Devan Weathers was pulling into her office parking lot from a lunch break when she got the phone call from her doctor.
She was 20 weeks pregnant with her second child and had received two abnormal ultrasounds. Her doctor had said she would be a good candidate for a new test called "Harmony," one of the increasingly popular noninvasive prenatal screening tests to enter the market in the past two years.
With a simple blood draw, the test can detect certain chromosomal abnormalities in a fetus with startling accuracy and earlier in pregnancies than ever before. It was during that parking lot phone call that Weathers got her test results and learned her baby girl would have Down syndrome.
"It may not have even been a two-minute phone call," said Weathers, 32, who lives just outside of Lexington, Ky. "I hung up the phone and started crying in the parking lot at work, all by myself."
After getting her test results, Weathers was certain she wouldn't terminate her pregnancy, but she didn't entirely accept it, either -- and she had no guidance from the medical community to help her.
"Nobody offered anything. Nobody told me about any resources," said Weathers, who only received the services of a genetic counselor once she was in the delivery room. "I had to do all of that on my own."
She said she felt completely different during her second pregnancy than she did during her first. She never sang to her unborn daughter, the way she had with her son. She never talked to her. Some days, she wished the baby would just pass away on her own.
She admits she was in need of counseling. The added support may have helped her overcome these feelings.
"It has been nothing at all like I was portraying it to be and what I was expecting it to be," she said of her daughter's birth in January. "The love that has been poured out, it is truly overwhelming."
As "Harmony" and other noninvasive tests like "MaterniT21” and “Verifi” become the new norm in prenatal care, medical professionals and genetic counselors hope that women will get the guidance they need. But Weathers' experience highlights the challenges that come with the rapid implementation of a technology that is meant to be paired with education and information for parents, as well as sensitivity on the part of medical providers -- and often is not.
HOW IT WORKS -- AND HOW IT DOESN'T
Huge strides are being made in noninvasive prenatal screening tests to provide women with more information about the genetic makeup of their unborn babies early on in pregnancy. The growing body of information that will be made available to parents in the near future is going to be more nuanced and complicated, both medically and ethically.
As it stands, a mother who takes a noninvasive test -- in which fetal DNA from her blood is analyzed -- can find out if her baby has Trisomy 21, more commonly known as Down syndrome, or Trisomy 13 or 18, which are more severe and sometimes fatal. In recent months, however, the testing companies have started offering screenings for sex chromosomal abnormalities, including Turner syndrome and Klinefelter syndrome. In the not so distant future, the list might include Tay-Sachs disease, sickle cell anemia and DiGeorge syndrome.
Experts predict the tests will effectively become the new way expectant mothers first get the news that their baby has an abnormality. They provide women with key genetic information 10 weeks into a pregnancy -- two weeks before women are often advised it's safe to reveal their pregnancies to the world -- and have a near perfect accuracy rate, at around 99 percent for Down syndrome.
But the way the new tests have been rolled out for Down syndrome offers a snapshot of what parents might face as the tests get more sophisticated to screen for less familiar disorders and diseases, and as more women opt to take them.
Some experts caution that the tests are moving from the lab to the marketplace at a speed that is unprecedented, and too fast for the necessary counseling that should happen alongside the changes. They worry how effectively the medical community can communicate increasingly complex information with life-altering significance in an age when providers spend less time with patients than ever before.
"The physicians do a great job talking about the technical aspects of the test and signing them up. But when it comes to [the news that] your fetus has Down syndrome when the test is positive, nothing really has changed," said Brian Skotko, a medical geneticist at Massachusetts General Hospital and co-director of the MassGeneral Down Syndrome Program. "Doctors still don't feel trained or have an accurate understanding."
That's a problem, Skotko said, because the number of women who find out about Down syndrome and other genetic abnormalities prenatally is going to increase dramatically.
The genetic research firm Sequenom in California was the first to launch a noninvasive prenatal test with MaterniT21 in October 2011. It has since processed more than 100,000 results. Dirk van den Boom, the CTO of Sequenom, estimates it will process between 150,000 and 200,000 tests in 2013 alone.
Three other companies also headquartered in California -- Ariosa, Verinata and Natera -- subsequently entered the fray with similar tests, and they're all now jockeying to make their product the test of choice for medical providers and insurance companies. The tests cost around $200 with insurance, and close to $2,800 without. Frost & Sullivan, a research firm, estimates that the prenatal testing market will grow to $1.6 billion by 2017, up from $1.28 billion in 2010.
In December of 2012, the American College of Obstetricians and Gynecologists recommended that the tests can be offered to all women 35 and older, and women of any age who are considered "higher risk." But clinical trials are underway to look at how the tests perform in pregnant women of all ages, and the results could be completed as early as a year from now. Experts anticipate that doctors will soon recommend the tests as part of routine care.
Noninvasive prenatal testing comes with a host of benefits, but it's also a tool so powerful that it prompts a critical question for the medical profession: What is the right amount of information to give parents? If the answer is to provide them with everything that's scientifically available, then another question remains: Can doctors and specialists provide the necessary communication and support to explain to parents what the tests mean in terms of options, odds and next steps?
Before tests like MaterniT21, an expectant mother might not know her baby was at risk for Down syndrome until well into her second trimester. She might get blood work and a sonogram between 11 and 13 weeks to identify anatomic indicators such as neck measurements. Together, those tests provide odds: A woman's risk of carrying a Down syndrome baby might be presented as 1 in 1,000 or 1 in 33. But 5 percent of the time, she'd get a false positive and often wouldn't get conclusive results from an amniocentesis until 15 weeks, or later.
Because the new tests can be done at 10 weeks -- and Natera's "Panorama" test can be done at nine -- they grant women more time to make an educated decision on whether to continue the pregnancy, or to prepare medically and emotionally to raise a child different from the one they might have expected.
Despite the high accuracy rates of the new tests, doctors stress that they are screening tests rather than diagnostic ones -- an important distinction, they argue. They say they strongly encourage women with positive results to get them confirmed through an invasive procedure such as an amnio or chorionic villus sampling, commonly referred to as CVS.
The noninvasive tests do sometimes produce false positives and negatives, though it's rare when that happens. In clinical trials, the tests had a false positive rate of 0.5 percent or less. But much has been made recently about how the tests performed in trials versus how they are doing in actual doctors' offices.
In describing the accuracy rate, reproductive geneticist Lorraine Dugoff said that "in actuality, in clinical practice, we don't really know what it is."
Dugoff is hoping to start a registry of false positives so experts can learn more about what causes them. She co-authored a paper, published in March in the American Journal of Obstetrics & Gynecology, outlining eight such cases that occurred in less than a year at two medical centers that were using the tests frequently.
The following month, the American College of Medical Genetics and Genomics started recommending both pre- and post-test counseling from a prenatal care provider or genetic counselor so that people are aware of the tests' limitations.
Barbara Biesecker, director of the Genetic Counseling Training Program at Johns Hopkins Bloomberg School of Public Health, argued that some of the nuances of the noninvasive tests could be lost if the tests become routine.
"I'm very concerned because there will be less counseling involved," she said. "I think OB-GYNs will ultimately order it at the same time as they order other tests and people won't know what they've consented to."
More tests will also mean that pregnant women who don't necessarily need to worry about problems could receive abnormal test results earlier in their pregnancy.
"From an OB-GYN's standpoint, you wouldn't spend the time talking to a 23-year-old about Down syndrome because their chances are so low. But if you're going to screen everybody, you're going to find them," Biesecker said. "That's a hard thing to figure out how to do well."
Anne Drapkin Lyerly, a bioethicist and trained OB-GYN with the University of North Carolina at Chapel Hill, explained that amnios are typically done with a lot of face-to-face communication. Blood tests tend not to get deployed as carefully.
"I think some of the challenges that are faced are these questions of counseling," Lyerly said. "How much do you need to talk to somebody before they have a blood test?"
'I WAS NEVER EXPECTING ANYTHING'
A mother of two from the Philadelphia area, who declined to give her name for privacy reasons, took MaterniT21 in February in part to appease her husband's concern about her age -- she is 38 -- and to find out the sex of her baby. (Some of the tests offer an additional perk: the ability to reveal the sex of the baby earlier.)
"I was kind of excited that maybe we might find out the sex," she said. "I thought we could get them in an envelope and take them home. This is all I was thinking about."
The woman admits to only half-listening during the genetic counseling appointment that preceded the test. A week later, the test came back positive for Down syndrome.
"I'd just gotten out of the shower and was half dressed in my towel. I picked up the phone and the genetic counselor was on the phone," the woman recalled. "She said, 'Unfortunately, I have some bad news for you.' That completely surprised me. Again, I was never expecting anything."
The woman went in for an amnio that same day. The genetic counselor never brought up either terminating or what it might be like to raise a child with Down syndrome, she said. The counselor seemed to want to delay talking about options until the diagnosis was official, but the amnio results came back two weeks later and confirmed it.
The expectant mom wanted to dive in to do all of her own research, since she has a Ph.D. and access to medical journals.
"What I did look for online was the numerical breakdowns," she said, citing statistics on children with Down syndrome who have congenital heart defects and intestinal problems. "That was key information that I homed in on. It would have been nice if it had come from the medical community."
She and her husband decided they didn't want their two older children to be responsible for taking care of a disabled sibling after they were gone. They are lacking financial resources and don't have family nearby to help.
The woman terminated in February at 17 weeks. She said it was the most difficult time of her life and she is still grieving.
After reading the stories of other women on BabyCenter.com, a pregnancy website with forums for expectant mothers, she created a memory box for her son, whom she named August. Among the items are his footprints, inked on a sheet of paper.
Jen SaeOng, a 35-year-old mother of two from Redondo Beach, Calif., also ended up doing all of her own research on Down syndrome after she got a positive result with MaterniT21 in January 2012. The visit with a genetic counselor, she said, was a disappointment.
"I had questions about how do I find my resources now? What are the local organizations around here? Where will I be going for early intervention services?" SaeOng said. "I got zero answers. Every single question was, 'I don't know, I don't know, ask your OB-GYN.'"
The OB-GYN told SaeOng to ask her pediatrician, and the pediatrician told her to ask the genetic counselor. SaeOng turned to online support on BabyCenter.com forums and read blogs authored by parents of children with Down syndrome.
SaeOng is a strong supporter of noninvasive testing. She stressed that it's important for women to be able to prepare and get to a place where they're excited about their pregnancies, regardless of whether they're "normal." But her hope is that any increase in popularity of the testing is matched with sensitivity from those delivering the results, something she said she didn't experience.
"There was this kind of sadness about it all," SaeOng said. "I know it's not something people wish for, but I do wish the news was delivered with more hope, because I was terrified and there's a lot of unnecessary fear from what my experience actually turned out to be."
Six months into her pregnancy, SaeOng went in for an EKG with a new doctor and told him she'd known for weeks that her son had Down syndrome.
"He still, after knowing that, looked me right in the eye and said, 'And you're going to keep it?'" SaeOng said.
Heather Hicks, a 36-year-old mother of three from Springfield, Ore., had an entirely different experience. An hour after a positive result with MaterniT21, Hicks and her husband were sitting in the office of the genetic counselor who had administered the test.
"She had the facts in front of her," Hicks said. "She had a binder that she went through, page by page."
The counselor provided the name of a local support group and promised that she'd have a package of materials for the couple upon their next visit.
"I felt like she did a very professional job of presenting everything equally. We never felt like we were pushed into one option over another," Hicks said.
In April, Hicks gave birth to a baby boy who has Down syndrome. She's grateful she learned about her son's condition prenatally because it gave her time to grieve the loss of the child she thought she'd have, accept that he would be different, and arrive at a point emotionally where she couldn't wait to meet him.
But Hicks is not convinced that her experience is the norm.
"I have heard from a lot of people, especially on the BabyCenter group where people are from all over the nation. It seems like a lot of women haven't gotten real positive care," she said. "They've had doctors who felt they should have terminated or who felt like a higher standard of care isn't necessary because their baby isn't perfect."
THE INFORMATION VOID
Dr. Anthony Gregg, chief of Maternal Fetal Medicine at the University of Florida, said that the adoption of new technologies always comes with a learning curve. Noninvasive prenatal testing is no different.
Gregg is on the board of the American College of Medical Genetics and Genomics, which released its policy statement on noninvasive prenatal tests in April.
It outlines the tests' limitations and offers recommendations for how counseling should be approached before and after the tests. He argued the document would help to close gaps in the consistency of care.
"Providers were really receiving their education indirectly through media resources or indirectly through corporations with interest," Gregg said. "Now that that void is filled, I think you're going to see a very fast change in the slope of the curve in how this is deployed further. And I think it will be deployed with prenatal care providers having much more knowledge and information about this."
Representatives from all four testing companies said they are committed to ensuring medical professionals provide women with the right information about how the tests work.
"We have a very good medical affairs team which goes out and gives seminars and is properly educating the OB-GYNs about the test and the test capabilities," said Dirk van den Boom, chief technology officer of Sequenom.
Making sure that women know what the tests can and can't do is an important step on the path to effective care, but it's also only part of the equation, according to Brian Skotko, the geneticist with MassGeneral. Women who end up facing a Down syndrome diagnosis, Skotko said, have long confronted challenges in terms of the quality of guidance they receive.
"The problem has always existed. We're expecting the numbers to skyrocket in terms of the number of prenatal diagnoses made, so without any improvement, we are going to stress an already stressed system even more," Skotko said. "Unless doctors right now decide to figure out what the resources are, figure out how to develop a counseling infrastructure within their clinics, it's going to become even more chaotic."
IS MORE INFORMATION BETTER, OR IS IT JUST MORE?
Going forward, a woman getting her blood drawn for prenatal testing can expect to see a longer list of potential problems with her baby than just the Trisomies and the sex chromosome-based abnormalities.
One of the testing companies confirmed that it will be offering screening for certain subchromosomal abnormalities -- which occur when tiny pieces of DNA are missing or duplicated -- by the end of this year. The severity of these disorders varies and the symptoms of just one disorder can sometimes range from mild to debilitating. The same tests that look for Down syndrome will also eventually show the presence of certain single-gene defects in a few years' time, and probably sooner.
For some parents, knowing ahead of time that a child will have a medical issue will make them more prepared to line up specialists and early intervention services. For others, it might mean a difficult decision about whether to terminate for a medical reason they hadn't yet considered.
As the available technology becomes more sophisticated, what remains to be determined is how much parents will want to know about their unborn children and how much doctors should share with them.
Barbara Bernhardt is a genetic counselor with the University of Pennsylvania who has experience with what can happen when expectant mothers are given all the facts about their babies' DNA prenatally.
Bernhardt did a study in 2012 on women who had microarray analysis and learned about every genetic microdeletion and microduplication, not just the ones known to cause diseases. It was done through an amnio or CVS, and available to the women for free. She said the results of the study have her worried about the future of noninvasive testing.
"They were all jumping at the opportunity, like why would I refuse more information? More is always better," Bernhardt said. "When they got this uncertain information, they realized that might not always be true."
Understanding that a fragment of a gene is linked to schizophrenia in some adults, but means nothing in others, was too much. Most of the women and even some genetic counselors in the study were overwhelmed and ill-equipped to handle the information, Bernhardt said.
In 38 years of practicing, Bernhardt said she has never seen genetic technology move as fast as it has in the past five years, or be so driven by industry rather than academia. As the technology moves forward, she expects much of the responsibility for educating parents about noninvasive prenatal testing to fall on the genetic counseling community.
"I'm not sure we're going to be up to the task," she said. "If the volume is tremendous, there aren't enough counselors."
Dr. Gregg, with the ACGG, noted that for years doctors have been scanning for many of these abnormalities invasively. In that sense, the new test result offerings won't be new to doctors, they'll just be new for a growing number of parents who are expecting.
Representatives from all four of the testing companies confirmed that they plan to screen for a much greater variety of defects in the near future. They all effectively argue the same thing: Women have already been able to access this information by other means, but now the industry is just making it easier for them to get that information earlier, and in a safer way. Various factors, they also claim, will mitigate the speed at which the menu of offerings will grow.
Matt Rabinowitz, the CEO of Natera, said that when his company rolls out more sophisticated screenings, they will only test for the most common and severe abnormalities that are confirmed to cause a specific disorder. What doctors ask for will help to dictate the future of what's available.
"We want to target things that can be tested by an invasive procedure that have good clinical significance, things that people would want to be able to act on, not information that's just going to confuse people," he said.
Rabinowitz said his company believes genetic counseling is crucial if the new technology is to be rolled out into everyday medicine, adding that he has a large team of counselors on staff who even take calls from patients.
Vance Vanier, vice president of global commercial operations for Verinata, predicted that if the tests become routine, OB-GYNs will start referring women with positive test results to fetal medicine specialists, who deal with high-risk pregnancies and are comfortable doubling as genetic counselors.
As the industry collectively increases the number of conditions they screen for, though, one potential negative side effect is seeing the accuracy rates decline.
"We develop this innovative revolutionary technology to decrease the number of women who would have an anmio or CVS, and now as we add on to the tests, we increase the false positive rate and we're going in the wrong direction," said Tom Musci, vice president of clinical and medical affairs for Ariosa and a maternal fetal medicine specialist.
Musci estimated that since the industry started testing less common chromosomal abnormalities, the combined false positive rate may already be greater than 3 percent.
"I think this is very powerful stuff, but as we add more things onto the menu we need to ask ourselves, 'What are we looking for and why are we looking for it?'" Musci said. "The counseling burden, the education burden. All these things have to be taken into consideration as we add more things."
Ronald Wapner, a genetic researcher at Columbia University who conducts trials on noninvasive tests, said the medical community is debating how much education patients will need as the technology makes its way into the commercial space.
"Nobody should ever argue we shouldn't get new information," Wapner said. "It's how we use the information."
Wapner noted that the eventual goal of prenatal genetic detections is to be able to correct the abnormalities in the womb. Until that time comes, the tests give parents more time to make decisions and to work on early intervention services for their children, whether they're medical, educational or behavioral.
Barbara Biesecker, the genetic counselor with Hopkins, agrees that having a few extra weeks to make a decision is no doubt a positive development. But there are other implications of having that knowledge, she said.
"As people are earlier in pregnancy they may also feel less bonded and attached to the fetus, and may be more willing to decide that they want to terminate the pregnancy and sort of start over, or try again," Biesecker said.
She argued that noninvasive prenatal testing has the potential to encourage the idea that children are disposable and that you can pick and choose the ones you like.
The question is, will it?
"We don't know," Biesecker said. "Maybe people will learn more and make informed decisions and realize that there's a lot of quality of life associated with living with Down syndrome, and make the decision to continue pregnancies they otherwise wouldn't. I don't know. I think that's an open question."
What is not an open question, however, is whether pregnant women will increasingly face an onslaught of information about their unborn children before they've begun to tell people the news. And with that information will come an enormous demand for specialists who know how to convey that information with the care it deserves.
CORRECTION: A previous version of this article stated that ACOG recommends noninvasive prenatal testing to women over the age of 35 and those considered "higher risk"; the college only recommends that the tests can be offered as part of screening.
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5 Weeks Pregnant
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You're nearly halfway through your pregnancy. How's your partner holding up? Tell him specific ways he can help you as your pregnancy progresses, whether you want him to come to your doctor's appointments, help out more around the house or just rub your aching back. <strong> What's happening to baby: </strong>Grow baby, grow! She's now more than 6 inches long and her ears are working. She might even be able to hear loud noises, in addition to the sound of your beating heart and growling stomach. <strong>What's happening to Mom: </strong>You know the dangers of high blood pressure, but you may also experience low blood pressure during your pregnancy, as your circulatory system expands at this time. Ward off any dizziness by making sure you don't stand up too quickly.
19 Weeks Pregnant
How are you holding up? If you're dealing with back pain, headaches or other nagging pains, talk to your doctor before you take any medication to make sure they won't harm your baby. <strong>What's happening to baby:</strong> Baby weighs in at about 7 ounces this week, and he is starting to grow hair! <strong>What's happening to Mom: </strong>You may start experiencing round ligament pain, a sharp pain in your stomach or hip caused by stretching of the round ligament, which supports your uterus.
20 Weeks Pregnant
Right about now, you're likely going in for an ultrasound, and you might be able to find out baby's gender, if you're so inclined. If you do, you can really step up your nursery-planning and name-choosing! <strong>What's happening to baby:</strong> Baby now weighs 9 ounces and she might be putting pressure on your lungs and bladder. <strong>What's happening to Mom: </strong>Your 20-week ultrasound is a chance for your doctor to see how the baby's growing, check out the placenta, amniotic fluid, look for birth defects and, of course, determine the baby's gender.
21 Weeks Pregnant
How's the name game going? Check out the <a href="http://today.msnbc.msn.com/id/42912883/ns/today-parenting/?ocid=twitter" target="_hplink">top 10 names from 2010</a>, courtesy of the Social Security Administration. <strong> What's happening to baby: </strong>Baby is now big enough to be measured from his head to heel. He's now roughly 8 ½ inches long and is producing meconium, which will become his first poop when he's born. <strong>What's happening to Mom: </strong>Swollen ankles, hands and feet are common in pregnancy -- after all, you've got a lot of extra fluid in your body right now! But if you notice sudden swelling in your hands and face, call your doctor. These are symptoms of preeclampsia, or dangerously high blood pressure.
22 Weeks Pregnant
If you'd like to fit in a babymoon, or one last pre-baby getaway, better do it soon. It's best to travel before you reach 28 weeks. If you fly, be sure to drink plenty of fluids and get up and move around every hour or so. <strong>What's happening to baby: </strong>Baby weighs 14 ounces and is looking more and more like a newborn: Her eyes are fully formed, her lips are becoming more noticeable and she even has eyebrows! At 22 weeks pregnant, an expectant mother is in the middle of her second trimester and may start to feel some movement in the womb. The baby is approximately 10 inches and nearly a pound. Her organs are developing at a rapid rate and she may now be moving her limbs and exploring her face. Lips, eyelids and eyebrows are more defined and although her eyes have formed, the iris lacks pigment. <strong> What's happening to Mom:</strong> Thanks to a surge of hormones, there are lots of changes for mom too. Her hair is more lustrous and her nails are growing at a more rapid rate. Stretch marks usually appear around this time and skin may take on different textures or shades due to increased melanin. Nipples and areolas often get darker and larger. Some women's feet begin to swell at this point, often going up a half or whole shoe size. Your growing uterus is nearly an inch above your belly button, and you're probably feeling pretty good: not too uncomfortable, and with energy to spare!
23 Weeks Pregnant
Do leg cramps wake you up at night? They're a common pregnancy complaint. Getting regular exercise and stretching your legs before you hit the sheets may help prevent them. <strong>What's happening to baby: </strong>Your baby has hit the 1-pound mark! If you're having a boy, his testes are making their descent; if you're having a girl, she's already developed her uterus and ovaries. <strong> What's happening to Mom: </strong>You're probably running to the bathroom more than ever, as your growing uterus continues to put pressure on your bladder.
24 Weeks Pregnant
Many moms- and dads-to-be give their baby a cute, weird or amusing nickname like Peanut, Lemon or Chaka Khan before she's born. Does your baby have an in utero nickname? <strong>What's happening to baby:</strong> Baby is slightly more than a foot long, and her lungs and brain are growing quickly. <strong>What's happening to Mom: I</strong>n the next few weeks, you'll be screened for gestational diabetes. You'll have to fast overnight, then swallow a super-sweet drink to test your blood sugar. If it's high and you're diagnosed with gestational diabetes, you'll have to follow a special diet and may also need medication. Untreated, gestational diabetes can cause problems for your baby, such as trouble breathing and other health problems.
25 Weeks Pregnant
Many moms-to-be have cravings throughout their pregnancies, whether it's for something they can't have, like a glass of wine, something they'd never normally eat, like a burger for a vegetarian or something that's just plain weird: Pickles and ice cream, anyone? Some women even crave dirt, chalk or other non-edibles. If you're among this last group, contact your doctor. <strong>What's happening to baby:</strong> Your 13-inch-long baby is busy packing on weight, so when she arrives, she'll have that irresistible baby fat. She's also probably moving around quite a bit -- when she's not sleeping! <strong>What's happening to Mom: </strong>Your uterus is now the size of a soccer ball. And you may notice some seemingly unrelated to pregnancy symptoms, like a stuffy nose, snoring or frequent nosebleeds. These things actually are pregnancy-related, as the increased blood flow throughout your body can restrict airflow in your nose and airway.
26 Weeks Pregnant
You're almost there -- just 14 weeks to go! If your baby were born now, there's a very good chance he'd survive: 80 percent of babies born at this time do, according to the March of Dimes. <strong>What's happening to baby:</strong> By the 26th week of pregnancy the fetus has grown to about one or two pounds. The baby has also begun to inhale and exhale amniotic fluid, an important part of developing his or her lungs. During the 26th week, the baby's ears have developed enough to allow him or her to hear noises outside of the womb. If it is a boy, his testicles will begin to make their descent to the scrotum, a process which typically takes two or three days. <strong>What's happening to Mom: </strong>How much weight have you gained so far? If you were at a healthy weight pre-pregnancy and haven't been going overboard when it comes to food, you've likely gained 16 to 22 pounds, but every woman is different. Your health care provider will let you know if you're gaining too much -- or too little -- weight. The 26th week of pregnancy can also often bring with it an increase in blood pressure and a few hormonal changes that can cause lower back pain.
27 Weeks Pregnant
As your second trimester comes to an end, start looking into labor and child care classes, consider taking a tour of the hospital (if it's offered) and ask your mom friends for pediatrician recommendations. <strong>What's happening to baby:</strong> He or she may get hiccups more and more often as your pregnancy progresses, and you'll be able to feel her hiccupping. The fetus has grown to about two pounds and 14 inches in length. He or she is also able to open and close their eyes for the first time and the baby will begin to develop to more regular sleep cycle. <strong>What's happening to Mom: </strong>Along with all the changes your body is going through, you may also be developing stretch marks on your belly or breasts. Unfortunately, you can't prevent them, but they will become less noticeable after the baby is born. More changes will begin to take place in the body. She will often experience more leg cramps because of baby weight that has been tacked on to her body. The expecting mother may also notice that she has a little less energy than she did during her first trimester.
28 Weeks Pregnant
You're in the home stretch now! Welcome to the third trimester. Swollen fingers and hands may mean you can no longer wear your wedding and engagement rings. Don't want to go without? Slip them on a chain and wear them as a necklace. <strong>What's happening to baby:</strong> Baby weighs about 2 ½ pounds, and she will be adding weight quickly in the next several weeks. Her brain is hard at work, becoming more complex and growing more tissue. <strong> What's happening to Mom: </strong>In the next few weeks, you may be fighting off leg cramps, constipation, hemorrhoids, sleeplessness and other annoyances. Take it easy as much as you can, and remember, it will all be over soon!
29 Weeks Pregnant
Your doctor may suggest that you do kick counts -- taking time every day to see how often your baby is moving. Ideally, you should feel at least 10 movements (everything counts, from harsh kicks to barely-there flutters) in two hours. <strong>What's happening to baby: </strong>He weighs nearly 3 pounds, has eyelashes and has opened his eyes! <strong>What's happening to Mom: </strong>As your skin stretches to accommodate your growing belly, you may be dealing with itchy skin. Ease the itch by keeping your belly moisturized.
30 Weeks Pregnant
If you're planning on donating or storing your baby's cord blood, you should get the paperwork in order before you deliver your baby. The American Academy of Pediatrics encourages donating the blood rather than paying the hefty fees for for private storage. <strong>What's happening to baby: </strong>Baby's eyes are quickly maturing: She can tell the difference between light and dark and can focus on light. By the 30th week, the average fetus will weigh about three pounds. More than a pint of amniotic fluid surrounds the fetus, though the amount of liquid will decrease as the baby grows and takes up more room in the womb. The fetus will begin to mimic breathing by pushing up the diaphragm up and down. <strong> What's happening to Mom: </strong>At this point, Mom may have trouble sleeping and can feel clumsier than usual. Mood swings are also common during the 30th week of pregnancy, as are bouts of depression. Are you getting nervous about labor? Talk to your doctor about your options for pain relief and ask her any questions you might have.
31 Weeks Pregnant
By now, you should have a rough idea of who's going to take over your workload while you're out of the office. Brief your boss, employees and coworkers about what needs to be done while you're on your maternity leave, in case you deliver earlier than expected. <strong> What's happening to baby: </strong>Baby is 15 ½ inches long and may weigh about 4 pounds by now. <strong> What's happening to Mom:</strong> At this point in your pregnancy, your breasts are bigger and may have stretch marks. They may also be leaking a yellowish liquid. It's nothing to worry about: The colostrum, or pre-milk, that's coming from your breasts now will also come out in the first few days after your baby is born before changing over to the milk that will nourish your baby, if you decide to breastfeed.
32 Weeks Pregnant
You may be feeling Braxton Hicks contractions by now. These "practice" contractions can last for up to two minutes as your uterine muscles tighten. When you feel them, don't panic, just do some deep breathing. And if you're at all concerned that it's the real thing, call your doctor. <strong>What's happening to baby: </strong>Baby weighs roughly 4 ½ pounds and is practicing breathing in preparation for her birth. <strong>What's happening to Mom:</strong> As baby grows bigger, your uterus may begin putting pressure on your diaphragm, making it harder for you to breathe. This is another reason to take it easy in these final weeks of pregnancy.
33 Weeks Pregnant
Take a few minutes now, while you have the time, to call your insurance company and find out what -- if anything -- they need from you, your employer or your doctor before or after your baby arrives. <strong>What's happening to baby: </strong>Baby now measures about 16 ½ inches from head to foot, and is steadily gaining weight. <strong>What's happening to Mom: </strong>Got heartburn? Blame your ever-expanding belly. To prevent it, eat smaller meals more often throughout the day, and avoid heartburn triggers, such as citrus foods, soda and fried or spicy foods.
34 Weeks Pregnant
Once you get baby's car seat, call your local police or fire department. In many states, they'll install the seat for you, or will check to make sure you've done it correctly to ensure that your baby is safe when riding in the car. <strong>What's happening to baby: </strong>He weighs about 5 pounds and is roughly 17 ½ inches long. Baby's bones are starting to harden, except for the bones in his skull, which stay soft until after birth, to make delivery possible. <strong>What's happening to Mom:</strong> As you wait for baby to arrive, you're probably feeling more uncomfortable than ever and not sleeping well. Many moms-to-be worry that their water will break at work or in public. But it's not that dramatic for most women, and, luckily, it usually happens at night when you're sleeping. If you start leaking an odorless fluid, call your doctor.
35 Weeks Pregnant
This week, your doctor may test you for group B streptococcus, a bacteria you may carry that can cause health problems in your baby. If you test positive, you'll get antibiotics during delivery to reduce the risk of passing it to baby. <strong>What's happening to baby:</strong> Her lungs are nearly fully developed, and she may weigh up to 6 pounds by now! She's likely in position for delivery, too. <strong>What's happening to Mom: </strong>As baby's arrival gets closer, you'll get some relief from your breathing problems as baby drops into your pelvis. This stage, called lightening, makes it easier to breathe, but now baby is putting more pressure on your bladder, which may mean more trips to the restroom than ever before. Lightening can also increase pressure on your bladder.
36 Weeks Pregnant
It's hard to imagine it now, but many women actually miss being pregnant: The constant attention from strangers, feeling those comforting kicks throughout the day and night and the built-in excuse to indulge in chocolate. <strong>What's happening to baby: </strong>Baby weighs anywhere from 5 ¾ to 6 ¾ pounds and may be as long as 19 inches. The little hairs that were covering her entire body are starting to go away as she prepares for her arrival. <strong>What's happening to Mom:</strong> Talk to your doctor about what to expect during delivery. You may not be planning for a Cesarean section, but you should be prepared in case it happens. According to data from the Centers for Disease Control and Prevention, a full 31 percent of all deliveries are C-sections.
37 Weeks Pregnant
This week, your baby is officially full-term. You made it! Of course, it's best for him to stay where he is until he's ready, and in some cases, that may mean another four weeks. <strong>What's happening to baby:</strong> He's now weighing in at around 7 pounds. If he's in breech position, your doctor may be able to turn him around so he's in the head down position. <strong> What's happening to Mom: </strong>You probably won't gain much more weight after this week. In the next few weeks, you may lose your mucus plug, which blocks the cervix throughout your pregnancy, keeping your baby safe from bacteria. You may not even notice when you pass the mucus plug, but it means your cervix is beginning to dilate, a process that can take hours, days or weeks.
38 Weeks Pregnant
It's time for final preparations: If you haven't packed your hospital bag yet, do it now. Make sure you have a car seat ready to bring baby home from the hospital and give your partner a list of people to call and e-mail once baby arrives. <strong>What's happening to baby: </strong>These last few weeks, baby is mainly just gaining weight and her brain and lungs are still maturing. By now, she may weigh up to 7 ½ pounds. The baby has also developed a firmer grasp and his or her organs have developed enough to sustain life outside the womb. Fingernails have also begun to develop. <strong>What's happening to Mom:</strong> In these last few weeks, you're likely still experiencing back pain, sleeping fewer hours than ever and dealing with swelling, mainly in your feet. Excessive swelling should be reported to the doctor if it does not subside. Any odd symptoms such as severe headaches or excessive weight gain should also be reported to a doctor immediately.
39 Weeks Pregnant
Once your baby arrives, you'll have little time for cooking, so consider freezing a few make-ahead meals, like lasagna and casseroles. Later, you'll be glad you did. <strong>What's happening to baby:</strong> Baby weighs anywhere from 6 ½ to 8 pounds and is 18 to 20 1/2 inches long. The fat her body is developing will help her regulate her body temperature outside the womb. <strong>What's happening to Mom: </strong>You're likely seeing your doctor weekly now, and pelvic exams will help him or her determine baby's position and whether (or how much) your cervix is dilated.
40 Weeks Pregnant
Welcome, baby! Your little one should make his appearance any day now, and you're likely desperate to meet him! Enjoy every minute. <strong>What's happening to baby: </strong>At birth, he'll weigh between 6 ¾ and 10 pounds and will be between 19 and 21 inches long, though, of course, every baby is different. Several months after birth, the soft spots on his skull will begin to harden. <strong>What's happening to Mom: </strong>You're probably anxious, excited and ready to meet the little person growing inside of you. Try to be patient if you go past your due date -- you'll have the rest of your life to spend time with your baby.