh and clean.

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5. Aden + Anais Muslin Swaddle Blanket Set

What does a new mama want most of all? Sleep. Sure, babies sleep a lot throughout the night and day, but they’re light sleepers, which often results in interrupted sleep for both you and baby. So what’s an under-slept mama to do? Swaddle. These super-soft muslin swaddles are breathable and cozy and last well beyond the swaddling days.

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Think about the gifts you would like to give

The first time I bought a mom-to-be a gift after my own child was born, I knew immediately what to look for on her registry: a diaper bag backpack, which I had come to have very strong opinions about after battling falling straps with my first diaper bag. This allowed me to feel like I had a personal touch in my gift, even if I brought one pre-selected by her.

I also appreciate it when my friends clearly incorporate their style into their registry choices, like with adorable baby outfits or nursery decor—and there’s no sweeter “thank you” than a picture from a friend showing your gift in use.

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1. Petunia Pickle Bottom diaper bag backpack

This super-stylish diaper bag from perennial favorite Petunia Pickle Bottom keeps everything (and we mean EVERYTHING) organized and easy-to-access whether you’re just heading out for a day of errands or a long-distance road trip adventure. And if you really want to up your game, PPB’s inter-mix kits provide separate structured organizers that fit perfectly.

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2. Tea Collection Outfit

With their gorgeous prints and top-notch quality, Tea Collection clothes are a go-to for gifting and for our own babies. They hold up wash after wash and make every single moment feel particularly photographable. Prices start at $28.

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3. Wooden tile letterboard

This one pulls double duty as fab wall decor and insta-worthy photo prop.

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Ask for things to grow with your child

Even though it’s called a baby registry, there’s no need to limit yourself to gifts to use before their first birthday. (To this day, I still have people who attended my baby shower to thank for the convertible bed that my oldest child sleeps in!) Knowing that I would have included more options with long lifespans into my registry—namely, a baby carrier that can be used during the newborn months, baby months and well into the toddler years. A well-designed baby carrier would have saved my back from serious pain because it would have allowed me to comfortably and ergonomically carry my toddler as she made her way into the 25lb+ club.

One brand that’s designed to grow with your baby and accommodates 7-45 pounds (up to about four years old) and offers both inward and forward-facing positions is Ergobaby. With several different design and style options, you can easily find one that caters to your parenting needs. Like the Omni 360, an all-in-one carrier that grows with baby from the newborn stages into the toddler years, or a newborn-specific carrier, like the Embrace. The best part? All ergonomic designs are supportive and comfortable for both baby and parent, offering extra lumbar support with breathable, lightweight mesh styles. Everyone (even grandparents!) can get a kick out of babywearing, which is a nice and welcomed break for parents. Having one of these on my registry would have certainly made those first few years so much easier.

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1. Ergobaby Omni 360 cool air mesh baby carrier

Carry them inward, outward, front or back with the Omni 360. It’s also constructed of lightweight and breathable mesh to keep you both cool, even in warmer temps.

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According to the American College of Obstetricians and Gynecologists (ACOG), exercising while pregnant increases the likelihood of a vaginal delivery while lowering your risk of negative side effects like excessive gestational weight gain, gestational diabetes and hypertensive disorders.

As your navigate all the changes over the next 10 months, exercise can help you get back to your body. Try these simple, safe and effective exercises for every trimester.

First-trimester pregnancy exercises

Squats

As an exercise that targets your glutes, quads, and hamstrings, squats are great to start in your first trimester—and keep doing throughout your pregnancy. Squatting during labor expands your pelvic outlet, allowing more room for your baby to descend.

To start, stand in front of a couch or chair, or use a wall if you feel comfortable and balanced. Keep your knees shoulder-width apart and try to squat down until your knees reach a 90-degree angle before slowly righting yourself again, focusing your attention on your glutes and legs. Repeat 10-15 times per set.

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Bicep curls

Babies might not seem heavy, but when you’re holding them for hours at a time, it takes a surprising amount of arm strength. In order to build that muscle now and avoid soreness later, use bicep curls to tone your arms.

Grab dumbbells you can comfortably hold for multiple reps (somewhere in the 3 to 5 lbs range). Stand with your feet slightly wider than your hips with your knees slightly bent.

Take a few seconds to bring the dumbbells toward your shoulders as you bend your elbows, then slowly lower the weights again. Repeat 10 to 15 times and build up to multiple sets per day.

Melting heart pose

The first trimester tends to be a rollercoaster for many, with symptoms such as headaches and round-the-clock nausea that can make you feel exhausted. To counteract this, look for yoga positions that emphasize relaxation, such as corpse pose, bridge pose, or melting heart pose.

To practice melting heart pose, or Anahatasana, get on your hands and knees, then walk your hands forward until your arms are almost fully outstretched while keeping your chin tilted up. Try to push your heart close to the floor as you keep your hips above your knees. You can place a yoga block on the ground under your forehead and rest your head there if it’s comfortable. Breathe, holding the pose for three to five minutes.

Second-trimester pregnancy exercises

Bird-dog

With the arrival of the second trimester, you’re likely to develop increased back pain as your baby begins to grow. Good posture will help to alleviate back aches—and you can work on strengthening your core with an exercise called bird-dog.

While on your hands and knees, slowly extend your left leg while stretching out your right arm and holding for several seconds when you’re fully extended. Engage your core and continue to breathe. Alternate between your opposite arm and legs and try for 15 reps.

Bridge pose

The middle of your pregnancy is really when stretching and strengthening exercises start to become more important as you begin to gain weight, shift your center of gravity and probably develop some soreness as your muscles become more stretched out.

One especially helpful pose is bridge pose. To do bridge pose, lie down on your back with your knees bent and feet flat on the floor. You may need to place a folded blanket under your shoulders for comfort. Then, walk your heels in toward your hips until your hands can touch the back of them (or even just get close). Push your tailbone toward the pubis and lift your buttocks off the floor while keeping your thighs and inner feet parallel. Lengthen the tailbone and lift your chin away from the sternum. Firm your outer arms and broaden your shoulder blades to hold the pose for 30 to 60 seconds.

Pilé squats

The pilé squat is similar to a normal squat, but it is done with more of a rotation that strengthens your quadriceps, hamstrings, and butt while improving your balance.

To do a pilé, stand next to the back of a kitchen chair with your hand resting upon the chair. Your feet should be parallel and hip-distance apart. Pull your belly button up and in while keeping your toes and knees turned out to about 45 degrees. Bend your knees, lowering your torso while keeping your back as straight as if you were against a wall.

Third-trimester pregnancy exercises

Curl and lift

Think bicep curls, but with more sitting to help ward off that third trimester fatigue.

To do a curl and lift, sit on a sturdy chair with your feet on the floor and your back straight. Start with your arms straight down at your sides and hold a weight in each hand with your palms turned toward your body.

Then, bend your elbows to form a 90-degree angle and lift the weights to shoulder height. To release, slowly lower your arms to your sides before returning to the starting position. Repeat for 15 reps.

Supported V-sits

To do a supported V-sit, you’ll need a balance trainer since you might not be able to do the position without assistance.

Lean your back against the balance trainer with feet flat on the floor and your arms extended in front of you. Begin by lifting one foot off the floor until it’s parallel with the floor. Hold it in that position for several seconds before returning to the starting position. Work up to 10 repetitions and then alternate your legs to build strength on both sides.

Standard wall push-up

During the third trimester, aim to focus on low-weight or bodyweight-only strength exercises. A standard wall push-up allows you to control your balance more easily and is adjustable to your strength level.

To begin, start with your feet and legs together as you face a wall. To adjust the strength needed for the wall push up, adjust the distance between you and the wall. (The closer you are, the easier it will be!) Your palms will lay flat against the wall at about shoulder level.

Then, you can bend your elbows as you lean your body towards the wall. Keep your back straight as you lower yourself and then push back into the starting position. Aim for 10 to 15 reps.

Exercises to avoid in pregnancy

Although you should always speak with your doctor about your exercise plan, ACOG has cited walking, stationary cycling, aerobic exercises, dancing, stretching, water aerobics, and resistance exercises during pregnancy as extensively studied and found to be both safe and beneficial.

It’s important to note that any exercises you’ll be doing should only be making you feel good. If you’re experiencing dizziness or pain in places such as your abdomen, chest, or head, stop your exercise and contact your doctor. You should avoid any exercise that causes trauma to the abdomen, any exercise that keeps you lying on your back for too long, and any exercise that can easily cause you to lose your balance. Additionally, pregnant people should not scuba dive as the fetus’s pulmonary circulation cannot filter bubble formation.

And if you didn’t exercise before pregnancy, it’s not too late to start. Just make sure you ease into it and don’t push yourself too hard. Pregnant people should stay well hydrated, wear loose-fitting clothing, and avoid high heat and humidity.

Check out some of our favorite products to make your pregnancy + pregnancy workouts just a little more comfortable!

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Ollie Gray Maternity Sneaker

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3. Ollie Gray Maternity

A pregnant person’s relationship with shoes can be a tricky one. Between swelling and the shifts and changes that occur as your feet support more weight, your go-to sneakers may no longer fit the bill. That said, there are very few sneakers that were specifically designed with pregnancy in mind. Until now! Ollie Gray, masters of the maternity and nursing bra recently launched a maternity sneaker that is a legit game changer. Every need has been considered and addressed with: flexibility that adapts as your feet change, breathability because hello! everything is HOT when you’re pregnant, a Vibram sole for gold-standard support and a pull-on style that’s as fresh as it is functional.

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We independently select and share the products we love—and may receive a commission if you choose to buy. You’ve got this.