Chen A et al. Mifepristone-induced early abortion and out- come of subsequent wanted pregnancy. Am J Epi, Am J Epi, 160(2), 2004. 160(2), 2004.

Beral V et al. Breast cancer and abortion: Collaborative re-a.n.a.lysis of data from 53 epidemiological studies. Lancet, Lancet, 363(9414), 2004. 363(9414), 2004.

Michels K et al. Induced and spontaneous abortion and incidence of breast cancer among young women. Arch Intern Med, Arch Intern Med, 167(8), 2007. 167(8), 2007.

65.Pregnancy and Birth Sourcebook, Third Edition Melbywe M et al. Induced abortion and the risk of breast cancer. NEJM, NEJM, 336(2), 1997. 336(2), 1997.

Jones RK et al. Abortion in the United States: Incidence and access to services, 2005. Perspectives on s.e.xual and Reproductive Health, Perspectives on s.e.xual and Reproductive Health, 40(1), 2008. 40(1), 2008.

Boonstra H. Mifepristone in the United States: Status and future. The Guttmacher Report on Public Policy, The Guttmacher Report on Public Policy, 5(3), 2002. 5(3), 2002.

Guttmacher Inst.i.tute. State funding of abortion under Medicaid. State Policies in Brief, State Policies in Brief, 2008. 2008.

Ibid.

Guttmacher Inst.i.tute. Restricting insurance coverage of abortion. State Policies in Brief, State Policies in Brief, 2008. 2008.

Ibid.

Jones RK et al. Abortion in the United States: Incidence and access to services, 2005. Perspectives on s.e.xual and Reproductive Health, Perspectives on s.e.xual and Reproductive Health, 40(1), 2008. 40(1), 2008.

Ibid.

Ibid.

Ibid.

Center for Reproductive Rights. Targeted Regulation of Abortion Providers, Targeted Regulation of Abortion Providers, 2007. 2007.

Guttmacher Inst.i.tute. Protecting access to clinics. State Policies in Brief, State Policies in Brief, 2008. 2008.

Guttmacher Inst.i.tute. Counseling and waiting periods for abortion. State Policies in Brief, State Policies in Brief, 2008. 2008.

Jones RK et al. Abortion in the United States: Incidence and access to services, 2005. Perspectives on s.e.xual and Reproductive Health, Perspectives on s.e.xual and Reproductive Health, 40(1), 2008. 40(1), 2008.

Guttmacher Inst.i.tute. Parental involvement in minors' abortions. State Policies in Brief, State Policies in Brief, 2008. 2008.

Additional copies of this publication (#3269-02) are available on the Kaiser Family Foundation's website at www.kff.org.

66.

Part Two

Understanding Pregnancy- Related Changes and Fetal Development

Chapter 8.

Are You Pregnant?

Chapter Contents.Section 8.1-Signs of Pregnancy .................................................. 70 Section 8.2-Understanding Home Pregnancy Tests ................. 72 Section 8.3-Calculating Your Dates: Gestation, Conception, and Due Date ...................................... 77 69.Pregnancy and Birth Sourcebook, Third Edition Section 8.1 Signs of Pregnancy From "Pregnancy," by the National Inst.i.tute of Child Health and Human Development (NICHD, www.nichd.nih.gov), part of the National Inst.i.tutes of Health, February 5, 2008.

What is pregnancy?

Pregnancy is the term used to describe when a woman has a growing fetus inside of her. In most cases, the fetus grows in the uterus.

Human pregnancy lasts about 40 weeks, or just more than 9 months, from the start of the last menstrual period to childbirth.

What are the signs of pregnancy?

The primary sign of pregnancy is missing one or more consecutive menstrual periods. However, because many women experience menstrual irregularities that may cause missed periods, women who miss a period should see their health care provider to find out whether they are pregnant or whether there is another health problem.

Others signs and symptoms of pregnancy may include: * nausea or vomiting, morning sickness; * sore b.r.e.a.s.t.s or nipples; * fatigue; * headaches; * food cravings or aversions; * mood swings; and * frequent urination.

How do I know I'm pregnant?

A pregnancy test is the best way to determine if you are pregnant. Home pregnancy test kits are available over the counter and 70 Are You Pregnant?

are considered highly accurate. A health care provider can also do a pregnancy test.

NICHD research in the 1970s found that high levels of the hormone human chorionic gonadotropin (HCG) in the urine were a.s.sociated with pregnancy. This research led to the development of the home pregnancy test that is commercially available today.

If you think you may be pregnant, or have a positive home pregnancy test, see a health care provider.

What is prenatal care and why is it important?

Prenatal care is the care woman gets during a pregnancy. Getting early and regular prenatal care is important for the health of both mother and the developing baby.

In addition, health care providers are now recommending a woman see a health care provider for preconception care, before she is even trying to get pregnant.

Health care providers recommend women take the following steps to ensure the best health outcome for mother and baby: * getting at least 400 micrograms of folic acid every day to help prevent many types of neural tube defects. Health care providers recommend taking folic acid both before and during pregnancy.

* being properly vaccinated for certain diseases (such as chickenpox and rubella) that could harm a developing fetus-it is important to have the vaccinations before becoming pregnant.

* maintaining a healthy weight and diet and getting regular physical activity before, during, and after pregnancy.

* avoiding smoking, alcohol, or drug use before, during, and after pregnancy.

What is a high-risk pregnancy?

All pregnancies involve a certain degree of risk to both mother and baby. But, factors present before pregnancy or that develop during pregnancy can place the mother and baby at higher risk for problems.

Women with high-risk pregnancies may need care from specialists or a team of health care providers to help promote healthy pregnancy and birth.

Factors present before pregnancy that can increase risk may include: 71.Pregnancy and Birth Sourcebook, Third Edition * young or old maternal age; * being overweight or underweight; * having had problems in previous pregnancies, such as miscarriage, stillbirth, or preterm labor or birth; and * pre-existing health conditions, such as high blood pressure, diabetes, or HIV/AIDS [human immunodeficiency virus/acquired immunodeficiency syndrome].

During pregnancy, problems may also develop even in a woman who was previously healthy. These may include (but are not limited to) gestational diabetes or preeclampsia/eclampsia.

Getting good prenatal care and seeing a health care provider regularly during pregnancy are important ways to promote a healthy pregnancy.

Section 8.2 Understanding Home Pregnancy Tests From "Pregnancy Tests: Frequently Asked Questions," by the Office of Women's Health (www.womenshealth.gov), March 20, 2009.

How do pregnancy tests work?

All pregnancy tests work by detecting a certain hormone in the urine or blood that is only there when a woman is pregnant. This hormone is called human chorionic gonadotropin, or hCG. It is also called the pregnancy hormone.

hCG is made when a fertilized egg implants in the uterus. This usually happens about six days after the egg and sperm merge. But studies show that in up to 10 percent of women, implantation does not occur until much later, after the first day of the missed period.

The amount of hCG rapidly builds up in your body with each pa.s.sing day you are pregnant.

72.Are You Pregnant?

Are there different types of pregnancy tests?

Yes. There are two types of pregnancy tests. One tests the blood for the pregnancy hormone, hCG. You need to see a doctor to have a blood test. The other checks the urine for the hCG hormone. You can do a urine test at a doctor's office or at home with a home pregnancy test (HPT).

These days, many women first use an HPT to find out if they are pregnant. HPTs are inexpensive, private, and easy to use. HPTs also are highly accurate if used correctly and at the right time. HPTs will be able to tell if you're pregnant about one week after a missed period.

Doctors use two types of blood tests to check for pregnancy. Blood tests can pick up hCG earlier in a pregnancy than urine tests can.

Blood tests can tell if you are pregnant about six to eight days after you ovulate (or release an egg from an ovary). A quant.i.tative blood test (or the beta hCG test) measures the exact amount of hCG in your blood. So it can find even tiny amounts of hCG. This makes it very accurate. A qualitative hCG blood test just checks to see if the pregnancy hormone is present or not. So this test gives a yes or no answer. The qualitative hCG blood test is about as accurate as a urine test.

How do you do a home pregnancy test?

There are many different types of home pregnancy tests (HPTs).

Most drugstores sell HPTs over the counter. They are inexpensive. But the cost depends on the brand and how many tests come in the box.

Most HPTs work in a similar way. Many instruct the user to hold a stick in the urine stream. Others involve collecting urine in a cup and then dipping the stick into it. At least one brand tells the woman to collect urine in a cup and then use a dropper to put a few drops of the urine into a special container. Then the woman needs to wait a few minutes. Different brands instruct the woman to wait different amounts of time. Once the time has pa.s.sed, the user should inspect the result window. If a line or plus symbol appears, you are pregnant.

It does not matter how faint the line is. A line, whether bold or faint, means the result is positive. New digital tests show the words "pregnant" or "not pregnant."

Most tests also have a control indicator in the result window. This line or symbol shows whether the test is working properly. If the control indicator does not appear, the test is not working properly. You should not rely on any results from an HPT that may be faulty.

73.Pregnancy and Birth Sourcebook, Third Edition Most brands tell users to repeat the test in a few days, no matter what the results. One negative result (especially soon after a missed period) does not always mean you're not pregnant. All HPTs come with written instructions. Most tests also have toll-free phone numbers to call in case of questions about use or results.

How accurate are home pregnancy tests?

Home pregnancy tests (HPTs) can be quite accurate. But the accuracy depends on the following factors: * How you use them: How you use them: Be sure to check the expiration date and follow the instructions. Wait ten minutes after taking the test to check the results window. Research suggests that waiting 10 Be sure to check the expiration date and follow the instructions. Wait ten minutes after taking the test to check the results window. Research suggests that waiting 10 minutes will give the most accurate result.

* When you use them: When you use them: The amount of hCG or pregnancy hormone in your urine increases with time. So, the earlier after a missed period you take the test, the harder it is to spot the hCG. The amount of hCG or pregnancy hormone in your urine increases with time. So, the earlier after a missed period you take the test, the harder it is to spot the hCG.

Many HPTs claim to be 99 percent accurate on the first day of your missed period. But research suggests that most HPTs do not always detect the low levels of hCG usually present this early in pregnancy. And when they do, the results are often very faint. Most HPTs can accurately detect pregnancy one week after a missed period. Also, testing your urine first thing in the morning may boost the accuracy.

* Who uses them: Who uses them: Each woman ovulates at a different time in her menstrual cycle. Plus, the fertilized egg can implant in a woman's uterus at different times. hCG only is produced once implantation occurs. In up to 10 percent of women, implantation does not occur until after the first day of a missed period. So, HPTs will be accurate as soon as one day after a missed period for some women but not for others. Each woman ovulates at a different time in her menstrual cycle. Plus, the fertilized egg can implant in a woman's uterus at different times. hCG only is produced once implantation occurs. In up to 10 percent of women, implantation does not occur until after the first day of a missed period. So, HPTs will be accurate as soon as one day after a missed period for some women but not for others.

* The brand of test: The brand of test: Some HPTs are more sensitive than others. So, some tests are better than others at spotting hCG Some HPTs are more sensitive than others. So, some tests are better than others at spotting hCG early on.

How soon after a missed period can I take a home preg- nancy test and get an accurate result?

Many home pregnancy tests (HPTs) claim to be 99 percent accurate on the first day of your missed period. But research suggests that 74 Are You Pregnant?

most HPTs do not always spot pregnancy that early. And when they do, the results are often so faint they are misunderstood. If you can wait one week after your missed period, most HPTs will give you an accurate answer. Ask your doctor for a more sensitive test if you need to know earlier.

My home pregnancy test says I am pregnant. What should I do next?

If a home pregnancy test is positive and shows that you are pregnant, you should call your doctor right away. Your doctor can use a more sensitive test along with a pelvic exam to tell for sure if you're pregnant. Seeing your doctor early on in your pregnancy will help you and your baby stay healthy.

My home pregnancy test says that I am not pregnant.

Might I still be pregnant?

Yes. Most home pregnancy tests (HPTs) suggest women take the test again in a few days or a week if the result is negative.

Each woman ovulates at a different time in her menstrual cycle.

Plus, the fertilized egg can implant in a woman's uterus at different times. So, the accuracy of HPT results varies from woman to woman.

Other things can also affect the accuracy. Sometimes women get false negative results when they test too early in the pregnancy. This means that the test says you are not pregnant when you are. Other times, problems with the pregnancy can affect the amount of hCG in the urine.

If your HPT is negative, test yourself again in a few days or one week. If you keep getting a negative result but think you are pregnant, talk with your doctor right away.

Can anything affect home pregnancy test results?

Most medicines should not affect the results of a home pregnancy test (HPT). This includes over-the-counter and prescription medicines, including birth control pills and antibiotics. Only medicines that have the pregnancy hormone hCG in them can give a false positive test result. A false positive is when a test says you are pregnant when you're not. Sometimes medicines containing hCG are used to treat infertility (not being able to get pregnant).

75.Pregnancy and Birth Sourcebook, Third Edition Alcohol and illegal drugs do not affect HPT results. But do not use these substances if you are trying to become pregnant or are s.e.xually active and could become pregnant.

For More Information For more information on pregnancy tests, contact the National Women's Health Information Center (800-994-9662) or the following organizations: American College of Obstetricians and Gynecologists 409 12th Street, SW P.O. Box 96920 Washington, DC 20090-6920 Phone: 202-638-5577 Website: www.acog.org American Pregnancy a.s.sociation 1425 Greenway Drive Irving, TX 75038 Phone: 972-550-0140 Fax: 972-550-0800 Website: www.americanpregnancy.org E-mail: [email protected] Planned Parenthood Federation of America 434 West 33rd Street New York, NY 10001 Toll-Free: 800-230-7526 Phone: 212-541-7800 Fax: 212-245-1845 Website: www.plannedparenthood.org U.S. Food and Drug Administration 10903 New Hampshire Avenue Silver Spring, MD 20903 Toll-Free: 888-463-6332 Website: www.fda.gov 76.Are You Pregnant?

Section 8.3 Calculating Your Dates: Gestation, Conception, and Due Date "Calculating Your Dates: Gestation, Conception & Due Date,"

2008 American Pregnancy a.s.sociation (www.americanpregnancy.org).

Reprinted with permission.

Gestational age, or the age of the baby, is calculated from the first day of the mother's last menstrual period. Since the exact date of conception is almost never known, the first day of the last menstrual period is used to measure how old the baby is.

Calculating Gestational Age Last menstrual period: If the mother has a regular period and knows the first day of her last menstrual period, gestational age can be calculated from this date. Gestational age is calculated from the first day of the mother's last menstrual period and not from the date of conception.