Sunday, January 2, 2011

24 weeks pregnant

How your baby's growing

Your baby's growing steadily, gaining about 99g/22oz since last week. His / Her skin is thin and fragile but his / her body is filling out and taking up more room in your uterus. He / She may also be developing a weakness for sweets. Taste buds are now forming, and, believe it or not, acquiring a sweet tooth is all part of it. The other big milestone your baby reaches at this stage of pregnancy is that he / she may now survive, with special care, if she is born prematurely.

How your life's changing

You may notice faint red streaks, otherwise known as striae, or stretch marks on your tummy, hips, buttocks and breasts. Lots of women have very itchy skin as well - pregnancy hormones can make your skin drier and stretching over a growing bump doesn't help. Rubbing on creams may make you feel more comfortable and help soothe the itching but it won't get rid of stretch marks and is unlikely to prevent them. While creams won't erase them, wearing a supportive bra may help prevent or minimise them on your breasts. They are very common at this stage of the pregnancy - about 90 per cent of women get them. Stretch marks are typical at this stage of pregnancy and will fade to silvery white marks after you give birth.

You may also find that your eyes are more sensitive to light, feeling gritty and dry - a perfectly normal pregnancy symptom known as dry-eye. To ease your discomfort, you can use an artificial tears solution to add moisture, available from pharmacies.

Things to consider

You may need to review your diet again if you have gestational diabetes.

Why, contrary to the old wives' tale, you can't do anything about your newborn's complexion.

If you haven't yet done so, write to your employer stating that you're pregnant and saying when you intend to start your maternity leave.

The fatigue you felt in the first three months may start to set in again, so take it easy.

Your baby is still on the skinny side with no body fat but his brain is growing rapidly and he's starting to fill the space in your uterus. By now, you probably have a definite "pregnant" shape and the linea nigra, a dark line of pigmentation, may appear down the centre of your abdomen. Your baby's taste buds are also forming and, believe it or not, his sweet tooth. Could that explain your sudden craving for dodol and kuih lapis? No one knows for sure but it's a good excuse, next time you find yourself stalking the kuih lady at the pasar malam.

Tour the hospital

It's a good idea to get to know your hospital, so you'll feel prepared when the big day arrives. If you can, take a tour, find out their policies on birth and delivery; ask about parking and arriving after hours.

• You still have plenty of time to discuss your pain relief options with your doctor.

• You may also ask the head nurse at the labour ward to take your through the admission procedures at your hospital.

Your foetus weighs more than 1.3 pounds / 600 grams. Though she / he still has little body fat and her skin is thin and fragile, she's now well-proportioned. Her brain is growing rapidly, and she is starting to fill the space in your uterus. From crown to heel she could measure 11.8 inches / 30 centimetres. If you went into labour at this time, however, many obstetricians and doctors would make every effort to halt the progress of premature labour to enable your baby to continue maturing.

Can skin changes in pregnancy be harmful?

Whilst common pregnancy skin changes pose no health problems, you should always talk to your doctor if your skin is inflamed, blistered, or you have a rash, irritation or itchiness that lasts more than a couple of days.

Because other conditions, unrelated to pregnancy, could bring about skin discolouration, you should always check with your doctor if you notice any changes, such as a change in the colour or size of a mole, or if pigmentation changes are accompanied by pain, tenderness or redness. Your doctor will be able to diagnose the condition, and make sure that you are given the appropriate treatment, should it be necessary.

Chloasma (pigmentation changes on your face and neck)

Also known as the "mask of pregnancy", chloasma has the appearance of brown patches of pigmentation on the forehead, cheeks and neck. On darker-skinned women, they appear as lighter patches. It's caused by the increased production of melanin, the tanning hormone, which protects the skin against ultraviolet light.

Exposure to sunlight will darken the patches, making them more obvious, so protect your skin with a high factor sunscreen (SPF15 or more). Few people wear hats around here, but you may want to consider wearing one now whenever you go out. If you feel the patches look unsightly, try blending in the colour with a tinted foundation. They will begin to fade within three months of your baby's birth.

Linea nigra (dark line running up your tummy)

This is a dark, vertical line, up to a centimetre wide that appears down the middle of your stomach, often crossing the navel. It tends to appear around the second trimester. It is caused by pigmentation in the skin where your abdominal muscles stretch and slightly separate; to accommodate your baby as it grows.

This line of pigmentation will fade within a few weeks of delivery, although you may need to give it a gentle rub to remove any dry skin. You will notice that other areas with pigmentation - such as your nipples, moles and freckles - may darken too, but this will also fade with time.

Glowing skin

The "bloom" or "glow" of pregnancy is not just a saying. Your skin retains more moisture during pregnancy, which plumps it up, smoothing out any fine lines and wrinkles that you may have. The glow that makes you look radiant is due to increased levels of blood circulating round your body. This may also make you feel slightly flushed sometimes.

The downside of this effect is that you may look puffy from water retention and that any red patches that you already have on your face may become more visible. Don't try to cut down on drinking water - your body needs fluids - but rest as much as you can. Any red patches will eventually calm down once you've given birth, but if you want to hide them, try using a moisturising foundation.

Spider veins

These tiny clusters of broken capillaries (small blood vessels), or spider naevi as they are sometimes known, most often appear on the cheeks. They are common in pregnancy, particularly if you are already prone to them. They are caused by the increased volume of circulating blood putting extra pressure on the capillaries, which are also more sensitive during pregnancy.

To reduce the chances of spider naevi appearing, protect your face from extremes of cold or heat, as exposure to either can encourage the problem. The veins will fade once your hormone levels have settled down after delivery.

Spots and acne

Pregnancy can sometimes trigger acne, which many of us have not experienced since adolescence. Higher levels of hormones can encourage the production of sebum - the oil that keeps our skin supple - and too much sebum causes pores to become blocked, resulting in greasy skin and spots.

Cleanse regularly with a gentle cleanser and use an oil-free moisturiser. If you prefer to avoid skin products, keep your skin fresh and clean by patting it dry rather than rubbing, so that you minimise the irritation to the acne. Don't use acne creams or treatments unless your doctor advises you to do so - some of them cannot be used when you are pregnant. A few weeks after your baby is born, your skin should return to its pre-pregnancy condition.

Stretch marks

The thin reddish or brownish (depending on your skin colour) lines of stretch marks usually appear on the abdomen, breasts and thighs. They affect between 75 and 90 per cent of pregnant women and may appear as you put on more weight during pregnancy, causing the skin to stretch.

Higher levels of hormones also disrupt your skin's protein balance, making it thinner than usual. After pregnancy, the reddish or brown pigmentation in the stretch marks gradually fades, and the streaks become lighter than the surrounding skin. It can take some time for them to fade.

Some lucky women have more elastic skin than others, meaning they won't get stretch marks, but for most of us they are simply a fact of pregnancy. You can try to minimise them by avoiding putting on weight too quickly, rubbing oil or cream rich in vitamin E over your abdomen to keep it supple, eating a healthy diet rich in vitamins E and C, and in zinc and silica to help to keep your skin healthy.

A research review of creams for preventing stretch marks found only one study, based in Spain, which showed creams to be of benefit. This was by massaging with a cream called Trofolastin, containing the active ingredients Centella asiatica extract, alpha tocopherol (vitamin E) and collagen-elastin hydrolysates.


As you put on weight, chafing can take place between your thighs or under your breasts, resulting in red, moist skin. Your skin may then become inflamed and blistered and you may notice an odour. This is a condition known as intertrigo. Keep the affected area as dry as possible and use talc to help absorb any moisture. Keep your skin cool by wearing cotton clothes and avoid wearing tights.

See your doctor about this chafing, especially if you are sweating a lot, as it may cause a fungal infection called thrush to develop. It is important to clear this up before your baby is born or it can be passed on to your baby.

Sensitive, irritated skin

Skin tends to become more sensitive during pregnancy, not only due to higher hormone levels, but because it has become more stretched and delicate. Soaps and detergents may suddenly cause irritation, or conditions such as eczema may become worse. Your skin may become more prickly than usual when exposed to sunlight.

Try to identify what could be causing your irritation - could it be your washing powder or a perfume that you use? Also, choose loose, cotton clothes and keep your body well-moisturised. Long soaks in a warm bath will dry out your skin so keep these to a minimum, or add bath oil that will help keep your skin supple. (But make sure you don't slip when you're getting in and out of the bath). Finally, always protect your skin from the sun with a high-factor sunscreen (SPF15 or more).

Rashes and itchiness

It is common for temporary rashes and itchiness to come and go during pregnancy, without any obvious cause. Increased hormone levels make you more sensitive to contact with substances that would not normally affect you. For instance, you may find you become sensitive to chlorine in the local swimming pool.

Thrush, which causes vaginal itching, and piles, which can cause itching around the anus, also occurs more often in pregnancy. Wear light, loose-fitting cotton clothes to keep your body cool. Talk to your doctor about safe treatments to use for thrush and piles - you may be given advice on increasing the fibre in your diet as a first line attack for piles.

For other areas, dabbing on calamine lotion should reduce the itching. If your rash or irritation lasts longer than a couple of days, get advice from your doctor.

Intense itching

Intense itching all over, particularly at night and on the palms of your hands and the soles of your feet, can be a sign of a rare liver disorder, obstetric cholestasis that only occurs in pregnancy. It tends to appear in the third trimester, from about 28 weeks pregnancy, and usually clears up within three weeks of delivery.

Although the exact cause is unknown, it is thought that high levels of oestrogen in pregnancy can prevent the liver from functioning properly resulting in increased levels of bile salts. The itching can be intense and sometimes intolerable and it can be worrying to find out that your liver is not working properly, but obstetric cholestasis will not damage your health.

The risks for your baby are less clear. Early research in the 1970s linked the condition to stillbirth but new evidence suggests that the risk of stillbirth is no higher than that for the rest of the population. There is no evidence that obstetric cholestastis affects your baby's growth or causes disability. Further research is needed.

Also, your eyes may be light-sensitive and may feel gritty and dry. This is a perfectly normal pregnancy symptom known as "dry-eye". To ease your discomfort, use an “artificial tears” solution to add moisture.

Easing those aches and pains

As your second trimester ends, your bump is getting bigger all the time and you may find that back pain, headaches and leg cramps are bothering you. Headaches can sometimes happen when you are dehydrated so make sure that you drink lots of water every day. And don't forget to eat something. Headaches are sometimes sparked by low blood sugar, so a carbohydrate-rich snack can help.

Calcium and vitamin D

Calcium is a key nutrient in pregnancy. Calcium helps your baby to grow strong bones and teeth, healthy nerves, heart and muscles. It also helps develop heart rhythm and blood clotting. Calcium is found in dairy products, tinned fish (especially if you eat the soft bones too), spinach and green beans, pulses, sesame seeds and almonds.

Your body needs vitamin D to help absorb calcium. It is made naturally in our bodies in response to sunlight. Experts recommend that all pregnant women take a supplement of 10mcg of vitamin D daily (if you are already taking a pregnancy multivitamin, check to see if it contains this amount of vitamin D). Good sources of vitamin D in your diet are oily fish, eggs and milk.

Lunch: ciabatta with halloumi, basil and sundried tomatoes

Serves one

1 ciabatta roll

1 clove garlic

2 slices halloumi cheese

Few leaves of fresh basil

2 sundried tomatoes, drained of oil

Rocket leaves, washed, to serve

Slice the ciabatta in half. Take the garlic clove, cut in half and rub the cut edge over the ciabatta. Roughly chop the sundried tomatoes, and arrange on the roll. Grill the cheese on the roll for a couple of minutes and add some fresh basil leaves. Grind over some black pepper and drizzle some olive oil on top. Serve hot, with a side salad of rocket leaves.

Snack: hummous with pitta bread (my favourite for time being)

Try this simple hummous with pitta bread for a high-carbohydrate snack which will keep your hunger at bay.

1 400g can chickpeas

1 tbsp tahini (sesame seed paste)

juice of half a lemon

1 clove garlic

1 tbsp olive oil

Wholemeal pitta bread, to serve

Drain the chickpeas and place in a food processor with the tahini, the lemon juice and the garlic clove, peeled. Whizz briefly to break up the chick peas and drizzle in the olive oil and a little water to make it a creamy mixture.

Chill in the fridge and serve with fingers of pitta bread. Vary the mixture by adding a tablespoon of finely chopped coriander, or a tablespoon of chopped pitted black olives.

Dinner: mushroom and celery pasta bake


Serves three to four people

Preparation time: 20 minutes

Cooking time: 15-20 minutes

This simple dish is full of calcium.

25g olive or sunflower spread (minimum 59 per cent fat)

2 sticks celery, chopped

150g baby button mushrooms

Pinch dried thyme (or 1 sprig fresh thyme, leaves only)

1 heaped tbsp flour (40g)

300ml semi-skimmed milk

100g mature cheddar, grated

150g penne or other pasta shapes

Preheat the oven to 190 degrees C. Melt the spread in a saucepan and add the chopped celery and mushrooms. Cook, gently, stirring occasionally for 5-10 minutes or until the celery is softening. Add the thyme.

Meanwhile cook the pasta according to the packet instructions, and drain. Stir in the flour to the mushroom and celery mixture and gradually stir in the milk. Bring to the boil, stirring all the time.

When the sauce has thickened, stir in three quarters of the cheese and the drained pasta. Tip into an ovenproof dish and sprinkle over the remaining cheese.

Bake for 15-20 minutes or until the cheese is golden brown. Serve at once with a colourful salad.

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