I'm Shilpi Mehta-Lee and I'm a high-risk pregnancy doctor.

I'm here today to answer your questions from the internet.

This is Pregnancy Support.

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@kingeniola asks, Apparently I can up my chances

of having twins if I eat loads of yams.

Please confirm.

It turns out, probably not.

Where this comes from is the Yuruba 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

and it's thought that perhaps this particular white yam

caused twinning to be increased in that patient population.

Whether you eat yams from your local grocery store

and that causes twinning is yet to be determined.

At @alybarrington asked,

Did you know they had pregnancy tests

in ancient Egyptian society?

This stuff is so damn cool.

Yes, in fact, they did have pregnancy tests

in ancient Egyptian society.

Women would urinate on these two bags of grain,

barley and wheat, that were responsive to estrogen,

and if those grains sprouted,

it meant that the mother was pregnant.

It's thought to have been about 70

to 80% accurate at detecting pregnancy,

which is really quite amazing.

Now we have a filtration type of lab

that you can do literally at home.

You pee on a stick.

The beta HCG, the human chorionic gonadotropin

that is formulated

when the embryo is forming in your uterus,

is excreted really early on,

so probably not the first two

to three days after you conceive,

but pretty much right after that.

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.

If it's a negative result, you'll only see one line

because it's just the control.

@kaecinema asks, How the hell does an ultrasound work?

It's like a hack where they see right through you.

It kind of is a hack where we do see right through you.

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.

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.

This is a two-dimensional image.

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.

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.

Now on these 3D images,

you can see more lifelike fetal images,

but we don't use them so much

in diagnosing medical problems.

We really still rely very heavily

on those two-dimensional images to diagnose fetal issues.

@toedavb asks, Is it okay to exercise during pregnancy?

Regular and routine exercise in pregnancy

is completely safe.

The fetus is in a pool of amniotic fluid.

It's always moving.

It's in a constant state of sort of anti-gravity,

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.

@Simply-Tootsiie ask, Why TF when you pregnant,

everything smells so effing weird?

All of my patients say, I can smell so much more.

It smells different. It smells funny.

There is an evolutionary theory about this.

It may help you to prevent eating something that's toxic

to either yourself or the pregnancy during that time.

@athonymw asks, What is vanishing twin syndrome

and what are the causes?

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.

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,

and that's called a vanishing twin.

That twin vanished.

The other twin will go on to form a totally normal embryo.

A vanishing twin in the first trimester

is not considered to be a dangerous outcome

that causes an adverse pregnancy outcome.

A lot of times when a twin gestation form,

20 or 30% of the time,

there's a vanishing twin.

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,

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.

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.

@BlueNeptune asks,

Do you think babies can taste in the womb?

Like damn, that [beep] is eating spaghetti again?

Actually, flavor molecules can pass

from the maternal bloodstream through the placenta

and into the amniotic cavity.

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.

Infants do gravitate towards similar food choices

as their moms do,

so it's possible that that flavor conditioning

and flavor imprinting happens in utero

rather than just after they're born.

@mesopissed asks, How the [beep] am I supposed to know

if I'm going into labor

when I've never been in labor before?

This is a tough question because it's true.

The vast majority of first time moms don't really know

what labor feels like.

There's one really great rule of thumb

in explaining how a patient can know that they're in labor.

We use the 5-1-1 rule.

That's where a patient feels cramping and contractions

and pain in their abdomen

and in through their pelvis every five minutes.

And that pain lasts approximately one minute

and it lasts for over an hour.

And if it's happening

and you have an hour of contractions,

you might wanna head to the hospital

or at least call your doctor.

@minetiract asks, Wait, do babies cry in the womb?

The amniotic fluid that is in the mother's uterus

makes it so that babies can't make really any sound,

but there are some studies to show

that perhaps at 28 weeks,

babies can start doing practice grimacing in the womb.

When we are performing ultrasound,

we actually look for different kinds of practice movements.

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,

but we don't usually look for practice crying.

@Vhusie_N says, Cryptic pregnancy will always shock me

'cause what do you mean you had cramps

and the next thing you were giving birth?

A cryptic pregnancy is where you don't know you're pregnant

until the end of the pregnancy or the third trimester.

Cryptic pregnancy probably happens about one in 500 times.

We think that it most likely happens

for one of two sets of reasons.

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.

And the other part of cryptic pregnancy

probably has to do with mental health,

patients who didn't recognize they were pregnant

due to mental health condition.

@allicatto asks, Are you telling me that the easiest way

to avoid cleaning cat litter is to be pregnant?

We really do advise women

not to change cat litter in pregnancy.

That's because some cats carry a parasite

called toxoplasmosis

and it can cause birth defects.

Toxoplasmosis isn't only found in the cat litter.

It can be found in the ground and in undercooked foods.

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.

They actually test for it.

In the United States, it's less ubiquitous

and we don't find that there's a need to test for it.

@finstanSG says,

At how many weeks do you think a fetus becomes viable?

The early third trimester, probably at about 24 weeks.

That's when a fetus can survive outside of the uterus.

That may change with advances in neonatology

and in technologies that can help earlier

and earlier fetuses survive.

@Kofi99 asks, Babies can poo inside the womb?

Yes, babies can poo inside the womb.

We call it meconium.

Meconium is really a natural byproduct

of swallowing the skin cells

and the hair cells in the amniotic fluid

all the way through the first, second,

and third trimesters of pregnancy.

This happens about 13% of the time,

and we can see that greenish tinge

to the amniotic fluid at birth.

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.

@trash_netflix says, How does Plan B work?

It basically delays ovulation for about 72 hours.

In a normal pregnancy, we wanna 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.

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.

@JanelleAngelie asks, Why does no one talk about

how terrible the first trimester is?

In the first trimester of pregnancy,

a lot of things are happening.

Your body is changing so much.

You're getting all that progesterone,

all that estrogen into your bloodstream.

The embryo is growing from a really small size.

The vast majority of the fetal organs are forming.

Up to about 12 weeks of pregnancy,

you're seeing bone and skin and heart structures,

and so organogenesis, that early part of the pregnancy,

is super, super important

and it probably does make you feel a little terrible.

@Kensetsu6 asks, What happens in the second trimester?

There's continued formation of the organs

through the second trimester.

That's when neurodevelopment begins,

when the brain starts developing.

There's also development of teeth and other organs.

This is probably about a late second-trimester fetus.

It's no longer the size of a small embryo.

It's really growing up to about the mother's belly button

or beyond.

Also, in the second trimester,

people start to feel a little bit better

about the pregnancy.

They're not feeling that surge of hormones.

They've sort of acclimated to that surge.

It's kind of called the golden trimester

because people feel less nauseated,

they have more energy, and they're less fatigued.

@KBrenishiaa says, Last trimester of pregnancy, 0/10.

Do not recommend.

The third trimester of pregnancy,

somewhere around 25 to 28 weeks,

going all the way to when you deliver,

can be really difficult.

The fetus is growing about a half a pound a week.

Your uterus is coming up to your diaphragm.

The uterus is pretty large like the size of a watermelon.

The uterine walls are really thinned out.

You're feeling heavier.

You're feeling more tired.

This is when all your organs are being sort of pushed

in different directions.

You might notice a difference in how you walk and move

because there's a change in the curvature of your spine.

There is a lot of fetal development happening

in the third trimester.

There's vision developing.

There's taste buds developing.

Most importantly,

at the very tail end of the third trimester,

you're gonna get fetal lung maturity.

After the baby's born,

they have to be able to take that first breath

and use those lungs.

So the third trimester is really, really important

for that time.

@breedp_ says, Why do so many people get pregnant

with quadruplets?

Eh, 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.

Current technologies really try to avoid

more than two fetuses in the uterus.

When you use in vitro fertilization or IVF,

you might get pregnant with one, maybe two fetuses.

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.

Before IVF, the most common reason

was kind of an error in ovulation.

You released two eggs at the time you conceived

and you created twins,

so it was more common in older patients,

in patients nearing menopause to have twins.

@Mongieeeeee asks,

The mortality rate with Black women during pregnancy

and delivery is way higher than any other race.

That's true.

Black women have higher risks

of maternal morbidity and mortality in pregnancy

as compared to their white and Hispanic counterparts.

We're still working on why that is and what the reasons are.

One is possibly just structural racism

within the health community

and the ways we learn about health and healthcare.

Other things include this idea of weathering,

where if you face racism every day,

you actually may have worse health outcomes.

@KashMadonna asks, Do the second pregnancy

make you show faster or something?

There is some plausibility to this.

When you're pregnant the first time,

your muscles haven't spread.

There hasn't been that diastasis of the muscles

in the front of the abdomen yet,

but in the second pregnancy,

all of that musculature

is already sort of stretched and moved,

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.

@neo_manceo asks, Guys, is there a difference

between termination of pregnancy and abortion?

Yes, there is a slight difference

between termination of pregnancy and abortion.

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.

@Daileeeeeen asks, As I keep getting further along

in this pregnancy,

all I want is junk food.

That is so off brand for me. I'm a healthy girl.

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,

fetuses are very parasitic.

They're gonna take all the nutrients they need

from the female body

and they're gonna use it

to create this embryo and this fetus.

What's really, really, really important in pregnancy

is to eat a healthy and well-balanced nutritious diet.

Nutrient-dense foods, so whole grains,

green leafy vegetables,

things that have protein, Omega-3 fatty acids,

anything that has vitamins.

As a mom, you're expanding your blood volume,

but also the fetus is actually making

its own new blood cells.

It needs the components to do so, right, and so do you.

You need iron, you need B12, you need folic acid.

@rufusjbacon asks, What is a pregnancy glow?

I, for one, have never seen a pregnant person glow.

There is sort of a pregnancy glow.

It's one of just those biological things that's happening

as you're getting pregnant and being pregnant.

Your skin might get a little oilier.

Your face might get a little rounder

as you increase the fat content of your subcutaneous tissue.

You also notice many times stronger nails,

thicker hair, fuller hair

because you're not losing hair as much during pregnancy.

@Tharealrambo951 asks,

What happens to the baby if you smoke while pregnant?

Babies can be smaller than they would be expected to be.

That's called small for gestational age.

Babies that don't weigh quite as much

as they should at birth.

They're also a host of other adverse outcomes

that we think are associated

with tobacco smoking during pregnancy.

Increased risk of abruption,

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.

So it's really important to consider quitting smoking

during pregnancy.

@jacob sctj asks, Like have you seen what happens

to your stomach on the inside as a baby grows?

Where do your organs shift and move?

In the very beginning of pregnancy,

your uterus is really, really small.

It's just sort of sitting in the lower pelvis.

It's only about the size of a lemon.

But as the uterus grows,

it's growing up to your belly button or even higher.

There are a lot of effects on all of your organs.

Most of the early effects are from progesterone.

So progesterone is a hormone

that's secreted by the placenta

into the maternal bloodstream.

It sort of lax in all of the cartilage

and those ligaments that are all over your body,

and it makes things looser.

It makes us able to adapt.

Your intestines, which are really just flexible

and no problem really,

they can just move aside and push to the sides.

But over time, in the third trimester, really late,

you might see that the pregnancy is really coming up

into your diaphragm.

You might even feel a little short of breath

as the liver and the lungs are pushed upward.

It's not an instant quick change

back to its normal shape and size

at the end of the pregnancy.

Women leave the hospital really feeling

like they still look pregnant.

The uterus looks about 20 weeks pregnant,

and as it shrinks down,

all those organs shift and go down.

@MamaMoxieB asks, I really need answers

as to WTF preeclampsia is definitively.

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.

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.

People ask if preeclampsia is on the rise,

and it turns out that probably preeclampsia

is somewhat on the rise.

There's just more recognition

of hypertensive disorders of pregnancy.

Patients getting pregnant later in life

or using assisted reproductive technology to get pregnant.

There's also more obesity, which we think is a risk factor

for developing preeclampsia.

There's ongoing research to sort of describe

how and why preeclampsia happens in certain patients

and not in others.

@lsnxxxx ask, Okay, but like is pregnancy brain real?

Because during my pregnancy, I swear I felt illiterate.

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.

And by the time the woman delivers,

they're these huge surges in oxytocin,

which can really change the way you're thinking

because oxytocin is a pleasure hormone.

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.

Now, what's more important

is what's we're carrying in the uterus,

and so there are pregnancy changes.

@delltrick 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.

Later in pregnancy, probably around 28 weeks,

the fetal auditory system really starts forming

so they can start to hear.

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.

@alivo22_vo asks,

Why do you think it's important

for women to take prenatal vitamins when pregnant?

Every pregnancy really should have a prenatal vitamin.

We recommend them not just during pregnancy,

but in the three months before you conceive.

You need to be storing all these vitamins early

in order to form the best and the healthiest fetus

and to keep yourself healthy.

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.

@Sirilloh ask, Us being pregnant an excuse to eat more

or do pregnant women really need to eat for two?

You don't need to eat for two during pregnancy.

What we really want is to see maybe a slight increase

in caloric intake,

but not that much.

The fetus is gonna develop

and grow as it normally would

if you just eat your normal healthy diet.

@dondang_syg asks, 3 months pregnant

and I don't see any baby bump yet.

Is that normal?

It's pretty common not to see a bump

because the pregnancy is really only to about this level

in your pelvis.

Some women show really early,

especially patients in their second pregnancy

can really show even at three months pregnancy,

but others won't show that early.

@taytheg asks, The only thing I've been missing

this whole pregnancy is sushi.

Your obstetrician or your provider

is not gonna want you to eat sushi during pregnancy.

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.

There are some forms of sushi that you probably can eat.

Vegetarian sushi, eel, those are cooked,

so if you're really missing sushi,

you could try those things.

@moonsyoong asks, Does pregnancy change your voice?

The short answer to that is probably yes.

Pregnancy does change voice.

There is a change in sort of that nasal congestion

during pregnancy 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.

@You_Addicted2Me says,

Nobody talks about how your teeth shift so bad during

and after pregnancy enough.

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.

It's not uncommon, and maybe we don't talk about it enough.

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.

That's completely normal in pregnancy.

@kaykiire asks, I don't know why,

but I love that little dark line

that be on pregnant bellies.

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.

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 and your face

and other places.

@Lindambui asks, I was today years old

when I learned about fetal microchimerism.

As a mother, I'm simultaneously awed, happy, and terrified.

Fetal microchimerism is where there are fetal DNA

or particles in the maternal bloodstream.

The mother, after she has the fetus, can have those cells

in that DNA in her maternal bloodstream forever.

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.

So those are all the questions for today.

Thanks for asking such fun and interesting questions.

And thanks for watching Pregnancy Support.

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