Before Pregnancy
Which tests should be done before pregnancy?
Pregnancy is actually one of the periods when a woman should be the healthiest. The expectant mother should not forget that she has a great responsibility for the health of the baby she carries in her womb. For this reason, it is important for a woman to conceive when she is physically and mentally the healthiest by planning and doing preliminary tests.
The tests I recommend before pregnancy in my clinic:
1- A detailed gynecological examination:
PAP Smear Test and HPV Test during gynecological examination
Transvaginal ultrasonography to evaluate the uterus and ovaries (uterus and ovaries). Evaluation of the uterine bed (medically called endometrium) in the uterus where the baby will settle in the uterus, evaluation of whether there is a fibroid or a different mass in the uterus, evaluation of whether there are cysts or masses in the ovaries, evaluation of the number of eggs and reserves in the ovaries provides information about whether it will be easy to conceive in the pre-pregnancy examination.
We see our patients who are planning pregnancy on certain days of menstruation and perform ovulation follow-up (determination of the most suitable days for pregnancy by ultrasonography).
2 - Blood tests to screen the general health of the expectant mother:
Hormone tests on the 2nd or 3rd day of menstruation and AMH test give information about fertility capacity.
SMA TEST: If not done at the time of marriage, an SMA test should be performed on one of the couples.
TORCH Infection Screening: TORCH is the abbreviation for Toxoplasma-Rubella-CMV-Herpes infections. If these infections occur during pregnancy, they can cause congenital anomalies in the fetus. If these infections are screened before pregnancy, some measures such as vaccination are taken to prevent such infections.
Replacing vitamin and iron deficiencies by checking hemogram, iron, ferritin, calcium, Vit B12, Vit D3 values.
Pre-pregnancy diabetes screening by checking blood glucose and Hga1c (3-month sugar average) values
Genetic Tests: If there is a disease known to be carried genetically in the family of one of the couples, chromosome or gene tests should be performed to determine whether the couple carries that disease.
Folic Acid Supplementation: Women planning pregnancy are recommended to take 400 mcg folic acid daily.
Women with a previous history of pregnancy with Neural Tube Defect are recommended 4-5 mg folic acid.
Coagulation Tests: Coagulation tests are not routinely requested from every pregnant woman. They may be requested from expectant mothers who have had 2-3 previous miscarriages or who are genetically carriers of a hematologic disease.
When should the SMA test be done?
SMA tests should be performed before planning a pregnancy. SMA is an autosomal recessive genetic disease. In order for the baby to be born with the disease, both mother and father must have positive SMA carrier genes. For this reason, it is sufficient to be performed on one of the couples. If one of the couple is positive, the other one should also be tested.
I got pregnant before I could be tested for SMA; what can I do?
One of the couple can be tested for SMA quickly. Continue the pregnancy. Routine pregnancy tests are requested. The test result can be obtained within 3 weeks, but there are also tests that can be obtained in 1-2 days. If the test result is negative, there is no need to do anything additional. If the test result is positive, the expectant mother is also tested immediately. If the test result is negative in the mother, there is no problem. If both couples have SMA Carriage, it can be screened whether there is SMA gene carriage in the genetic structure of the baby by scanning the mother's blood without harming the baby with tests we call Fetal Dna Analysis.
When are screening tests performed during pregnancy?
1- Dual Screening Test
The first screening test is the dual screening test between 11-14 weeks.
In the double screening test, first an evaluation is made by ultrasonography. The baby's HEAD_POPO distance (CRL measurement), nasal bone and nuchal translucency (nuchal translucency; nt) are measured. On the same day, 1 tube of blood is taken from the mother and PAPP A and BHCG hormone values are checked in the blood. All these values are put into a statistical program and a risk assessment is made in terms of the presence of diseases such as Trisomy 21/Trisomy 13/18 for the baby. The double screening test is not a diagnostic test. A risky result is not an indication that the baby has a disease. Values of 1/250 and below are considered as a risky group; diagnostic tests are requested. Definitive diagnostic tests; chorionic villus sampling, amniocentesis and cordocentesis
2- Triple Screening Test
It is performed between 16-20 weeks. On the day of the test, biometric measurements of the baby are made by ultrasonography. On the same day, BHCG, Alpha fetoprotein, estriol values are checked in the blood sample taken from the mother. All measurements and blood values are evaluated in a statistical program; Trisomy 21 Trisomy 13/18, Neural Tube Defect diseases are evaluated whether there is a risk in terms of risk. The cut-off value is 1/250 and below and is considered as a risk group. The triple screening test is not a diagnostic test. If the test is in the risky range, it does not mean that the baby carries the disease. For definitive diagnosis, amniocentesis or cordocentesis can be performed depending on the gestational week.
3-Tetriple Screening Test
It is performed between 16-20 weeks. On the same day, biometric measurements of the baby are made by ultrasonography, BHCG; Inhibin, Alpha fetoprotein, estriol values are checked in the blood sample taken from the mother. All diseases screened in the triple screening test can also be screened with the quadruple screening test. In recent years, it has replaced the triple screening test because of its higher reliability. As with other screening tests, the quad screening test is not a diagnostic test. In case of risky results, diagnostic tests such as amniocentesis or cordocentesis should be performed.
4-NIPT TEST (Fetal DNA Analysis)
From the beginning of pregnancy, fetal cells are detected in the mother's blood. The number of cells detected increases over the weeks. In fetal DNA analysis, the presence of common genetic diseases (Trisomy 21, Trisomy 18, Trisomy 13 and genetic diseases related to sex chromosomes) is tried to be detected in these cells by examining the cells of the baby in the blood sample taken from the mother from the 9th week.
Compared to other screening tests, it has the highest reliability.
The test is completed in 10-14 days. It allows sex to be determined in the early weeks. NIPT tests can be performed in the USA and European countries and these tests are now being performed in genetic laboratories in Istanbul and Ankara.
Why wait for the 9th week for NIPT (Fetal DNA Analysis) test?
In order for the accuracy and reliability of the tests to be high, the number of cells belonging to the baby passing into the mother's blood must reach a certain rate. That is why these tests are performed starting from the 9th week.
Should a pregnant woman who has had a dual screening test have a triple or quadruple test?
Double, triple and quadruple screening tests are tests that are performed at different weeks but screen for the same diseases. The alpha fetoprotein value checked in triple and quadruple screening tests also screens for neural tube defects. However, Neural Tube Defects can also be diagnosed by ultrasonography.
Can a urine test be negative for pregnancy and a blood test be positive?
Screening for pregnancy with a urine test is not always the most reliable method. BHCG in the blood allows the pregnancy to be detected before the gestational sac can be seen by ultrasonography.
The most reliable test is always a blood test for BHCG.
While the urine test is faintly positive, the blood test may be negative and pregnancy may not be present.
At which week is the sugar loading test performed? Is it done for everyone?
As of the 24th week of pregnancy, insulin resistance increases in every pregnant woman. For this reason, Sugar Loading test is recommended for every pregnant woman for screening purposes.
Pregnant women who have been diagnosed with diabetes before pregnancy or who have been diagnosed with diabetes in tests at the beginning of pregnancy do not need to do a loading test again at 24 weeks.
When can the heartbeat and sac be seen?
Depending on the characteristics of the ultrasonography device used, the detection of the baby's heartbeat may vary. With transvaginal ultrasonography, the heartbeat can be clearly observed around 5 weeks 5 days 6 weeks.
What is the BHCG value when pregnancy can be seen by ultrasonography?
It is possible to see the gestational sac on ultrasonography when the BHCG value is between 1500-2000
What is Organ Screening in Pregnancy? How many weeks into pregnancy and what is it for?
Organ scanning during pregnancy is medically referred to as second level ultrasonography. It is an ultrasonography in which the baby's organs and limbs are evaluated in detail, starting from the head to the toes. The baby is examined for any organ abnormalities.
It is performed between 18-22 weeks when the development of the baby's organs is completed.
Who should undergo genetic testing?
Genetic tests during pregnancy are divided into invasive and non-invasive tests.
Non-invasive testing is fetal DNA analysis that does not harm the fetus and mother. It can be done to anyone who wants. It is a more reliable test than double, triple and quadruple screening tests. By detecting the cells of the baby in the mother's blood, it is determined whether those cells carry genetic diseases.
Invasive tests are amniocentesis, in which the amniotic fluid is sampled by inserting a thin needle into the gestational sac in the womb, or cordocentesis or chorionic villus sampling, in which the cord blood is sampled. These tests carry a 1-2% risk of miscarriage as they interfere with the integrity of the sac through a needle.
In which weeks of pregnancy can intercourse occur?
Sexual intercourse is not prohibited from the beginning of pregnancy until the last month, unless there are risky situations such as miscarriage threat & placenta previa (placement of the baby's partner close to the cervix).
Does nausea and vomiting occur in every pregnancy? If so, at what week does it go away?
Yes, nausea and vomiting are quite common during pregnancy.
In English, it is also called 'Morning Sickness' or 'morning sickness', but it can occur at any time of the day.
It is most common in the first trimester of pregnancy, i.e. the first 12 weeks.
It starts especially around 5-6 weeks. It reaches its most severe state between 8-12 weeks when BHCG, the pregnancy hormone, reaches its peak. It draws a plateau between 12-16 weeks. During this period, 2-3 days may be nausea-free and very good; but the other days may be very nauseous again. Usually. By the 16th week, the nausea is gone. However, for some women it may continue until the end of the pregnancy.
Nausea and vomiting are associated with an increase in hormones such as estrogen and progesterone during pregnancy. The second trimester is usually a time when these symptoms ease and decrease. For women who experienced severe nausea and vomiting in the first trimester, these symptoms
usually subside between 16 and 20 weeks of pregnancy.
However, every woman's experience is different and for some, these symptoms may persist throughout the pregnancy. In such cases, medical treatments are available to relieve nausea and prevent vomiting.
Usually nausea is triggered by the consumption of liquid and watery foods. Pregnant women with this complaint are therefore advised to eat solid, dry foods
Are tetanus and pertussis vaccines given during pregnancy? How many doses should be given and when?
Yes, tetanus and pertussis vaccines can be given during pregnancy. These vaccines boost the mother's immune system during pregnancy to help the baby become immune in the first few months after birth. This ensures that some antibodies are passed to the baby before the baby is born and so helps protect the baby in the first months of its life.
Tetanus vaccine (TT) and pertussis vaccine (dTpa) are usually given between 27 and 36 weeks of pregnancy. Both vaccines are usually given in a single injection.
For pregnant women who have not already received their primary dose or have not completed their missed dose, a primary vaccination program is administered. This usually includes 2 doses of TT for tetanus vaccine and 1 dose of dTpa for pertussis vaccine. Those with a complete history of previous tetanus vaccination usually receive a single dose of dTpa between 27 and 36 weeks of gestation.
However, each pregnancy and vaccination schedule is individual and your doctor should recommend the most appropriate vaccination schedule for you. In particular, a different schedule may be used at other times of pregnancy or depending on your health condition.
The general practice of the Ministry of Health in our country is to administer 2 doses of tetanus vaccine during pregnancy. However, ACOG (American Association of Obstetricians and Gynecologists) has switched the 2nd dose vaccine to pertussis vaccination at 27 weeks. The administration of pertussis vaccine during pregnancy provides protection against zaturee disease in the newborn period. In our clinic, 2nd dose vaccination is administered to pregnant women who wish to receive pertussis vaccine.
How is Rh incompatibility detected during pregnancy and what should be done afterwards?
Rh incompatibility in pregnancy is a condition caused by RH factor differences between mother and baby. To detect Rh incompatibility, the Rh factor in the mother's blood is checked during pregnancy. If the mother is Rh-negative and the baby's father is Rh-positive, the baby is likely to be Rh-positive. In this case, antibody levels in the mother's blood are monitored.
If the mother is Rh negative and her baby is Rh positive, there is a risk of Rh incompatibility between mother and baby. This can cause the mother to produce antibodies against Rh-positive antigens in her blood, which can jeopardize the health of the next baby to be born. If the mother is Rh negative and the baby is confirmed to be Rh positive, this involves the mother taking an antibody called Rh immunoglobulin (RhIG) at certain times of pregnancy. This medicine helps prevent a possible reaction to the baby's Rh-positive cells in the mother's blood.
It is important for a woman with Rh incompatibility to have indirect coombs tests before and during each pregnancy and to take appropriate precautions. In this way, the health of the baby can be protected and pregnancy complications can be prevented
Can I have a pet during pregnancy?
Having a pet is usually not a problem during pregnancy, but it is important to take some precautions. There are some special cases, especially with cats:
1. Cat feces and Toxoplasmosis: The Toxoplasma parasite found in cat feces can cause infection during pregnancy and can harm the baby. It is therefore important to change the litter regularly and avoid direct contact with cat feces. You can also get toxoplasma from poorly washed greens and poorly cooked meat contaminated with cat feces.
2. Cat scratching: Cat scratching can increase the risk of infection. If you are scratched during pregnancy, it is important to clean the wound immediately and seek medical advice.
3. Pet Cleaning and Care: It is important to take pets to the vet regularly, keep them up to date with vaccinations, and keep them clean.
4. Other Pets: There are no special risks associated with dogs or other pets, but it is still important to pay attention to hygiene and care.
It is important to remember that keeping a pet during pregnancy can be enjoyable and healthy. However, it's also important to take precautions and take steps to reduce the risks. Therefore, if you have concerns about your pet during pregnancy, it is advisable to consult a doctor or veterinarian.
What is the ideal diet during pregnancy?
A healthy and balanced diet during pregnancy is extremely important to meet the needs of mother and baby. An ideal pregnancy nutrition plan is based on the following basic principles:
1. Variety and Balanced Nutrition: It is important to get enough of each food group. Create a diet rich in protein, carbohydrates, healthy fats, vitamins and minerals. Make sure to eat fruits, vegetables, whole grains, protein sources (e.g. chicken, fish, eggs, legumes) and healthy fats (e.g. olive oil, avocado).
2. Folic acid and iron supplements: Folic acid supplementation is recommended before and during pregnancy. In addition, the body's need for extra iron increases during pregnancy, so iron supplements may be recommended by the doctor.
3. Calcium and Vitamin D: Calcium and vitamin D are important for the baby's bone health. It is important to consume dairy products, green leafy vegetables and foods rich in vitamin D.
4. Fluid Intake: It is important to drink more water during pregnancy. Try to drink at least 8-10 glasses of water a day. Also, other sources of fluids such as fruit juices, milk, freshly squeezed fruit juices can be beneficial.
5. Avoid Prepared Foods: It is important to choose fresh, natural and healthy foods instead of processed or prepared foods. Avoid refined sugars, excess salt and processed fats.
6. Limit Caffeine and Alcohol Consumption: Limit caffeine intake and avoid alcohol if possible.
7. Communicate with your doctor or nutritionist: Keep in regular contact with your doctor or a nutritionist during pregnancy. This way, you can create an appropriate nutrition plan and meet your needs.
Can laser botox applications be performed during pregnancy?
It is generally not recommended to perform cosmetic applications such as laser and botox during pregnancy. There is not enough information about the safety and effects of such applications and there may be some risks.
1. Laser Applications: There is insufficient information about the effects of laser applications on the baby during pregnancy. The effect of laser on tissues under the skin and blood circulation is unknown.
Therefore, it is generally recommended to avoid laser applications during pregnancy.
2. Botox Injections: Botox contains a substance called botulinum toxin and reduces wrinkles by temporarily paralyzing muscles. However, there is not enough information about the effects of using this substance during pregnancy on the baby. Therefore, it is recommended to avoid Botox injections during pregnancy.
Also, hormone changes in the body during pregnancy can cause some changes in the skin, and these changes may be naturally reversible. Therefore, it is important to consult your doctor before undergoing cosmetic interventions.
It is important to consult your doctor for information about cosmetic procedures that may be safe and effective during pregnancy. In general, it is recommended to avoid cosmetic interventions during pregnancy and to be cautious so as not to put the baby's health at risk.
What should be the ideal weight gain during pregnancy?
Ideal weight gain during pregnancy is important for the health of mother and baby. However, the ideal weight gain is different for each woman and depends on factors such as pre-pregnancy body mass index (BMI) and general health.
Weight gain during pregnancy as recommended by the American Pregnancy Association is generally as follows:
Women with Normal BMI:
o Normal BMI (18.5 to 24.9): Weight gain of about 11.5 to 16 kg (25 to 35 pounds) is recommended.
o First trimester: Approximately 1.1 to 1.4 kg (1 to 3 pounds)
o Intake of about 0.5 kg (1 pound) per week
o Most weight gain during pregnancy occurs in the second and third trimesters.
2. Women with a Reduced BMI (BMI < 18.5):
o Weight gain of about 12.5 to 18 kg (28 to 40 pounds) is recommended.
3. Women with High BMI (BMI > 25):
o Weight gain of approximately 7 to 11.5 kg (15 to 25 pounds) is recommended.
4. Women with Very High BMI (BMI > 30):
o Weight gain of approximately 5 to 9 kg (11 to 20 pounds) is recommended.
These recommendations are general guidelines and each woman's specific health status and weight gain needs during pregnancy may be different. Your doctor will monitor your pre-pregnancy health status and your weight gain during pregnancy and will set an appropriate weight gain goal for you.
Excessive weight gain or insufficient weight gain can lead to pregnancy complications and harm the health of the baby. Therefore, a balanced diet and regular exercise are important to achieve healthy weight gain goals during pregnancy.
