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0:00
I'm Dr. Shy Mjoli, and I'm a high-risk pregnancy doctor.
0:00
I'm here today to answer your questions from the internet.
0:06
This is Pregnancy Support.
0:11
King Anola asks, "Apparently, I can up my chances of having twins if I eat loads of yams. Please confirm."
0:16
It turns out probably not.
0:18
Where this comes from is the Yuba people of Nigeria have a specific yam that has a lot of estrogen-like chemicals in it, and that area of the world has a really high incidence of twinning.
0:31
And it's thought that perhaps this particular white yam caused twinning to be increased in that patient population.
0:38
Whether you eat yams from your local grocery store and that causes twinning is yet to be determined.
0:38
Ali Barrington asked, "Did you know they had pregnancy tests in ancient Egyptian society? This stuff is so damn cool."
0:38
Yes, in fact, they did have pregnancy tests in ancient Egyptian society.
0:38
Women would urinate on these two bags of grain, barley and wheat, that were responsive to estrogen.
0:38
And if those grains sprouted, it meant that the mother was pregnant.
0:38
It's thought to have been about 70 to 80% accurate at detecting pregnancy, which is really quite amazing.
1:13
Now we have a filtration type of lab that you can do literally at home.
1:18
You pee on a stick.
1:24
The beta HCG, the human chorionic gonadotropin that is formulated when the embryo is forming in your uterus, is excreted really early on.
1:29
So probably not the first 2 to 3 days after you conceive, but pretty much right after that.
1:35
And when you have high levels of HCG as it's filtering through that stick, if there's a positive result, you'll see two lines because the HCG will bind to one of the lines.
1:47
If it's a negative result, you'll only see one line because it's just the control.
1:56
K. Cinema asked, "How the hell does an ultrasound work? It's like a hack where they see right through you."
1:56
It kind of is a hack where we do see right through you.
2:00
This all started in the time of World War I and World War II, where you were using sound waves through water to detect a submarine.
2:10
They recognized that there was a medical application to this where you could use sound waves to hit the fetal skin and walls and really create an image on a computer screen.
2:10
This is a two-dimensional image.
2:12
The probe is coming through the maternal skin from about here and reflecting sound waves through the amniotic fluid back onto the probe in order to create a computer-generated two-dimensional image.
2:31
More recently, there's been a development of three-dimensional fetal imaging that still uses that same sound wave technology to create a three-dimensional image of your fetus.
2:31
Now, on these 3D images, you can see more lifelike fetal images, but we don't use them so much in diagnosing medical problems.
2:31
We really still rely very heavily on those two-dimensional images to diagnose fetal issues.
2:31
Todav B. asks, "Is it okay to exercise during pregnancy?"
2:31
Regular and routine exercise in pregnancy is completely safe.
2:31
The fetus is in a pool of amniotic fluid.
2:31
It's always moving.
2:31
It's in a constant state of sort of anti-gravity.
2:31
So we don't really think that it feels the jostling of movement up and down when you go for a 5K run or any sort of run.
2:31
Simply Tootsie asked, "Why TF, when you pregnant, everything smells so effing weird?"
3:19
All of my patients say, "I can smell so much more, it smells different, it smells funny."
3:24
There is an evolutionary theory about this.
3:26
It may help you to prevent eating something that's toxic to either yourself or the pregnancy during that time.
3:39
Hony MW asked, "What is vanishing twin syndrome and what are the causes?"
3:39
This is a uterus, and there is a fetus here, and this is one gestational sac, and then there's a second empty gestational sac.
3:48
And what that means is this pregnancy most likely formed two embryos, but only one made it to the stage where you can see a small embryo and a heartbeat.
3:48
And that's called a vanishing twin.
3:48
That twin vanished.
3:48
The other twin will go on to form a totally normal embryo.
3:48
A vanishing twin in the first trimester is not considered to be a dangerous outcome that causes an adverse pregnancy outcome.
3:48
A lot of times when a twin gestation forms, 20 or 30% of the time, there's a vanishing twin.
3:48
It's thought to be the main driver of this test that we now do on most pregnant women called non-invasive prenatal testing being falsely positive every once in a while.
4:27
When we do that test and we sequence that DNA, there's an extra chromosome 21, 13, or 18, or a change in the sex chromosome material.
4:36
That's thought to be because in vanishing twin syndrome, the DNA may still be floating around in the maternal bloodstream and cause a false positive result if that vanished twin was actually abnormal.
4:51
Blue Neptune asks, "Do you think babies can taste in the womb, like damn, that is eating spaghetti again?"
4:58
Actually, flavor molecules can pass from the maternal bloodstream through the placenta and into the amniotic cavity.
4:58
It's possible that there are flavor molecules passing into the fetal mouth and through the nose so that they can smell and taste what the mom eats.
4:58
Infants do gravitate towards similar food choices as their moms do.
4:58
So it's possible that that flavor conditioning and flavor imprinting happens in utero rather than just after they're born.
4:58
Miso Pissed asked, "How the am I supposed to know if I'm going into labor when I've never been in labor before?"
5:31
This is a tough question because it's true, the vast majority of first-time moms don't really know what labor feels like.
5:37
There's one really great rule of thumb in explaining how a patient can know that they're in labor.
5:43
We use the 5-1-1 rule.
5:43
That's where a patient feels cramping and contractions and pain in their abdomen and in through their pelvis every 5 minutes, and that pain lasts approximately 1 minute, and it lasts for over an hour.
5:59
And if it's happening and you have an hour of contractions, you might want to head to the hospital or at least call your doctor.
5:59
Mind Tracked asks, "Wait, do babies cry in the womb?"
6:00
The amniotic fluid that is in the mother's uterus makes it so that babies can't make really any sound.
6:10
But there are some studies to show that perhaps at 28 weeks, babies can start doing practice grimacing in the womb.
6:18
When we're performing ultrasound, we actually look for different kinds of practice movements.
6:23
So we're looking for practice breathing, which is where the diaphragm goes up and down, and you might be able to see fluid coming in and out of the nostrils.
6:31
But we don't usually look for practice crying.
6:38
Vuzi N. says, "Cryptic pregnancy will always shock me because what do you mean you had cramps and the next thing you were giving birth?"
6:40
A cryptic pregnancy is where you don't know you're pregnant until the end of the pregnancy or the third trimester.
6:47
Cryptic pregnancy probably happens about 1 in 500 times.
6:49
We think that it most likely happens for one of two sets of reasons.
6:53
One, there was some irregularity in your periods or you were breastfeeding so that you didn't get periods, or you had bleeding in the early part of your pregnancy so you didn't know you were missing a period.
7:07
And the other part of cryptic pregnancy probably has to do with mental health, patients who didn't recognize they were pregnant due to a mental health condition.
7:12
Aliat asks, "Are you telling me that the easiest way to avoid cleaning cat litter is to be pregnant?"
7:17
We really do advise women not to change cat litter in pregnancy.
7:21
That's because some cats carry a parasite called toxoplasmosis, and it can cause birth defects.
7:26
Toxoplasmosis isn't only found in the cat litter.
7:30
It can be found in the ground and in undercooked foods.
7:32
In other countries, like in Europe, specifically France, there can be a higher level of exposure to toxoplasmosis because of undercooked meats and cheeses and things that may expose patients to parasites.
7:42
They actually test for it.
7:44
In the United States, it's less ubiquitous, and we don't find that there's a need to test for it.
7:50
Fins Fan SG says, "At how many weeks do you think a fetus becomes viable?"
7:53
The early third trimester, probably at about 24 weeks.
8:00
That's when a fetus can survive outside of the uterus.
8:02
That may change with advances in neonatology and in technologies that can help earlier and earlier fetuses survive.
8:15
Kof 99 asked, "Babies can poo inside the womb?"
8:12
Yes, babies can poo inside the womb.
8:15
We call it meconium.
8:23
Meconium is really a natural byproduct of swallowing the skin cells and the hair cells and the amniotic fluid all the way through the first, second, and third trimesters of pregnancy.
8:23
This happens about 13% of the time, and we can see that greenish tinge to the amniotic fluid at birth.
8:23
It can be important in the neonatal period because an increase in meconium can sometimes make it more difficult for babies to breathe once they're born.
8:23
Trash Netflix says, "How does Plan B work?"
8:23
It basically delays ovulation for about 72 hours.
8:36
In a normal pregnancy, we want to ovulate from our ovary, and that egg comes into the tube, and that's where it meets the sperm either in the tube or in the uterus.
9:00
What Plan B does is it basically prevents ovulation so that there is no egg to meet the sperm during this time, which means you can't conceive during the most important 72 hours after sex.
9:12
Chanelle Angelie asks, "Why does no one talk about how terrible the first trimester is?"
9:17
In the first trimester of pregnancy, a lot of things are happening.
9:21
Your body is changing so much.
9:21
You're getting all that progesterone, all that estrogen into your bloodstream.
9:24
The embryo is growing from a really small size.
9:28
The vast majority of the fetal organs are forming up to about 12 weeks of pregnancy.
9:33
You're seeing bone and skin and heart structures.
9:36
And so organogenesis, that early part of the pregnancy is super, super important, and it probably does make you feel a little terrible.
9:44
Ketsu 6 asks, "What happens in the second trimester?"
9:47
There's continued formation of the organs through the second trimester.
9:50
That's when neurodevelopment begins, when the brain starts developing.
9:54
There's also development of teeth and other organs.
9:57
This is probably about a late second trimester fetus.
9:59
It's no longer the size of a small embryo.
10:01
It's really growing up to about the mother's belly button or beyond.
10:06
Also, in the second trimester, people start to feel a little bit better about the pregnancy.
10:11
They're not feeling that surge of hormones, they've sort of acclimated to that surge.
10:14
It's kind of called the golden trimester because people feel less nauseated, they have more energy, and they're less fatigued.
10:22
K. Brisha says, "Last trimester of pregnancy, zero out of ten, do not recommend."
10:28
The third trimester of pregnancy, somewhere around 25 to 28 weeks, going all the way to when you deliver, can be really difficult.
10:28
The fetus is growing about a half a pound a week.
10:28
Your uterus is coming up to your diaphragm.
10:28
The uterus is pretty large, like the size of a watermelon.
10:28
The uterine walls are really thinned out.
10:28
You're feeling heavier, you're feeling more tired.
10:28
This is when all your organs are being sort of pushed in different directions.
10:50
You might notice a difference in how you walk and move because there's a change in the curvature of your spine.
10:56
There is a lot of fetal development happening in the third trimester.
10:58
There's vision developing, there's taste buds developing.
11:02
Most importantly, at the very tail end of the third trimester, you're going to get fetal lung maturity.
11:06
After the baby's born, they have to be able to take that first breath and use those lungs.
11:12
So the third trimester is really, really important for that time.
11:14
BDP says, "Why do so many people get pregnant with quadruplets?"
11:24
I don't really think it's true, but there is a lot of media attention on higher order multiples, multiples that are more than twins, and that's usually more common using assisted reproductive technology.
11:31
Current technologies really try to avoid more than two fetuses in the uterus.
11:41
When you use in vitro fertilization or IVF, you might get pregnant with one, maybe two fetuses.
11:44
But if you use different types of assisted reproductive technology that make your ovaries excrete more eggs, you might get pregnant with triplets or quadruplets, and we really, really, really try to avoid that because it's not that safe for either the fetuses or the mother.
12:01
Before IVF, the most common reason was kind of an error in ovulation.
12:04
You released two eggs at the time you conceived, and you created twins.
12:08
So it was more common in older patients, in patients nearing menopause, to have twins.
12:16
M. asks, "The mortality rate with black women during pregnancy and delivery is way higher than any other race."
12:21
That's true.
12:23
Black women have higher risks of maternal morbidity and mortality in pregnancy as compared to their white and Hispanic counterparts.
12:29
We're still working on why that is and what the reasons are.
12:33
One is possibly just structural racism within the health community and the ways we learn about health and health care.
12:40
Other things include this idea of weathering, where if you face racism every day, you actually may have worse health outcomes.
12:53
Cash Madonna asked, "Do the second pregnancy make you show faster or something?"
12:53
There is some plausibility to this.
12:56
When you're pregnant the first time, your muscles haven't spread.
13:01
There hasn't been that diastasis of the muscles in the front of the abdomen yet.
13:01
But in the second pregnancy, all of that musculature is already sort of stretched and moved.
13:01
And so that growing uterus shows more quickly because there isn't as much of a force downward as there would be in the first pregnancy.
13:16
Neomano asks, "Guys, is there a difference between termination of pregnancy and abortion?"
13:21
Yes, there is a slight difference between termination of pregnancy and abortion.
13:30
Abortion can be either spontaneous, which means you miscarry, or it can be a termination of pregnancy where you elect to terminate because there's an abnormality or for any number of family reasons.
13:37
Diene asks, "As I keep getting further along in this pregnancy, all I want is junk food.
13:47
That is so off-brand for me, I'm a healthy girl."
13:47
In the beginning of pregnancy, a lot of women do just eat crackers because they're feeling so nauseated during that early part of pregnancy.
13:54
Fetuses are very parasitic.
13:56
They're going to take all the nutrients they need from the female body and they're going to use it to create this embryo and this fetus.
14:01
What's really, really, really important in pregnancy is to eat a healthy and well-balanced, nutritious diet, nutrient-dense foods, whole grains, green leafy vegetables, things that have protein, omega-3 fatty acids, anything that has vitamins.
14:15
As a mom, you're expanding your blood volume, but also the fetus is actually making its own new blood cells.
14:22
It needs the components to do so, right?
14:24
And so do you.
14:27
You need iron, you need B12, you need folic acid.
14:29
Rufus J. Bacon asks, "What is a pregnancy glow? I for one have never seen a pregnant person glow."
14:35
There is sort of a pregnancy glow.
14:37
It's one of just those biological things that's happening as you're getting pregnant and being pregnant.
14:43
Your skin might get a little oilier.
14:44
Your face might get a little rounder as you increase the fat content of your subcutaneous tissue.
14:48
You also notice many times stronger nails, thicker hair, fuller hair because you're not losing hair as much during pregnancy.
14:58
The real Rambo 951 asks, "What happens to the baby if you smoke while pregnant?"
15:03
Babies can be smaller than they would be expected to be.
15:05
That's called small for gestational age, babies that don't weigh quite as much as they should at birth.
15:11
There are also a host of other adverse outcomes that we think are associated with tobacco smoking during pregnancy, increased risk of abruption.
15:18
That's where the placenta separates from the uterine wall before it's time to deliver and can cause significant bleeding behind the placenta and even fetal loss.
15:18
So it's really important to consider quitting smoking during pregnancy.
15:18
Jacob SCTG asks, "Like, have you seen what happens to your stomach on the inside as a baby grows, where do your organs shift and move?"
15:18
In the very beginning of pregnancy, your uterus is really, really small.
15:18
It's just sort of sitting in the lower pelvis.
15:18
It's only about the size of a lemon.
15:18
But as the uterus grows, it's growing up to your belly button or even higher.
15:18
There are a lot of effects on all of your organs.
15:52
Most of the early effects are from progesterone.
15:54
So progesterone is a hormone that's secreted by the placenta into the maternal bloodstream.
16:03
It sort of laxens all of the cartilage and those ligaments that are all over your body, and it makes things looser.
15:58
It makes us able to adapt.
16:06
Your intestines, which are really just flexible and no problem really, they can just move aside and push to the sides.
16:13
But over time in the third trimester, really late, you might see that the pregnancy is really coming up into your diaphragm.
16:19
You might even feel a little short of breath as the liver and the lungs are pushed upward.
16:23
It's not an instant quick change back to its normal shape and size at the end of the pregnancy.
16:40
Women leave the hospital really feeling like they still look pregnant.
16:40
The uterus looks about 20 weeks pregnant, and as it shrinks down, all those organs shift and go down.
16:40
Mama Moxy B. asked, "I really need answers as to WTF preeclampsia is definitively."
16:40
Preeclampsia is where you have an abnormal rise in your blood pressure at the end of pregnancy, and most likely it's happening because you are having all of these cytokines and inflammatory markers increasing disproportionately at the end of pregnancy, causing your body to react almost like it's an autoimmune response.
16:40
Preeclampsia is basically caused by endothelial damage, damage to the vascular system, and you can see signs of preeclampsia with platelets dropping, with your liver enzymes going up, people can develop headaches.
16:40
People ask if preeclampsia is on the rise, and it turns out that probably preeclampsia is somewhat on the rise.
17:25
There's just more recognition of hypertensive disorders of pregnancy, patients getting pregnant later in life or using assisted reproductive technology to get pregnant.
17:36
There's also more obesity, which we think is a risk factor for developing preeclampsia.
17:40
There's ongoing research to sort of describe how and why preeclampsia happens in certain patients and not in others.
17:53
LSN XXXX asked, "Okay, but like, is pregnancy brain real? Because during my pregnancy, I swear I felt illiterate."
17:55
There is like 15 to 40 times more progesterone floating around in your body, and it does change your brain and the way you think.
18:03
And by the time the woman delivers, there are these huge surges in oxytocin, which can really change the way you're thinking because oxytocin is a pleasure hormone.
18:14
It's really, really possible that as we focus more on our pregnancy, some of the other extraneous stuff that we used to have at top of mind no longer is.
18:21
Now what's more important is what's we're carrying in the uterus.
18:25
And so there are pregnancy changes.
18:27
Delrick asks, "Why do babies in the womb kick when they hear certain music? Surely they can't have that much experience being not born yet."
18:36
Later in pregnancy, probably around 28 weeks, the fetal auditory system really starts forming so they can start to hear.
18:43
They can hear music, maternal organ movement, and there are some studies to suggest that auditory stimuli can make your baby move or kick in a different way, and that there may be some recognition of even the maternal voice or the paternal voice after birth.
19:03
Aloo 22 orvo asks, "Why do you think it's important for women to take prenatal vitamins when pregnant?"
19:05
Every pregnancy really should have a prenatal vitamin.
19:07
We recommend them not just during pregnancy, but in the 3 months before you conceive.
19:14
You need to be storing all these vitamins early in order to form the best and the healthiest fetus and to keep yourself healthy.
19:20
If you don't have enough folic acid in your bloodstream, you're at higher risk for developing neural tube complications, complications with your brain and the spine of the fetus.
19:34
Sirilo asks, "Is being pregnant an excuse to eat more, or do pregnant women really need to eat for two?"
19:36
You don't need to eat for two during pregnancy.
19:38
What we really want is to see maybe a slight increase in caloric intake, but not that much.
19:42
The fetus is going to develop and grow as it normally would if you just eat your normal healthy diet.
19:55
Dong Dang Sig asked, "3 months pregnant, and I don't see any baby bump yet. Is that normal?"
19:55
It's pretty common not to see a bump because the pregnancy is really only to about this level in your pelvis.
20:02
Some women show really early, especially patients in their second pregnancy can really show even at 3 months pregnancy, but others won't show that early.
20:17
TEG asked, "The only thing I've been missing this whole pregnancy is sushi."
20:17
Your obstetrician or your provider is not going to want you to eat sushi during pregnancy.
20:21
It's because it's undercooked, and you have a higher risk of being exposed to things that aren't safe for the pregnancy, like listeria or parasites.
20:32
There are some forms of sushi that you probably can eat, vegetarian sushi, eel, those are cooked.
20:32
So if you're really missing sushi, you could try those things.
20:32
Moon Yung asks, "Does pregnancy change your voice?"
20:32
The short answer to that is probably yes, pregnancy does change your voice.
20:32
There is a change in sort of that nasal congestion during pregnancy.
20:32
As all the blood vessels come to the surface, your nose can kind of feel stuffy and make your voice sound different, but there's also probably some voice box changes happening as that progesterone and estrogen is increasing in your bloodstream.
20:32
You Addicted to Me says, "Nobody talks about how your teeth shift so bad during and after pregnancy enough."
20:32
As the early part of pregnancy has a lot of progesterone, there's a change in your gums, and your teeth can move and shift during pregnancy.
21:17
It's not uncommon, and maybe we don't talk about it enough.
21:20
The one thing that a lot of patients notice is that when they brush their teeth, they see a little bit of extra gum bleeding.
21:26
That's completely normal in pregnancy.
21:28
Kier asks, "I don't know why, but I love that little dark line that be on pregnant bellies."
21:40
That little dark line is called a linea nigra, and it's essentially where the two parts of your abdomen came together when you were in your own mother's uterus.
21:44
During pregnancy, all the hormones can make it so that melanocytes come to the surface, not only in that linea nigra, but you can notice darker areas in your skin on your face and other places.
21:53
Lindam Buy asked, "I was today years old when I learned about fetal microchimerism.
21:53
As a mother, I'm simultaneously awed, happy, and terrified."
21:53
Fetal microchimerism is where there are fetal DNA or particles in the maternal bloodstream.
21:53
The mother, after she has the fetus, can have those cells and that DNA in her maternal bloodstream forever.
21:53
When a woman is donating organs to somebody that she's a genetic match for, fetal microchimerism can make that match a little bit more tenuous because she's got some DNA from her fetuses in her bloodstream, so she may not be an exact match.
21:53
So those are all the questions for today.
21:53
Thanks for asking such fun and interesting questions, and thanks for watching Pregnancy Support.