Section 2 A Healthy Pregnancy Section 2 Objectives 䊳 Identify four behaviors that are essential for a healthy pregnancy. 䊳 Explain the importance of prenatal care throughout pregnancy. Objectives Before class begins, write the objectives on the board. Have students copy the objectives into their notebooks at the start of class. 1. Focus Warm-Up Myth/Fact Ask students to share their do’s and don’ts for pregnant women. List them on the board. Refer back to this list throughout the section, correcting any misconceptions that students might have had. Vocabulary • • • • • • • • • • prenatal care obstetrician trimester ultrasound chorionic villus sampling amniocentesis ectopic pregnancy miscarriage preeclampsia gestational diabetes Chapter 19 need to visit the doctor until she begins to show, or look pregnant. Fact Regular doctor visits from the beginning of pregnancy until the birth are recommended to ensure health. . s Appt Doctor’ AM 0 :0 10 List some other do’s and don’ts for pregnant women. Review and update your list when you complete this section. Amanda starts her day with a bowl of oatmeal. Later, she and her husband go out for a brisk walk. At night, she skips a party where people will be smoking. Amanda and her husband are thinking about having a baby. Even before she becomes pregnant, Amanda started taking extra care to have a healthy pregnancy. Getting proper nutrition and exercise and avoiding drugs and environmental hazards are especially important both before and throughout pregnancy. Proper Nutrition “Now you’re eating for two,” people sometimes say to pregnant women. This is because a pregnant woman needs to eat more calories to support the growth of her own body and the developing embryo or fetus. During pregnancy, a woman needs to consume about 300 more calories than usual. The best way to obtain these extra calories is to eat a well-balanced diet rich in the key nutrients listed in Figure 4. One vitamin that is especially important during pregnancy is folic acid, or folate. Folic acid is essential for proper development of an embryo’s neural tube, which later develops into the spinal cord and brain. The neural tube forms early in an embryo’s development, often before a woman knows she is pregnant. Therefore, a woman should not wait until she knows she is pregnant to get enough folic acid. Doctors recommend that all women of childbearing age consume at least 0.4 mg (400 micrograms) of folic acid every day. Sensitive Issues 492 Myth A pregnant woman doesn’t Staying Healthy During Pregnancy Teaching Transparency W66 Discussing prenatal care may be distressing to girls in your class who are pregnant, have been pregnant, or think they could be pregnant. Boys who are fathers, or think they could be fathers, might also be concerned. Be aware of any student who is more self-conscious than usual. Take care not to draw attention to this student. Focus only on prenatal care from the perspective of a married couple, but do make yourself discreetly available to answer questions. A Healthy Pregnancy 492 Chapter 19 I! FY Changes During Pregnancy Almost every organ and system in a woman’s body is affected by pregnancy. The most important changes occur in the reproductive system. Ovulation and menstruation cease. The muscular walls of the uterus get stronger and more elastic. The cervix produces a mucus plug that prevents bacteria from entering the uterus. A pregnant woman also experiences physiological changes that allow sufficient blood and oxygen to reach the growing embryo. Her heart beats slightly faster, and the volume of blood circulating in her body increases. The amount of oxygen her body uses increases by 15 to 20 percent. 2. Teach Exercise Regular physical activity is also important for a healthy pregnancy. A fit woman will better meet the extra energy demands of carrying the fetus. She also reduces her risk for diabetes and other health problems during pregnancy. A woman should get her doctor’s approval for her exercise program. Some forms of exercise should be avoided—for example, horseback riding, where there is a high risk of falling. Avoiding Alcohol and Other Drugs As soon as she plans to become pregnant, a woman should abstain from all alcohol, tobacco, and any other drugs not prescribed or approved by her doctor. These substances, even in small amounts, can harm or kill the developing baby, decrease the newborn’s chance to live, or cause lifelong problems. For example, women who drink alcohol during pregnancy risk having a baby with fetal alcohol syndrome. As you read in Chapter 15, symptoms of fetal alcohol syndrome may include mental retardation, minor to severe heart defects, and delayed growth. Some drugs that are typically safe outside of pregnancy can cause harm to a fetus. A pregnant woman should talk to her doctor before using any prescription drugs or over-the-counter drugs, such as pain medications; creams and lotions; and vitamins. Likewise, a woman should get her doctor’s approval before using herbal teas or herbal supplements. Connect to YOUR LIFE Which recommendations for pregnant women are also good everyday advice for yourself? L3 EL Reading/Note Taking 19-2 L2 Adapted Reading/Note Taking 19-2 Staying Healthy During Pregnancy L3 Active Learning FIGURE 4 Proper nutrition contributes to the healthy development of a baby. Reading Tables Name three nutrients that play a role in the development of the nervous system. Important Nutrients During Pregnancy Nutrient Needed For Folic acid Formation of neural tube; brain and spinal cord development Protein Muscle formation and growth Calcium Bone and tooth formation; nerve and muscle development Iron Oxygen delivery by blood cells Vitamin A Cell and bone growth; eye development Vitamin B complex Nervous system development Explain that pregnant women can participate in many forms of exercise, but are cautioned against participating in others. Have students work in small groups to prepare an informational brochure about exercise for pregnant women. The brochure should help the women distinguish forms of exercise that are not appropriate from forms that are highly recommended. Students should divide up the task of collecting data. Some can search reliable Web sites. Others can interview an obstetrician and a fitness instructor who works with pregnant women. L2 Visual Learning: Figure 4 Review the nutrients listed in Figure 4. Discuss food sources of these vitamins and minerals. If necessary, refer students to the charts in Chapter 8, Section 2. Explain that pregnant women are routinely given vitamin supplements as part of their prenatal care. Ask: Why should women who are considering pregnancy get adequate amounts of these nutrients? (Critical embryonic development has already occurred before a woman realizes that she is pregnant.) Caption Answer folic acid, calcium, vitamin B complex Connect to Sample answer: proper nutriYOUR LIFE tion, exercise, and avoiding Pregnancy, Birth, and Childhood 493 alcohol and other drugs L2 Less Proficient Readers After students read about the four behaviors that are essential for a healthy pregnancy, have them create a word web that summarizes the reading. Suggest that students use the title of the subsection, Staying Healthy During Pregnancy, in the center circle of the web. Students can use the run-in headings to name the behaviors that branch from the center circle. Finally, students should add details in circles that are attached to each behavior. Pregnancy, Birth, and Childhood 493 Chapter 19, Section 2 Avoiding Environmental Hazards Some common substances found in the environment, including many chemicals and diseasecausing organisms, can seriously harm a fetus. Pregnant women should take care to avoid exposure to these substances. L3 Building Health Skills Advocacy Have students write an e-mail to an imaginary older cousin or sister who is newly pregnant. In their e-mails, students should describe one environmental hazard their cousin or sister might inadvertently come into contact with. Students should explain how this substance or organism can harm the growing embryo and advocate for avoiding it. 䊳 X-rays The radiation from X-rays can harm a developing embryo or fetus. This is why doctors and dentists ask women if they could possibly be pregnant before taking an X-ray. 䊳 Lead The main source of exposure to lead is from lead-based paint present in older homes. If a pregnant woman lives in a home built before 1978, she should contact her state health department for information on getting her home tested for lead. 䊳 Mercury Most exposure to this dangerous metal comes from eating contaminated fish. Pregnant women should eat commercially caught fish only once a week, and should not eat swordfish or shark. 䊳 Cat litter Cat feces can contain a parasite that is especially dangerous to a developing fetus. Pregnant women should avoid contacting soiled cat litter or garden soil. Prenatal Care L2 Building Vocabulary Point out the meanings of the Latin roots of the word trimester. Tri- means “three;” mensis means “month.” Ask students to list and define other words beginning with the prefix tri-. (Triangle, a figure with three angles; trilogy, a story with three parts; triplets, three babies born at the same time.) Then ask students to think of words that use the Latin root word mensis. (Semester, originally a school term of six months; menstruation, bleeding that occurs each month in fertile women) FIGURE 5 A doctor monitors the health of the mother-to-be and her fetus during regular prenatal visits. Prenatal Care Besides taking care of herself at home, a woman also needs to plan for prenatal care, or medical care during her pregnancy. Her doctor visits should be under the supervision of an obstetrician, a doctor specialized in pregnancy and childbirth. The chances of having a healthy baby greatly increase if the mother visits her doctor or clinic for regular checkups throughout pregnancy. The Three Trimesters A pregnancy is divided into three periods of time— trimesters —each of which is approximately three months long. Figure 5 lists things the parents-to-be can expect at routine visits. L3 Cooperative Learning Explain to students that during visits to her doctor, a pregnant woman has an opportunity to ask questions about her pregnancy, as well as how to care for her baby after it is born. Have student groups produce a list of questions that a woman might ask her doctor during a prenatal visit. Then ask groups to share their questions with the class. First Trimester Second Trimester • Record medical history and weight • Note conditions that could affect the pregnancy • Monitor heartbeat of fetus • Measure growth of uterus • Prescribe prenatal vitamins as needed 494 • Monitor for complications using ultrasound and other tools Chapter 19 and Health L2 Summary Have students write a summary about how to stay healthy during pregnancy. Students should base their summaries on the four behaviors that are essential for a healthy pregnancy described in the section. 494 Chapter 19 Summaries should clearly differentiate between behaviors that should be practiced and behaviors that should be avoided. Challenge students to limit their summaries to one or two paragraphs. Monitoring Tools Prenatal care gives a pregnant woman access to the latest medical tests and technologies. 䊳 Ultrasound Did you know that your first pictures may have been taken months before you were born? High-frequency sound waves, or ultrasound, are used in most pregnancies to create an image of the developing fetus. Ultrasound may be used at any point during pregnancy, although it is typically used in the sixteenth to twentieth week. Using ultrasound, a doctor can tell the age of the fetus, whether it is a boy or girl, and if the heart, muscles, and bones are developing normally. Ultrasound may also detect the presence of more than one fetus or confirm the position of the fetus in the uterus. 䊳 Chorionic Villus Sampling Around the eighth week of pregnancy, some women will undergo a test called chorionic villus sampling, or CVS. To perform the test, the doctor removes and tests a small piece of the developing placenta. CVS can detect inherited disorders in the embryo such as hemophilia or extra chromosomes. The test is only done when risk factors are present, such as a family history of genetic disorders or when the mother is over the age of 35. An older mother has an increased risk of having a baby with Down syndrome or other chromosomal abnormalities. 䊳 Amniocentesis Another test that may be done around the fourteenth to sixteenth week of pregnancy is amniocentesis (am nee oh sen TEE sis). The procedure involves inserting a needle into the woman’s abdomen and uterus to remove a small amount of amniotic fluid surrounding the fetus. The doctor then tests fetal cells naturally found in this fluid for abnormalities. Like CVS, amniocentesis is only performed when the fetus is at higher risk for a genetic disorder. CVS and amniocentesis are not routine tests because they slightly increase the risk of miscarriage, or death of the fetus. Connect to YOUR LIFE L2 Visual Learning: Figure 5 Use the charts in Figure 5 showing typical events during prenatal checkups to begin a discussion on the importance of prenatal care. Ask: What kinds of issues are addressed by the doctor during the first trimester? (preparing for future changes during the pregnancy, helping the mother change her behaviors to ensure a healthy baby) What is the focus of prenatal care during the second trimester? (the health of the mother and the developing fetus and the presence of complications) The third trimester? (getting ready for delivery and monitoring the fetus and mother for any health issues) Explain that fathers are encouraged to accompany the mother during prenatal visits to give support, share in the joy of monitoring the growth of the fetus, and help make decisions about complications that might arise. L1 Active Learning Share pictures of ultrasound images of your own children or those of fellow teachers, friends, or family. Pass around the photos, or alternatively, make them into slides to project, and have students name any structures they can identify. Point out that internal structures, such as the brain, heart, stomach, and skeleton, are also imaged by ultrasound and may be visible in your pictures. Help students locate any internal parts that show up in your pictures. Remind students that ultrasound is a very useful, low-risk tool for doctors to check on the health of a fetus. Have you ever seen an ultrasound picture of a fetus? What features could you recognize? Third Trimester • Check position and size of fetus • Check for warning signs of premature, or early, birth • Continue to monitor for complications • Discuss birth process L3 Building Health Skills Pregnancy, Birth, and Childhood 495 EL English Language Learners The terms that describe the monitoring tools used during pregnancy and the possible complications of pregnancy might be difficult for students to say and comprehend. Work with students to create a notebook or bulletin board display of these terms. Include pictures or diagrams for terms that lend themselves to visuals (such as ultrasound and amniocentesis). Also include phonetic spellings and simple definitions. Have students practice saying the terms by pairing them with students who can pronounce the terms correctly. Making Decisions Explain that it is possible for parents to learn the sex of their baby during pregnancy. Discuss the advantages and disadvantages of learning this information. Then ask students to write a paragraph explaining whether or not they would want to know the baby’s sex if they had to make this decision. Connect to Recognizable features include YOUR LIFE arms, legs, head, eyes, fingers, and toes. Pregnancy, Birth, and Childhood 495 Chapter 19, Section 2 L3 Content Update Use the Web Code to access up-to-date information about pregnancy care. Have students complete the Web activity. For: Updates on pregnancy care Visit: www.SciLinks.org/health Web Code: ctn-6192 3. Assess Complications Problems can occur at any time during pregnancy. For some of these complications, timely treatment can reduce negative consequences or even save the life of the woman or fetus. 䊳 Ectopic pregnancy In the very rare case of an ectopic pregnancy, the blastocyst implants in the fallopian tube or elsewhere in the abdomen, instead of in the uterus. It cannot develop normally and may put the mother’s life at risk. Surgery is necessary to remove the embryo and repair the damaged fallopian tube. 䊳 Miscarriage The death of an embryo or fetus in the first 20 weeks of pregnancy is called a miscarriage. Almost all miscarriages take place during the first trimester. They can occur before or after a woman knows she is pregnant. At least 15 percent of recognized pregnancies end in miscarriages. Miscarriage is usually caused by a serious genetic defect, but it is sometimes due to illness or a drug the mother has taken. In other cases, there is no apparent reason for a miscarriage. 䊳 Preeclampsia Preeclampsia (pree ih KLAMP see uh), which is also called toxemia, is characterized by high blood pressure, swelling of the wrists and ankles, and high levels of protein in the urine. Its onset is usually in the second or third trimester. Preeclampsia prevents the fetus from getting enough oxygen. This serious condition is treated with bed rest or medication. 䊳 Gestational Diabetes Diabetes that develops in pregnant women is called gestational diabetes and is marked by high blood sugar levels. It usually develops later in pregnancy. If untreated, excess blood sugar can pass through the placenta to the fetus. The fetus may grow too large, which increases the risk of a difficult birth. The birth may also occur early, resulting in breathing problems for the newborn. Evaluate These assignments can help you assess students’ mastery of the section content. Section 2 Review Answers appear below. Teaching Resources • Practice 19-2 • Section 19-2 Quiz L2 Reteach Have students work in groups to create a poster that describes the four behaviors that are essential to a healthy pregnancy. Students should also add prenatal doctor visits and their importance. L4 Enrich Teaching Resources • Enrich 19-2 Health at Health at Home Section 2 Review Key Ideas and Vocabulary Home Ultrasound Pictures Students’ paragraphs should describe their impressions of the ultrasound pictures and the parts of the fetus they were able to discern. Students should also describe how the parents were feeling and how the ultrasound pictures affected those feelings. 1. List four healthy habits that a pregnant woman should adopt before and during pregnancy. 2. Why is prenatal care so important throughout pregnancy? 3. About how long is each trimester of a pregnancy? 4. What is chorionic villus sampling? Under what conditions is it sometimes recommended? 5. Describe three symptoms of preeclampsia. How is it treated? 496 Ultrasound Pictures Ask your mother or other relative with children if she saved any ultrasound pictures from her pregnancy. Ask permission to see the pictures. Ask about her emotions during the ultrasound—were she and the father scared, happy, excited? Write a paragraph about the pictures and the parents’ experience. Critical Thinking 6. Evaluating From the following list, which food choice is generally recommended for pregnant women: swordfish, spinach, wine, herbal tea? 7. Comparing and Contrasting How are chorionic villus sampling and amniocentesis alike? How are they different? Chapter 19 Section 2 Review 1. get proper nutrition, exercise, avoid alcohol and other drugs, avoid environmental hazards 2. Prenatal care greatly increases the chances of having a healthy baby. 3. three months 496 Chapter 19 4. A small piece of the placenta is removed and tested; when there is a family history of a genetic disorder or when the mother is over the age of 35. 5. high blood pressure, swelling of the wrists and ankles, high levels of protein in the urine; bed rest or medication 6. spinach 7. Similarity: Both are tests performed when the fetus is at risk for a genetic disorder. Difference: Fetal cells in the amniotic fluid are tested in amniocentesis. A piece of the placenta is tested in chorionic villus sampling.