Session 5: Week 26 - Are You Too Sweet
Main Education Topics: Upcoming labs, Immunizations, Fetal Movement
What blood work is done in the third trimester?
What blood work is done in the third trimester? In the third trimester, we typically do the diabetes screening, which is the one-hour glucose test. We also do the anemia screening, which is a CBC. Additionally, we add on some STD screenings that the state recommends to ensure we’re not missing anything late in pregnancy.
Why is the glucose test important? The glucose test is important because undiagnosed diabetes carries a risk of fetal stillbirth. To monitor everything we can during pregnancy, we want to ensure that if we do find diabetes, we control it well.
What is gestational diabetes? Gestational diabetes often occurs in the third trimester and is becoming more common as we see more obesity in the community and family history risks. It increases the risk of fetal compromise, so screening and catching it is essential. With gestational diabetes, there are risk factors such as the baby getting too big, excess fluid around the baby, and risks during delivery like shoulder dystocia and obstructed labor. Therefore, we recommend monitoring it closely. Monitoring involves keeping track of blood sugars throughout the pregnancy and controlling them with diet whenever possible. If needed, we add medication, with insulin being the safest option, though some patients may prefer oral medications. If diabetes is controlled with medications, either insulin or oral, we monitor more closely due to the increased risk to the fetus. Gestational diabetes is also a precursor to developing diabetes later in life, so we recommend regular diabetes screenings after pregnancy, usually yearly.
What vaccines are recommended during pregnancy and why should I get them? During pregnancy, we recommend the Tdap vaccine in the third trimester, anytime from 27 to 36 weeks. It covers whooping cough (pertussis), and the antibodies produced will cross the placenta, giving immunity to the baby and protecting them for the first few months of life. Even if you received the vaccine before pregnancy, it’s still recommended to get it again in the third trimester for initial antibody protection. We also offer the RSV vaccine during RSV season (September through January), given between 32 and 36 weeks, to protect the baby from RSV after birth. Additionally, we recommend the flu vaccine if you’re pregnant during flu season. It’s very safe and helps protect both you and the baby, especially since pregnancy can weaken the immune system, making the flu more severe and potentially leading to hospitalization.
How do I do kick counts and what is normal? For kick counts, ensure the baby is active by drinking something sweet or cold, then lie on your left side for the best blood flow to the uterus. Start timing and count the baby’s movements or kicks. Once you get 10 movements or kicks, you can stop. If you reach two hours without 10 movements, contact OB triage for monitoring to ensure everything is going well.
Week 26 Pregnancy Insights
During the second and third trimester, your provider will order routine lab testing, generally between 24-28 weeks gestation. These include:
- Complete Blood Count - screening for anemia and blood disorders
- Glucose Tolerance Test - screening for gestational diabetes
- HIV repeat test - standardized for protection of all babies
- Antibody testing if RH Negative
Immunizations
Some vaccines given during pregnancy are given to protect the baby from getting very ill after birth; this includes Tdap and RSV. Other vaccines, like COVID-19 and Influenza, can prevent serious illness in both pregnant people and their infants after they are born.
The CDC recommends that pregnant women should get the flu vaccine. Influenza is more likely to cause illness that results in hospitalization in pregnant people than in people of reproductive age who are not pregnant. Flu also may be harmful for a pregnant person’s developing baby.
Is this vaccine safe for me and my baby?
Yes, the flu vaccine is safe during pregnancy for mom and baby. It can protect you during and after pregnancy and can also protect your baby for several months after birth against flu and flu-related hospitalizations. The pregnant parent passes antibodies onto the developing baby during pregnancy. Those who are vaccinated while pregnant or breastfeeding also develop antibodies against flu that they can share with their infants through their breast milk. Pregnant people should get the Flu shot and not the nasal spray flu vaccine.
When should I get the Flu vaccine?
For most adults, September and October are generally good times to be vaccinated each year. It is recommended that pregnant people get vaccinated during any trimester of their pregnancy.
The CDC recommends that pregnant women should get a dose of Tdap during every pregnancy, to protect the newborn from whooping cough (pertussis).
Whooping cough, sometimes called pertussis, is a serious disease that can cause babies to stop breathing. In the U.S., about half of babies younger than 1 year old who get whooping cough are hospitalized. About 7 in 10 deaths from whooping cough are among babies younger than 2 months old. These babies are too young to be protected by their own vaccination.
Whooping cough spreads from person to person when coughing or sneezing. It also spreads when people spend a lot of time together or share breathing space, like when you hold your newborn on your chest. Some people with whooping cough may have a mild cough or what seems like a common cold. Since symptoms can vary, children and adults may not know they have whooping cough and can end up spreading it to babies they are in close contact with.
Is this vaccine safe for me and my baby?
Yes, Tdap vaccine is very safe for you and your baby. The most common side effects are mild, like redness, swelling or pain where the shot is given in the arm. This should go away within a few days. You cannot get whooping cough from the vaccine. The vaccine does not contain any live bacteria.
When should I get the Tdap vaccine?
The CDC recommends the Tdap vaccine administration during the 27th-36th week of pregnancy so that your body can create antibodies and pass them to your baby before birth. These antibodies will help protect your newborn right after birth and until your baby gets his own first whooping cough vaccine at 2 months. During the first few months of life, your baby is most vulnerable to serious complications from this disease.
If I recently got this vaccine, why do I need it again?
The number of antibodies in your body is highest about 2 weeks after getting the vaccine but then starts to decrease over time. That is why the vaccine is recommended during every pregnancy - so that each of your babies gets the greatest number of protective antibodies form you and the best protection possible against this disease.
Mom: Only you can provide your newborn baby with the best protection possible against whooping cough.
You may have heard that your baby's father, grandparents, and others who will be in contact with your baby will need to get their whooping cough vaccine as well. The strategy of surrounding babies with protection against whooping cough is called "cocooning." However, cocooning may not be enough to prevent whooping cough illness and death. This is because cocooning does not provide any direct protection (antibodies) to your baby, and it can be difficult to make sure everyone who is around your baby has gotten their whooping cough vaccine. Since cocooning does not completely protect babies from whooping cough, it is even more important that you get the vaccine while you are pregnant.
The CDC recommends that pregnant women should receive a single dose of the RSV vaccine so that their babies are protected against severe RSV disease from birth through 6 months of age. Either maternal RSV vaccination or infant immunization with RSV monoclonal antibody is recommended. Most infants will not need both.
Is this vaccine safe for me and my baby?
Yes, the RSV vaccine is safe for you and your baby. The most common side effects are pain at the injection site, headache, tiredness, and nausea. There is, however, a small chance of a preterm birth. Women and their health care providers should discuss the relative advantages and disadvantages of the vaccine and decide if it the right choice for them.
When should I get the RSV vaccine?
The CDC recommends the RSV vaccine be administered during the 32nd-36th week of pregnancy so that your body can create antibodies and pass them to your baby before birth. The vaccine is given during peak RSV season (typically from September through January) to prevent severe RSV disease in infants.
Is the RSV vaccine recommended to protect pregnant people from RSV?
The RSV vaccine given to pregnant people is intended to protect their infants. For most younger or middle-aged adults, RSV is a mild illness with cold-like symptoms. However, it can be much more severe for infants and older adults.
Is the RSV vaccine recommended to be given during each pregnancy?
Currently, there is no data that is available on the effectiveness of the first lifetime dose during subsequent pregnancies. More dada is needed to determine whether additional doses should be given in subsequent pregnancies. The CDC will continue to evaluate the data and may update recommendations prior to the next RSV season.
To learn more about vaccines during pregnancy, visit https://www.cdc.gov/vaccines/pregnancy/index.html
Fetal Movement
Fetal movements are the kicks, rolls, and hiccups of your unborn baby. You may start to feel these movements when you are 20 weeks pregnant. Fetal movements show that your unborn baby is getting the oxygen and nutrients he needs before birth. Fewer fetal movements may signal a problem with your baby’s health.
Fetal activity can be described by 4 states, from least to most active. During quiet sleep, your unborn baby may be still for up to 2 hours.
During active sleep, he kicks, rolls, and moves often. During the quiet awake state, he may only move his eyes. The active awake state includes strong kicks and rolls.
You may feel your baby move more after you eat, or after you drink caffeine. You may feel your baby move less while you are more active, such as when you exercise. You may also feel fewer movements if you are obese. Certain medicines can change your baby’s movements. Tell your health care provider about the medicines you are taking.
It is important to keep a log of your baby’s movements at home. Start a timer and record the time it takes for you to feel 10 fetal movements. Pick a time when baby is active to start counting, preferably around the same time every day. Fetal movement is most often felt when you lie quietly on your left side. After each day's counting session, compare that time with your past sessions.
Once you’ve felt 10 movements, the test is over. If you’ve reached the 2 hour mark on the timer and if you haven’t felt your baby move at least 10 times, please proceed to OB triage for further monitoring.
Pages in this section
- Session 5: Week 26 - Are You Too Sweet
- Session 1: Week 10 – You’re Pregnant: Now What?
- Session 2: Week 14 – We made it! Bring on 2nd Trimester!
- Session 3: Week 18 - Hey Baby, There You Are
- Session 4: Week 22 - Premature Labor
- Session 6: Week 30- I’m Getting Ready for You!
- Session 7: Week 32- What do I do when you’re here?
- Session 8: Week 34 - Boobs, Blues, and Contraception
- Session 9: Week 36 – Are we there yet?
- Session 10: Week 38 – Here comes your eviction notice!