presentation at 32 weeks pregnant

Pregnancy Week by Week

32 Weeks Pregnant

Key Takeaways at 32 Weeks Pregnant

• Soon, baby will “drop” from up near your ribs to down near your pelvis.
• Baby is most likely positioned head down at this point. Don’t panic if your ob-gyn or midwife says that they’re in breech position . There’s still time for your little one to turn.
• If you’re expecting multiples or have a high-risk pregnancy, your doctor may have ordered a 3D/4D ultrasound . (Yes, you’ll be able to discern baby’s facial features.)
• You might be feeling a little sticky down there. Vaginal discharge picks up in preparation for labor and delivery. (This is a good thing that helps prevent infections!)
• Watch for those Braxton Hicks practice contractions. They can be a bit uncomfortable, but should go away with movement. If they get more intense and more frequent, give a call to your doctor or midwife to make sure it’s not preterm labor .

Ready or not?! At 32 weeks pregnant, baby’s birth still seems far into the future, but you and baby are getting ready in a lot of ways… just in case there’s an early arrival. You’re probably dealing with some end-of-pregnancy to-dos, like telling your health insurance there’ll be a new arrival soon, and figuring out how the heck to install an infant car seat.

Video Recap at 32 Weeks

3d views: my baby, my body.

See their progress for yourself with our 3D interactive tool.

Baby at Week 32

Baby is getting ready for their descent and, as we mentioned, is likely in the head-down position now. They’re probably feeling even more cramped.

How big is baby at 32 weeks?

Your 32-week baby is as big as a squash. Still growing strong, baby measures about 16.7 inches and weighs between 4 and 4.5 pounds at 32 weeks pregnant.

Are babies fully developed at 32 weeks?

They’re getting closer every week as you near the end of pregnancy. Most development is done by now—baby has even started to "practice" breathing!—and the major work left is gaining weight. If baby’s born at 32 weeks, they would still be only around 4-4.5 pounds, which is considered low birth weight.

32 weeks pregnant is how many months?

Thirty-two weeks pregnant in months is around eight months pregnant. (Remember, though, most doctors track your progress in weeks, not months.)

32 week ultrasound

You’ll probably have a 32-week pregnancy checkup, since most OBs like to see their patients about every other week at this point in pregnancy. You probably won’t have a 32 weeks pregnant ultrasound, though—unless you have pregnancy complications or there’s something specific your doctor wants to check. For example, for women who are 32 weeks pregnant with twins, the doctor might want to perform extra monitoring from week 30 on.

Either way, you’re just weeks away from meeting your baby (or babies)! Isn’t it exciting?

Pregnancy Symptoms at Week 32

Intensity is building in the symptoms department, since heartburn and contractions tend to get more noticeable in the third trimester. But we’re guessing you’re so excited about baby’s impending arrival, these 32 weeks pregnant symptoms aren’t slowing you down—at least not too much.

More Braxton Hicks contractions

Those “practice contractions” are likely getting more frequent and stronger. (This might be confused with 32 weeks pregnant cramping.) There’s one big difference between Braxton Hicks contractions and the real deal: These guys are painless (they just feel like the uterus is tightening) and go away. Real contractions just keep coming. Women who are 32 weeks pregnant with twins are at higher risk for preterm labor, so definitely watch for contractions that don’t let up.

Darker nipples

Whoa! Those areolas might look darker thanks to hormonal changes. No one knows exactly why, but one theory is they darken so baby can see them better for breastfeeding. Your body is pretty amazing, huh?

Shortness of breath

Don't worry: Baby is getting plenty of air. You’re not, though, so don’t push yourself too hard if you have trouble catching your breath .

Check with your doctor first, but she’ll likely tell you to go ahead and pop an antacid. They’re safe for most moms-to-be to take during pregnancy if you struggle with heartburn .

Leaky boobs

Your breasts are probably noticeably bigger and they may even have begun producing colostrum, which is the thick yellow fluid that baby will eat in the first few days of life. Don’t be surprised to see a little bit leaking at this point.

Vaginal discharge

The increased discharge is your body’s way of preparing for delivery; it prevents infection down there. Keep your eye out for the mucus plug—this thick, gooey (sometimes bloody) substance covers the cervix until a few days (or just hours) before labor, when your body expels it. Another thing to keep an eye on: discharge that seems more like a watery liquid. If you’re having a constant flow that’s more like water than discharge, your water might have broken, causing a slow leak. If that’s the case, call the OB and get to the hospital, stat.

Your Pregnant Belly at 32 Weeks

A 32 weeks pregnant belly should measure about 30 to 34 centimeters from the top of the uterus to the pelvic bone. If you’re 32 weeks pregnant with twins, you’re obviously feeling more weighed down than other 32 weeks pregnant women. And chances are, you’re also even closer to delivery, since the average twin pregnancy is considered full term at 37 weeks, with the typical twin pregnancy lasting 35 to 36 weeks.

How can you tell if baby is head down at 32 weeks?

Sometime between now and around week 34 , baby will “drop” from up near your ribs to down near your pelvis, where they’ll hang out in the head-down position until delivery. When this happens, you may notice you suddenly go from “carrying high” to “carrying low.” This isn’t a guarantee, though; some babies don’t drop until Mom is actually in labor.

Is 32 weeks safe to deliver?

It’s still a little too early to deliver baby at 32 weeks. If babies are born any time before 37 weeks, they are considered premature . There are many different medical treatments available for babies born early, which may include a stay in a neonatal intensive care unit (NICU) until baby is ready to go home. Don’t panic—you’ve probably developed a good relationship with your OB at this point, and you can trust you and baby will be in good hands.

Have your support person attend those OB appointments, especially the last few weeks of your pregnancy to help prepare them for labor and delivery. Remind them to be as proactive as possible, when helping, instead of taking a back seat.

PsyD, PMH-C, a clinical psychologist and owner of Orchid Wellness & Mentoring in Cincinnati, Ohio

Tips for 32 Weeks Pregnant

You’ve got this—only about eight weeks left to go! No time like the present; here’s what you can do this week to prioritize your health and that of baby’s.

Smaller is better when it comes to meals

Avoid dreaded heartburn by not filling your plate or going for seconds. Small meals are more manageable for your digestive system if you’ve been dealing with heartburn or acid reflux. Just eat more frequently, about five or six times a day, and continue to avoid foods that are heavy on fat or spiciness.

Maintain good posture

Hunching over can make it harder to breathe—and who needs that when you’re 32 weeks pregnant? Let your lungs fill with much-needed air by sitting or standing up straight; this can also help relieve any third-trimester aches and pains too.

Keep your underwear clean and dry

Yes, this is a good hygiene tip at any time, but especially during pregnancy if you have vaginal discharge. Using a pantiliner or wearing cotton underwear and changing it when needed not only keeps you comfortable, but it may also make it easier to monitor discharge for any signs of color or texture changes that could need medical attention.

Take a short walk

If you’ve been lying down and your Braxton Hicks contractions aren’t letting up, a little exercise may do the trick. Try walking for a bit, but don’t go too far—if the contractions don’t stop, they may be the real thing, and you’ll need to call your doctor.

Phew, sleeping was rough. I'm a back sleeper, and rolling from one side to the other was brutal. The one thing that did help was a massive pregnancy pillow. It was shaped like a U so it could be scrunched, tucked, and manipulated in almost every way for maximum comfort.

Lauren K., mom of two

Pregnancy Checklist at Week 32

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

Kaiser Permanente, Pregnancy: Dropping (Lightening) , July 2023

Cigna, Ultrasound in Pregnancy (including 3D, 4D and 5D Ultrasound) , June 2023

Mayo Clinic, Labor and Delivery, Postpartum Care

Cleveland Clinic, Signs That Labor Is 24 to 48 Hours Away , April 2021

StatPearls, Braxton Hicks Contractions , August 2023

American Pregnancy Association, 32 Weeks Pregnant

American Journal of Obstetrics & Gynecology, Fetal Age and Patterns of Human Fetal Breathing Movements , July 1980

Stanford Medicine Children's Health, Prematurity

Mayo Clinic, Prenatal Care: 3rd Trimester Visits , July 2022

StatPearls, Sonography 3rd Trimester and Placenta Assessment, Protocols, and Interpretation , June 2023

Ultrasound, Ultrasound Surveillance in Twin Pregnancy: An Update for Practitioners , August 2022

Mayo Clinic, 3rd Trimester Pregnancy: What to Expect , March 2022

Advances in Experimental Medicine and Biology, Anatomy and Physiology of the Breast during Pregnancy and Lactation , August 2020

Harvard Medical School, Shortness of Breath In Pregnancy

University of Chicago Medicine, GERD and Pregnancy

StatPearls, Anatomy, Colostrum , February 2023

Cleveland Clinic, Water Breaking , October 2022

Cleveland Clinic, Fundal Height , January 2022

Cleveland Clinic, Twin Pregnancy , June 2022

Cleveland Clinic, Fetal Positions for Birth , March 2020

American College of Obstetricians and Gynecologists, How to Tell When Labor Begins , November 2021

March of Dimes, Premature Babies , October 2019

Cleveland Clinic, Heartburn During Pregnancy , January 2021

Tufts Medical Center, Trouble Breathing During Pregnancy

Women’s Health, Role of Female Intimate Hygiene in Vulvovaginal Health: Global Hygiene Practices and Product Usage , September 2017

Learn how we ensure the accuracy of our content through our editorial and medical review process .

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Week 32 of Your Pregnancy

Discover how your baby-to-be is developing at 32 weeks pregnant, and learn more about what you should expect during this intergral period.

Design By Alice Morgan / Illustration by Tara Anand

It's week 32 of your pregnancy. Your unborn baby is growing faster than ever. All major organs (except for the lungs) are now fully developed. Your baby’s skin has changed too. And they are about the size of a Napa cabbage. But what else is going on? Learn all about their development now that you are 32 weeks pregnant. Also, learn about the importance of taking care of your prenatal mental health .

Pregnancy Week 32 Quick Facts

• At 32 weeks, you are 8 months pregnant
• You have 8 weeks until your due date
• You're in the third trimester

Your Unborn Baby's Size at 32 Weeks 

Your unborn baby weighs about 3.75 pounds and is about 16.9 inches long. To put it another way, they are about the size of a Napa cabbage.

Pregnancy Symptoms Week 32 

As you enter your eighth month of pregnancy, you may be experiencing new symptoms. That, or recurrent symptoms may (still) be popping up. Some common symptoms during week 32 of pregnancy include:

• Hemorrhoids
• Lower back Ppain
• Prenatal depression, anxiety , or other mental health concerns

"Hemorrhoids are a common issue that can occur during pregnancy, especially in the third trimester," says Stanislaw Miaskowski, M.D., an OB-GYN of the Orlando Health Winnie Palmer Hospital for Women and Babies in Orlando, Florida. "Hemorrhoids are swollen veins in the rectal area that can cause discomfort and pain.” In certain instances, hemorrhoids and the rectal area can become very swollen. Get medical help if there is significant bleeding or pain, he says. "More aggressive treatments such as surgery or banding may be necessary."

Experts recommend that pregnant individuals do their best when it comes to low back pain and discomfort that may start to increase starting at week 32.

"Due to relaxing ligaments, a shifting center of gravity, stretching and weakening efficiency of abdominal wall muscles, changes in posture, and the extra weight of the pregnancy, pregnant individuals may experience low back pain," says Teresa Tan, M.D. , OB-GYN at Altos Medical Group at Stanford Medicine Children's Health in Mountain View, California.

Get professional medical help if the pain is severe or persistent—especially if it’s accompanied by fever, urinary pain, contractions/labor, or vaginal bleeding since this could be a sign of premature labor or that something else is wrong, says Dr. Tan.

Anytime you have questions about any medical or health issue, be sure to contact your health care provider.

Developmental Milestones 

What's going on with your fetus during week 32 of pregnancy? Well, a lot, actually. All of the fetus’ major organs—except for the lungs—are considered to be fully developed. There are some exciting skin changes too. Your unborn baby's skin is now opaque instead of transparent, and they may be extra active: kicking, moving, and even doing somersaults. 

Design by Alice Morgan

Prenatal Tests and Doctor's Appointments 

The majority of pregnant people will visit the doctor for a routine 32-week check-up.

Blood pressure readings are highly recommended during every prenatal visit. If you do not want to know your weight, let the staff know as soon as you're called into the exam room. 

It's important to advocate for yourself during your prenatal check-ups. Routine cervical exams are rarely necessary during every visit. Certain tests, such as urine testing are recommended each visit. Talk to your doctor about what tests are indicated and why so you can make informed decisions about your care.

Common Questions at This Pregnancy Stage

What can you do about hemorrhoids?

Hemorrhoids during pregnancy are common. In fact, it is believed that 25 to 35% of all pregnant people will get hemorrhoids. And while they can be uncomfortable, Dr. Miaskowski says there are ways to treat and (in some cases) prevent hemorrhoids. 

• Increase fiber intake. Eating a diet high in fiber can help prevent constipation, which can exacerbate hemorrhoids. Foods such as whole grains, fruits, and vegetables are good sources of fiber.
• Stay hydrated. Drinking plenty of water can help soften stool and prevent constipation.
• Take warm baths:. Soaking in a warm bath can help relieve discomfort and reduce inflammation.
• Use topical creams. Over-the-counter creams and ointments can help reduce pain and inflammation.
• Use a donut pillow. Sitting on a donut-shaped pillow can help alleviate pressure on the rectal area and reduce discomfort.

What can you do about low back discomfort or pain?

Another common complaint during week 32 of pregnancy is low back pain. But Dr. Tan believes low back pain can be alleviated with proper support. " Lower back pain can be helped with supportive clothing and shoes, a maternity support girdle, back support when sitting, safe lifting, sleeping on one's side, a full body pillow, staying active, and prenatal yoga/stretching," Dr. Tan says. She also advises avoiding prolonged standing, or even prolonged, intensive physical therapy exercises.

How should you handle prenatal depression, anxiety, and/or other mental health issues?

When most people talk about pregnancy-related anxiety and depression, they talk about postpartum depression —a condition which affects parents after the birth of their child. However, some pregnant people will experience mental health shifts during pregnancy—and these prenatal conditions can be just as worrisome. 

If you are experiencing prenatal depression, anxiety, or another mental health issue, you should speak to your health care provider. Getting a referral to a mental health professional may be just what you need, as most prenatal conditions can be treated with therapy, medication, and/or a combination of both. Lifestyle changes can also be helpful.

Things You Might Consider This Week 

You're 32 weeks pregnant, and while you’ve probably given a lot of thought to things like baby’s nursery , parental leave , and your birth plan , now is a good time to look ahead at what comes next. It’s a great time to think about infant CPR. 

Infant CPR classes prepare you to perform CPR on a baby in the event of an emergency. They teach you life-saving skills, including how to perform rescue breathing and/or first aid from choking. And while no parent wants to think of the unthinkable, being prepared is important.

Speaking of planning ahead, if you haven’t already started looking for a health care provider for your baby, now is a great time to do so. Ask your OB-GYN, friends, and family for recommendations, and do your research, i.e. make sure they take your health insurance.

Support You May Need This Week

You may be putting the final touches on your baby’s nursery at week 32 of pregnancy—or perhaps you're just getting started. There is no wrong answer or approach. But whether you're painting or washing sheets, you may need help getting things set up. Ask your partner (if you have one) or friends and loved ones to chip in. Many hands make light work.

As your pregnancy progresses, you may find your anxiety increasing. It is normal to be stressed by the uncertainty of the future and what lies ahead. But it’s important you do not brush off or diminish your feelings. Find time for self-care, i.e. take a walk, schedule a prenatal massage, or talk to a friend. Be honest and forthcoming about your feelings and, if needed, seek professional help. You do not have to go through this alone. 

Head over to week 33 of pregnancy

What Week 32 of Your Pregnancy Is Really Like

Related articles.

32 Weeks Pregnant

Your baby is the size of a

napa cabbage

At 32 weeks pregnant and throughout your third trimester of pregnancy, you've got a lot to think about and plenty to do. Not only are you experiencing various physical and emotional changes, but you're also busy checking things off to prepare for your baby's arrival. Read on for insights on your baby’s development at 32 weeks, tips on handling potential symptoms, and strategies for navigating this stage of pregnancy.

Highlights at 32 Weeks Pregnant

Here's what to know about and what to at 32 weeks pregnant:

Your baby may move into the head-down position at 32 weeks or in the coming weeks in preparation for birth.

At 32 weeks, your baby may have hair on their head, eyelashes, eyebrows, and visible toenails.

Become familiar with the signs and symptoms of labor at 32 weeks and prepare your route to the hospital for when the time comes.

Do you have all your newborn essentials? We have some recommendations below.

Have you found the perfect name for your baby? If not, find some inspiration by using our fun Baby Name Generator:

RELATED PREGNANCY TOOL

Baby Name Generator

By gender :, 32 weeks pregnant: your baby’s development.

As your due date draws near, your little one is continuing to grow and develop into the tiny human you’ll soon meet. Check out these exciting developments:

At 32 weeks pregnant, your baby is getting closer and closer to looking like the baby you’ll meet when they’re born. For example, their eyelashes, eyebrows, and even the hair on their head are now all in place.

They’ve recently started shedding the lanugo—those fine hairs that covered your baby’s body—and most of it will be gone by now, though some babies are born with a little lanugo.

If you’re having a little boy, his testicles have started to descend into his scrotum.

Your baby may be standing on their head now, or sometime soon; most babies move into the head-down position at least a few weeks before birth. Don't be surprised if your little acrobat decides to change positions several times before they’re born. You might feel them jostling into place as they flip. You may also be feeling some pressure or movement in your pelvic area at 32 weeks or closer to your due date as your baby “drops” down into a deeper position in your pelvis.

More and more fat is forming under your baby’s skin. This has slowly turned your baby’s skin from see-through to its current, opaque state.

That’s not all: Your baby’s toenails have been growing and are now visible. Get those baby nail clippers ready—you’ll be cutting those teeny-tiny nails soon enough!

If you’re 32 weeks pregnant with twins, check out our twin pregnancy symptoms week-by-week guide .

How Many Months Is 32 Weeks Pregnant?

How far along is 32 weeks pregnant? Well, at 32 weeks pregnant, you’re generally considered to be in your eighth month . It all depends on how you group the 40 weeks of pregnancy into 9 months, as they don’t fit neatly.

Baby's Size at 32 Weeks Pregnant

It’s common to wonder how big your baby is at 32 weeks. Now that you’re 32 weeks pregnant, your baby weighs around 4 pounds and measures about 11 inches in length, crown to rump—they’re about the size of a napa cabbage! How cute!

Your Baby: What Does 32 Weeks Pregnant Look Like?

The visual below illustrates what your little one might look like and how they may be positioned at 32 weeks.

Your Body at 32 Weeks Pregnant

During pregnancy, you may experience changes in your mouth, teeth, and gums that might cause some discomfort. These could include:

Sensitive gums. If your gums feel more sensitive, or if they swell or bleed when you brush or floss, it might help to rinse with salt water and use a softer brush.

Teeth feeling looser. Hormonal changes can cause your ligaments to relax, and these same hormones may also affect the tiny ligaments that hold your teeth in place. As these ligaments relax, your teeth may feel looser. Rest assured: It’s unlikely you’ll actually lose a tooth for this reason, and this feeling usually goes away after you’ve given birth.

Mouth sores. You may get these sores because your immune system is working overtime to remove germs from your mouth. The good news is that the sores typically go away after pregnancy.

It’s important to floss daily, brush twice a day, and keep up with your regular dental checkups every six months. Experts recommend arranging any elective dental procedures to happen in the first half of the third trimester (around about now) if they weren’t taken care of in the second trimester. Your dentist may recommend postponing any major dental work until after you’ve given birth.

32 Weeks Pregnant: Your Symptoms

At 32 weeks pregnant, here are some of the symptoms you may be experiencing:

Leg cramps. Have you been experiencing sharp, painful cramping in your calves around 32 weeks pregnant? You’re not alone! Unfortunately, this is a common symptom of late pregnancy. It’s not known why these leg cramps occur. Try to stretch your legs before going to sleep at night. If you experience a cramp, flex your foot upward and back and massage your calves in downward strokes. This should help.

Diarrhea. It's never pleasant, but you could come down with a bout of diarrhea around 32 weeks pregnant or at any time in pregnancy. If this happens, make sure to drink plenty of water to stay hydrated. Sometimes, diarrhea during pregnancy can also be a sign of preterm labor, so if you notice any symptoms like abdominal cramps, pelvic pressure, low backache or pain, regular contractions, or your water breaking around 32 weeks pregnant—with or without diarrhea—contact your healthcare provider immediately.

“Pregnancy brain.” You might have heard of this and be wondering whether symptoms like forgetfulness and difficulty concentrating are actually caused by your pregnancy. Though pregnancy brain isn't a true medical condition according to experts, many experience these symptoms. Try keeping to-do lists if you’re struggling to remember things. Read up on “pregnancy brain” to find out more.

How Big Is a Pregnant Belly at 32 Weeks?

Although every bump is different, it’s likely that your uterus has grown to about midway between your breasts and belly button this month. Your fundal height (the distance between your pubic bone and the top of your uterus) may be between about 12 to 13 ½ inches (30 to 34 centimeters) at 32 weeks.

What Does 32 Weeks Pregnant Look Like?

For a better idea of your belly size at 32 weeks pregnant, check out the visual below:

32 Weeks Pregnant: Things to Consider

Here are some things for you to consider at 32 weeks pregnant:

Keep an eye out for symptoms like sudden weight gain, persistent headaches, changes in vision, pains in the upper abdomen or shoulder, and swelling or puffiness at 32 weeks pregnant or any time in your pregnancy. These could be signs of a pregnancy-related high blood pressure disorder called preeclampsia . If you notice any of these symptoms, tell your healthcare provider right away.

Get to know the signs and symptoms of preterm labor to stay prepared at 32 weeks pregnant and learn the difference between real contractions and Braxton Hicks contractions . If you suspect you may be in preterm labor, contact your healthcare provider immediately. Your provider may be able to suggest ways that could help you avoid a preterm delivery at 32 weeks, like bed rest, drinking lots of fluids, or medications that can help stop the contractions. In some cases, a hospital stay may be recommended.

Around 32 weeks pregnant your healthcare provider may ask you to monitor fetal movements to see if there’s a sudden increase or if they’ve slowed down—your provider will be able to suggest how to proceed. One option could be to do “kick counts,” keeping track of how long it takes to count 10 movements. Pick a time of day when your baby is typically energetic—for example after you’ve eaten a meal. Download our fetal movement tracker .

Though you still have a way to go until your pregnancy is full term , you may have a lot on your plate in these final few weeks. To make life a little easier, check out our list of best baby products , along with some great recommendations from Pampers parents. And because diapers will be one of your most used products once your little one arrives, check out our helpful diaper size and weight chart guide .

32 Weeks Pregnant: Questions for Your Healthcare Provider

Here are some questions you may want to ask your healthcare provider at 32 weeks pregnant or any time in your third trimester:

What kind of vaginal discharge should I expect and when should I contact my healthcare provider about it?

When will my baby be fully developed?

Is it OK to bend over at 32 weeks pregnant?

Will I need to see my healthcare provider more often during the third trimester? And will I receive an ultrasound at 32 weeks pregnant?

At 32 weeks pregnant, what are some symptoms not to ignore and are there any special precautions I should take during the third trimester of pregnancy?

Are any of my past pregnancy complications likely to reappear this time around?

What labor pain relief options are available, and which is recommended for me?

32 Weeks Pregnant: Your Checklist

The following checklist may come in helpful during these final weeks of pregnancy:

☐ If a friend or loved one is hosting a baby shower for you soon and you’re planning to have a gift registry, now is a good time to take care of this. Use this baby registry checklist to make sure you’ve got the essentials covered.

☐ Stock up on any newborn baby essentials you’re still missing. If you haven’t already, you could consider planning the layout of the nursery, and thinking about how you'd like to decorate it.

☐ If you’re planning on traveling by car, do a practice drive to the hospital or birthing center around 32 weeks pregnant so that you can time how long it takes to get there. You might want to plan some alternative routes, should there be a traffic jam or road construction on the day you go into labor.

☐ Ask if you can do a tour of the hospital or birthing center. This is a good chance to familiarize yourself with hospital policies and learn about the options that are available to you.

☐ Familiarize yourself with our contractions tracking chart so you’ll know how to time contractions when the time comes.

How We Wrote This Article The information in this article is based on the expert advice found in trusted medical and government sources, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.

• American College of Obstetricians and Gynecologists. Your Pregnancy and Childbirth: Month to Month, 6th ed. (Washington, DC: American College of Obstetricians and Gynecologists, 2015).
• American College of Obstetricians and Gynecologists. Your Pregnancy and Childbirth: Month to Month, 7th ed. (Washington, DC: American College of Obstetricians and Gynecologists, 2021).
• Mayo Clinic. Guide to a Healthy Pregnancy, 2nd ed. (Rochester, MN: Mayo Clinic Press, 2018).
• Cleveland Clinic. “Fundal Height.”
• Kids health. “Week 32.”
• Mayo Clinic. “Fetal Development.”

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You might find your bump is making it harder to walk and making you "waddle". That's your body's way of compensating for all that extra weight up front.

What's happening in my body?

Over the next 4 weeks, you'll gain around 450g a week. Your baby will be putting on weight too, with around 1kg of extra fat.

The extra chubbiness will help your baby to stay at the right temperature after they're born. It's very easy for little bodies to get too hot or too cold.

Your baby is probably head down now, ready for birth ("cephalic presentation"). Try not to worry if this is not the case – there's still time.

However, if you get to around week 36 and your baby is not head down, your doctor or midwife might offer ways to encourage your baby to turn into position.

As your baby gets bigger, there will be less space in your womb. You should still feel movements, at the same rate, until you give birth.

If there are any changes to the patterns, or your baby stops moving, contact your midwife or hospital as soon as possible.

Your choice of maternity service

You've probably got a good idea now about where you would like to give birth.

If you're having a planned caesarean section , find out how long you can expect to be in hospital so you can get prepared and make any arrangements you need, for instance care for your other children. The average hospital stay is 3 or 4 days.

Ask as many questions as you like and make sure you're confident with your choice. If you're not sure, you can change your mind.

Find out what other people think of your local NHS maternity services .

If you're worried about how coronavirus might impact your birth plan, visit the Royal College of Obstetricians and Gynaecologists for the most up-to-date advice.

Within 24 hours of giving birth, you'll be asked if you would like your baby to have vitamin K , which is recommended by the Department of Health for all babies.

Vitamin K is important because it helps the blood to clot and can prevent a very rare condition called vitamin K deficiency bleeding, which can cause brain damage and even death. It is usually given as a jab in the thigh and is very safe.

It's your right to refuse the jab or ask for the vitamin to be given by mouth (orally) instead. Decide what is best for your baby and discuss it with your partner.

3rd trimester pregnancy symptoms (at 32 weeks)

You may be feeling more tired than usual. Try and take plenty of rests throughout the day.

Your signs of pregnancy could also include:

• sleeping problems ( week 19 has information on feeling tired )
• stretch marks ( week 17 has information on stretch marks )
• swollen and bleeding gums ( week 13 has information on gum health during pregnancy )
• pains on the side of your baby bump, caused by your expanding womb ("round ligament pains")
• piles ( week 22 has information on piles )
• indigestion and heartburn ( week 25 has information on digestive problems )
• bloating and constipation ( week 10 has information on bloating )
• leg cramps ( week 20 has information on how to deal with cramp )
• feeling hot
• swollen hands and feet
• urine infections
• vaginal infections ( week 15 has information on vaginal health )
• darkened skin on your face or brown patches – this is known as chloasma or the "mask of pregnancy"
• greasier, spotty skin
• thicker and shinier hair

You may also experience symptoms from earlier weeks, such as:

• mood swings ( week 8 has information on mood swings )
• morning sickness ( week 6 has information on dealing with morning sickness )
• weird pregnancy cravings ( week 5 has information on pregnancy cravings )
• a heightened sense of smell
• sore or leaky breasts ( week 14 has information on breast pain ) – a white milky pregnancy discharge from your vagina and light spotting (seek medical advice for any bleeding)

Read Tommy's guide to common pregnancy symptoms .

What does my baby look like?

Your baby, or foetus, is around 42.4cm long from head to heel. That's about the same length as a bunch of celery.

Your baby is perfectly formed but needs to put on weight – that's what the next few weeks are all about.

Download Tommy's leaflet about baby movements .

Action stations

Have you chosen a pushchair yet? If you're buying one second-hand, check the brakes work and that it's the right height for you.

You might also like to get a baby sling for the first few weeks. Babies love the close contact, and you will too.

Choose a carrier that will support your baby's head and check the straps are secure. Read some tips on what to buy on the NHS website .

This week you could also...

You have maternity rights . You can ask for a risk assessment of your work place to ensure that you're working in a safe environment.

You should not be lifting heavy things and you may need extra breaks, and somewhere to sit.

You can also attend antenatal appointments during paid work time.

It's a good time to tone up your pelvic floor muscles. Gentle exercises can help to prevent leakage when you laugh, sneeze or cough.

Get the muscles going by pretending that you're having a pee and then stopping midflow.

Visit Tommy's for more information on pelvic floor exercises.

Ask your midwife or doctor about online antenatal classes – they may be able to recommend one. The charity Tommy's has lots of useful information on antenatal classes and preparing you for birth .

Ask your partner if they would like to take part in the antenatal classes. Even if you've had children before, antenatal classes are still worth going to as you can meet other parents-to-be.

The NCT offers online antenatal classes with small groups of people that live locally to you.

Do your best to stop smoking and give up alcohol , and go easy on the tea, coffee and anything else with caffeine .

Ask your midwife or GP for support.

To keep bones and muscles healthy, we need vitamin D.

From late March/early April to the end of September, most people make enough vitamin D from sunlight on their skin. However, between October and early March, you should consider taking a daily vitamin D supplement because we cannot make enough from sunlight.

Some people should take a vitamin D supplement all year round, find out if this applies to you on the NHS website.

You just need 10 micrograms daily (it's the same for grown-ups and kids). Check if you're entitled to free vitamins .

It's recommended that you do 150 minutes of exercise a week while pregnant .

You could start off with just 10 minutes of daily exercise – perhaps take a brisk walk outside. Check out Sport England's #StayInWorkOut online exercises (scroll to the pregnancy section).

Listen to your body and do what feels right for you.

There's no need to eat for 2.

Now you're in the 3rd trimester, you may need an extra 200 calories a day, but that's not much. It's about the same as 2 slices of wholemeal toast with margarine.

You just need to eat a healthy balanced diet, with a variety of different foods every day, including plenty of fruit and veg. Have a look at our guide to healthy eating in pregnancy .

You may be able to get free milk, fruit and veg through the Healthy Start scheme .

How are you today?

If you're feeling anxious or low, talk to your doctor or midwife who can point you in the right direction to get all the support that you need. You could also discuss your worries with your partner, friends and family.

You may be worried about your relationship, or money, or having somewhere permanent to live.

Don't keep it to yourself – it's important that you ask for help if you need it.

Getting pregnant again is probably the last thing on your mind right now. However, now is a good time to start planning what type of contraception you would like to use after your baby is born.

Getting pregnant again could happen sooner than you realise, and too short a gap between babies is known to cause problems.

Talk to your GP or midwife to help you decide.

You will be offered newborn screening tests for your baby soon after they are born.

These screening tests are recommended by the NHS because they can make sure your baby is given appropriate treatment if needed.

Your decisions about whether or not you want these screening tests will be respected, and healthcare professionals will support you.

Ask your midwife or doctor for more information about newborn screening .

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Fetal development: The 3rd trimester

Fetal development continues during the third trimester. Your baby will open his or her eyes, gain more weight, and prepare for delivery.

The end of your pregnancy is near! By now, you're eager to meet your baby face to face. Your uterus, however, is still a busy place. Here's a weekly calendar of events for fetal development during the third trimester. Keep in mind that measurements are approximate.

Week 28: Baby's eyes partially open

Twenty-eight weeks into your pregnancy, or 26 weeks after conception, your baby's eyelids can partially open and eyelashes have formed. The central nervous system can direct rhythmic breathing movements and control body temperature.

By now your baby might be nearly 10 inches (250 millimeters) long from crown to rump and weigh nearly 2 1/4 pounds (1,000 grams).

Week 29: Baby kicks and stretches

Fetal development 27 weeks after conception

By the end of the 29th week of pregnancy — 27 weeks after conception — your baby can kick and stretch.

Twenty-nine weeks into your pregnancy, or 27 weeks after conception, your baby can kick, stretch and make grasping movements.

Week 30: Baby's hair grows

Thirty weeks into your pregnancy, or 28 weeks after conception, your baby's eyes can open wide. Your baby might have a good head of hair by this week. Red blood cells are forming in your baby's bone marrow.

By now your baby might be more than 10 1/2 inches (270 millimeters) long from crown to rump and weigh nearly 3 pounds (1,300 grams).

Week 31: Baby's rapid weight gain begins

Thirty-one weeks into your pregnancy, or 29 weeks after conception, your baby has finished most of his or her major development. Now it's time to gain weight — quickly.

Week 32: Baby practices breathing

Thirty-two weeks into your pregnancy, or 30 weeks after conception, your baby's toenails are visible.

The layer of soft, downy hair that has covered your baby's skin for the past few months (lanugo) starts to fall off this week.

By now your baby might be 11 inches (280 millimeters) long from crown to rump and weigh 3 3/4 pounds (1,700 grams).

Week 33: Baby detects light

Fetal development 31 weeks after conception

By the end of the 33rd week of pregnancy — 31 weeks after conception — your baby's eyes can detect light.

Thirty-three weeks into your pregnancy, or 31 weeks after conception, your baby's pupils can change size in response to a stimulus caused by light. His or her bones are hardening. However, the skull remains soft and flexible.

Week 34: Baby's fingernails grow

Thirty-four weeks into your pregnancy, or 32 weeks after conception, your baby's fingernails have reached his or her fingertips.

By now your baby might be nearly 12 inches (300 millimeters) long from crown to rump and weigh more than 4 1/2 pounds (2,100 grams).

Week 35: Baby's skin is smooth

Thirty-five weeks into your pregnancy, or 33 weeks after conception, your baby's skin is becoming smooth. His or her limbs have a chubby appearance.

Week 36: Baby takes up most of the amniotic sac

Thirty-six weeks into your pregnancy, or 34 weeks after conception, the crowded conditions inside your uterus might make it harder for your baby to give you a punch. However, you'll probably still feel lots of stretches, rolls and wiggles.

Week 37: Baby might turn head down

Thirty-seven weeks into your pregnancy, or 35 weeks after conception, your baby has a firm grasp.

To prepare for birth, your baby's head might start descending into your pelvis. If your baby isn't head down, your health care provider will talk to you about ways to deal with this issue.

Week 38: Baby's toenails grow

Thirty-eight weeks into your pregnancy, or 36 weeks after conception, the circumference of your baby's head and abdomen are about the same.

Your baby's toenails have reached the tips of his or her toes. Your baby has mostly shed all of his or her lanugo.

By now your baby might weigh about 6 1/2 pounds (2,900 grams).

Week 39: Baby's chest is prominent

Thirty-nine weeks into your pregnancy, or 37 weeks after conception, your baby's chest is becoming more prominent. For boys, the testes continue to descend into the scrotum. Fat is being added all over your baby's body to keep him or her warm after birth.

Week 40: Your due date arrives

Fetal development 38 weeks after conception

By the end of the 40th week of pregnancy — 38 weeks after conception — your baby is considered full term.

Forty weeks into your pregnancy, or 38 weeks after conception, your baby might have a crown-to-rump length of around 14 inches (360 millimeters) and weigh 7 1/2 pounds (3,400 grams). Remember, however, that healthy babies come in different sizes.

Don't be alarmed if your due date comes and goes with no signs of labor starting. Your due date is simply a calculated estimate of when your pregnancy will be 40 weeks. It does not estimate when your baby will arrive. It's normal to give birth before or after your due date.

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• Pregnancy: Stages of pregnancy. Office on Women's Health. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/stages-pregnancy. Accessed Feb. 25, 2020.
• Frequently asked questions: Pregnancy FAQ 156: Prenatal development: How your baby grows during pregnancy. American College of Obstetricians and Gynecologists. http://www.acog.org/Patients/FAQs/Prenatal-Development-How-Your-Baby-Grows-During-Pregnancy. Accessed Feb. 25, 2020.
• American College of Obstetricians and Gynecologists. Your Pregnancy and Childbirth: Month to Month. 6th ed. American College of Obstetricians and Gynecologists; 2015.
• Moore KL, et al. The Developing Human: Clinically Oriented Embryology. 11th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Feb. 25, 2020.

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Breech Position: What It Means if Your Baby Is Breech

Medical review policy, latest update:.

Medically reviewed for accuracy.

What does it mean if a baby is breech?

What are the different types of breech positions, what causes a baby to be breech, recommended reading, how can you tell if your baby is in a breech position, what does it mean to turn a breech baby, how can you turn a breech baby, how does labor usually start with a breech baby.

If your cervix dilates too slowly, if your baby doesn’t move down the birth canal steadily or if other problems arise, you’ll likely have a C-section. Talk your options over with your practitioner now to be prepared. Remember that though you may feel disappointed things didn’t turn out exactly as you envisioned, these feelings will melt away once your bundle of joy safely enters the world.

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32 Weeks Pregnant with Twins

What can you expect at 32 weeks pregnant with twins? We’ve compiled a list of common symptoms, to-do’s this week, pregnancy tips, pregnancy concerns, questions to ask your doctor, advice from other pregnant moms of twins, and tons of other info below to help you through this week in your twin pregnancy. Enjoy!

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32 Weeks Pregnant With Twins Video

What’s going on with those twinnies, 5 tips for a better 32nd week, advice from other twin moms, concerns other twin moms had, questions twin moms had for their doctor, 32 weeks pregnant video, typical tests that are done, product recommendations.

• An excerpt from “What To Do When You’re Having Two”

Belly Photos at 32 Weeks Pregnant With Twins

Ultrasound photos at 32 weeks pregnant with twins, articles you should read this week, videos to check out, register for class.

Our new  digital twin pregnancy journal  is up for sale on the Twiniversity Etsy store! This is the first and only digital journal exclusively for twin pregnancy. It’s the perfect way to record your precious twin pregnancy memories to cherish for years to come.  Click here to learn more… and while you’re at it, check out our expecting twins classes and Twiniversity Shop !

• Median weight for dichorionic twins: 4lbs, 4oz*
• Median weight for monochorionic twins: 4lbs

*This is the week at which dichorionic twins deviate from singleton weight reference charts.

You’re probably gaining weight at a more rapid pace — about a pound a week. Half of that weight goes straight to your babies, who will gain one-third to half their birth weight in the next six weeks in preparation for life outside the womb.

• Cook and freeze nutritious meals to enjoy after you’re home from the hospital. This is great advice if you have freezer space. If you don’t, you should consider buying a chest freezer to hold everything, including meals that friends/family may drop off once the babies have arrived.
• Pick out baby names. One of the top worries of twin parents is choosing the right names for their babies, and then (in the case of same-sex twins) deciding which baby gets which name. After the babies are born, don’t let the hospital staff or your family pressure you into finalizing names until you are 100% sure. Check with your doctor, but you typically have about 14 days after the birth to finalize baby names.

• Don’t stand for long periods of time, if you can help it.
• Soak your feet with Epsom salts to help swelling.
• Try to stretch or even take a gentle/prenatal yoga class.
• Sleeping with a pillow between your knees helps with the back and legs.
• Take a warm bath if you start to feel restless and agitated.

I tried kinesio tape for belly support for the first time and it was actually helpful. Call your insurance and figure out how to get your breast pump if you haven’t already. Tie up loose ends with maternity leave paperwork ASAP! Leave the chores alone and rest rest rest! – Amy B., Baton Rouge, LA

Follow doctor’s orders, even if it means staying in the hospital overnight for observation. – Vanilynne G., Flushing, NY

The doctor told me to listen to my body and it honestly is the best advice. – Naomi C., Bolton, England

Drink plenty of water… there’s never too much! – Isabel W.

This is the 4th quarter of the game, you’re going to be tired, you’re going to feel like you’ve been giving your all and can’t give anymore, but you’re almost there, keep your eye and your heart on the prize of 2 healthy beautiful babies! – Amy B., Baton Rouge, LA

Be strong, I have to try and motivate myself almost everyday. It’s hard but for me making it to 32 weeks is a miracle. I try to keep my mind off the pain by reading and playing simple games on my phone when I’m relaxing. I also keep my hubby updated to my state of mind, in case I say something hurtful….LOL – Bahiya, Johannesburg, South Africa

Emergency panty liners are your friend. – Kelly B., Jacksonville, FL

Need some twin parent friends? Get the support you need with a Twiniversity Membership. Benefits include a monthly twin parent club meeting on Zoom, access to a private Facebook group just for twin parents, and a video library of twin parenting lessons. Visit Twiniversity.com/membership to join today!

• When will they come? Will I be able to do this? Will it be a c-section?
• I’m currently on bedrest and am concerned about having the babies early. Glad to have hit the 32 week mark and almost 33 week mark, but would really like to carry them for at least a few more weeks if not, more! I’m also nervous about the possibility of having a cesarean.
• Pain management during labor; debating an epidural.
• I can barely get any sleep which is taking a toll on me physically, but also mentally too.
• Not knowing when I will have the babies, will I go into labor on my own? Will the doctors have to induce me? Will it be a natural delivery or C-section?  There are still a lot of unknowns for the next few weeks.

• How far do you think I’ll go?
• Can you check for dilation?
• How big do you think they will be?
• What position are the babies in?
• What is different about a vaginal delivery of twins at the hospital (versus a singleton delivery)?
• What is the difference between an epidural and a spinal block?
• If twin A is head down and twin B is breech can I deliver vaginally?
• Will the babies still have enough room to flip by 37 weeks?
• If they’re in position do I have to get induced, or can I schedule a C section?
• Are my birth plan expectations realistic for your practice and hospital?
• When will my cerclage be removed?
• Symptoms of early labor to watch for?
• When will cervical checks begin?
• When will GBS swab be done?
• Why do I have itching all over at times?
• Both babies are currently transverse. Is there is still a chance of them flipping to head down?

It is common to have weekly nonstress testing (NST) with fluid assessments starting at 32 weeks in an uncomplicated twin gestation. As your pregnancy progresses you will likely be scheduled more and more frequently, building to every 1-2 days as you get closer to full term. A nonstress test is used to evaluate your babies’ health before birth. The goal of a nonstress test is to provide useful information about your babies’ oxygen supply by checking their heart rates and how it responds to your babies’ movements. The test might indicate the need for further monitoring, testing, treatment or delivery. A nonstress test typically requires no special preparation. During the nonstress test, you’ll lie on a reclining chair. You’ll have your blood pressure taken at regular intervals during the test and each baby will be monitored while you relax in a recliner for 20 minutes, playing on your phone or reading a book.

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An excerpt from “ What To Do When You’re Having Two “

Research different birthing techniques.

It would be foolish to choose one technique before the labor, because you really don’t know what will work for you until you’re in the moment, especially if this is your first labor.  You may think that deep breathing will work fine to get you through the contractions, but when those contractions hit, you might need something else. The best thing to do is research several birthing techniques (the Bradley Method, Hypno-birthing, Lamaze, etc.) so that you have many tools in your arsenal when the time comes.  If you are planning to have a drug-free delivery, remember that taking a shower, prenatal massage, using the birthing ball, breathing techniques, and sitting in a warm tub are all fabulous ways to help get you through the pain if your doctor is okay with them.

Pregnant with twins and not sure where to start? Visit the Ultimate Twin Pregnancy Guide to find all the top articles and resources to get you ready for twins. While you’re at it, check out our expecting twin classes and Twiniversity shop !

REMINDER: Don’t forget to take a belly shot!

What You DON’T Need When You’re Having Twins

I’m Having Twins! What Do I Need To Know?

What’s The Biggest Challenge About Having Twins?

Have you taken your expecting twins class yet? We offer a great class on demand so you can take it on your own schedule! There are so many video modules covering everything from your twins’ baby registry to your first week at home with twins! Sign up today to get started before your twins arrive .

Need a plan for the first week home with twins? Book your 60-minute twins \post-delivery strategy session on a video call with Lauren Oak, Twin Expert and Certified Postpartum Doula (and mom of twins!), to create a customized game plan for you and your twins when they come home.  Click here to learn more… and while you’re at it, check out our Twiniversity Shop and Twin Parent Memberships .

Want to get weekly emails about your twin pregnancy? Sign up for the Twiniversity email list! Subscribe today to get emails about giveaways, events, weekly article roundups, and more! We’ll be sending you a weekly twin pregnancy email to keep you on track with your pregnancy to-do list! Click here to learn more… and while you’re at it, check out our expecting twins classes and personal twin parent coaching services.

• AAFP. 2011c. Your baby’s development: The third trimester . American Academy of Family Physicians.
• Mayo Clinic. 2014b. Fetal development: The third trimester .
• MedlinePlus (ADAM). 2015. Fetal development .
• OWH. 2010. Stages of pregnancy . U.S. Office on Women’s Health.
• ACOG. 2015. FAQ156. Prenatal development: How your baby grows during pregnancy . American College of Obstetricians and Gynecologists.

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RSV Update and Vaccine Recommendations

CDC recommends an RSV vaccine for people who are 32-36 weeks pregnant to protect their babies from severe RSV. The vaccine is recommended for seasonal use: in the continental US this generally means September through January. The seasonality of RSV season can vary, so state, local or territorial health departments may recommend different timing for administration for your area.

What CDC knows

Respiratory Syncytial Virus (RSV) can cause serious illness in infants, young children, and older adults. RSV season is right around the corner and immunization is an important way to protect against severe RSV.

What CDC is doing

Today, CDC recommended an RSV vaccine for people who are 32-36 weeks pregnant to help protect their babies from severe RSV. CDC has also recommended RSV immunization to protect babies and toddlers. For older adults, CDC recommends an RSV vaccine, using shared clinical decision-making.

Key Takeaways

• RSV season, which is typically in fall and winter, is right around the corner.
• RSV activity has already started to increase in the Southeastern United States.
• RSV can cause serious illness in infants, young children, and older adults. In fact, RSV is the leading reason that babies are hospitalized in the United States.
• Today, CDC recommended an RSV vaccine for people who are 32-36 weeks pregnant to protect their babies from severe RSV. The vaccine is recommended for seasonal use: in the continental US this generally means September through January. The seasonality of RSV season can vary, so state, local or territorial health departments may recommend different timing for administration for your area.
• In August 2023, CDC recommended a new RSV immunization called nirsevimab to protect babies and some toddlers from severe RSV during the RSV season.
• In July 2023, CDC recommended RSV vaccine for adults ages 60 and over, using shared clinical decision-making . This means these individuals should talk to their healthcare provider about whether RSV vaccination is appropriate for them at this time.

Respiratory syncytial virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms. However, it can be dangerous for babies, toddlers, and older adults.

Each year in the United States, RSV causes approximately :

• 1 million visits to a healthcare provider (non-hospitalization) among children younger than 5 years.
• 58,000–80,000 hospitalizations among children younger than 5 years.
• 100–300 deaths in children younger than 5 years.
• 60,000–160,000 hospitalizations among adults 65 years and older.
• 6,000–10,000 deaths among adults 65 years and older.

This year, CDC has recommended three new immunizations to protect those most at risk of severe RSV. With these immunizations against RSV, we have an amazing opportunity to save lives and keep babies, toddlers, and older adults out of hospitals– but only if they are used.

What is Happening with RSV Right Now?

At the beginning of September, CDC notified healthcare providers that RSV activity was increasing in the southeastern United States, which is usually the first region where RSV season starts each year. Over the fall, virus activity increases north and west to the rest of the United States and peaks in winter months.

At this time, RSV activity in regions outside the southeastern United States remains low. This is typical for a normal RSV season. If we are facing a typical RSV season this year, an increase in RSV activity in these regions might be expected in the next month or two.

You can follow how much RSV and other respiratory viruses are affecting your community on CDC's website .

Actions for the Public

As we head into the fall and winter and respiratory viruses start to spread, take steps now to protect yourself and others .

Parents and expecting parents: Talk to your doctor about the two different types of RSV immunizations to determine which option might be best for you and your baby.

Adults ages 60 or over: Talk to your doctor to see if RSV vaccine is right for you.

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Growth chart: Fetal length and weight, week by week

Find out how big your baby is in each week of pregnancy, using our fetal growth chart measurements of average length and weight.

How do you determine fetus size by week?

Fetal growth chart, fetal weight by week: how it changes, your baby's size by week.

There are different methods for estimating how big a fetus is, which is why you'll find different numbers depending on the source.

Experts have formulas they use to come up with the estimated fetal weight (EFW) and height of a fetus, and the formulas aren't always the same. The measurements that are used in equations to estimate weight usually include biparietal (head) diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur (thigh bone) length (FL).

Height is a straightforward measurement, but the method of measuring it changes after the first trimester. For the first 13 weeks, the height measurement is taken from the top of the head to the baby's bottom. After the first 13 weeks, the measurement is taken from the top of the head to the baby's heel – explaining why, on the chart below, your baby appears to grow 3 inches from week 13 to week 14!

Hadlock, the main source we use in our fetal growth chart, provides one of the most commonly used – and most accurate – equations for estimating fetal height and weight. The American College of Obstetrics and Gynecology (ACOG) and the Society for Maternal and Fetal Medicine (SMFM) use Hadlock's figures to diagnose and manage fetal growth conditions, such as intrauterine growth restriction (IUGR).

The numbers on our chart should coincide with the numbers your healthcare provider will be checking against when they measure your baby using ultrasound . (Providers don't measure height after 13 weeks, however, so don't expect to get those numbers at your ultrasound appointments.)

Note that the data used by Hadlock was gathered from middle-class Caucasian women with no history of maternal diseases known to affect fetal growth and no evidence of congenital anomalies . Your provider may make adjustments based on your individual circumstances.

Wondering how big your baby is during each week of pregnancy? The numbers in our chart below can give you a sense of your baby's size. Keep in mind that your baby may be much smaller or larger than these averages. That's okay – after all, healthy babies can weigh less than 5 pounds or more than 9 pounds at birth.

Boy's measurements are different than girl's measurements, even this early. For the numbers on our chart, we've taken an average of boys and girls. And remember, the height measurements up to 13 weeks are head-to-bottom estimates, while the height measurements starting at week 14 are head-to-toe estimates.

Thanks to Dr. Mark Curran, maternal-fetal medicine specialist, for his help preparing this chart.

Your baby steadily gains weight over the course of your pregnancy, but it's not always at the same rate. If you're having one baby (not twins or multiples), your baby's rate of growth accelerates until 35 weeks , then decelerates.

Here are some highlights, based on estimations:

• Up until 16 weeks, a fetus grows an average of about 19 grams per week, gradually increasing from 7 grams per week at 8 weeks to 15 grams per week at 12 weeks and 29 grams per week at 16 weeks.
• By 20 weeks, a fetus is gaining about 59 grams per week (just over 2 ounces).
• By 30 weeks, a fetus is gaining about 175 grams each week (more than 6 ounces).
• At 35 weeks, a fetus is gaining about 215 grams each week, or about 7.5 ounces. At this point their growth rate peaks.
• After 35 weeks, growth slows to about 188 grams per week, or 6.6 ounces. (Twins slow earlier, at around 28 weeks, and then average about 170 grams each week.)
• In the last few weeks of pregnancy, the growth rate continues to gradually slow to about 168 grams (a little less than 6 ounces) per week by week 40.

Using a tape measure stretched over your belly, your provider will use a fundal height measurement to check your baby's size at your prenatal visits . Beginning at about 24 weeks, the measurement in centimeters should roughly match the gestational age of your baby. If you're 26 weeks pregnant, for example, your fundal height should be about 26 cm, give or take a centimeter in each direction.

If your provider is concerned that your baby is too small, they'll monitor your baby's size with ultrasound, which is more accurate. Using ultrasound, your practitioner can take various measurements (head circumference and diameter, abdomen circumference, femur length) and use them to estimate your baby's size. They may also use a Doppler ultrasound to look at the blood flow to your placenta .

If your baby's estimated weight is less than the 10th percentile for their gestational age, they may be diagnosed with intrauterine growth restriction (IUGR), also called fetal growth restriction (FGR). IUGR can happen at any time during pregnancy. Some babies with IUGR just turn out to be small for their age, but sometimes there's a problem that's preventing the baby from growing properly.

At birth, a baby with IUGR is called "small for gestational age." While most SGA babies who are otherwise healthy grow just fine, some (especially those born prematurely ) are at higher risk of problems such as c-section , jaundice , low blood sugar , and even long-term developmental and health problems.

Here are some highlights of your baby's growth during pregnancy:

At 20 weeks , about the midpoint in your pregnancy, your baby is transmitting taste signals to their brain. And you may feel them hiccupping. Your baby's weight at 20 weeks is about 11.68 ounces, and they're about the length of a (10.12-inch) banana.

At 32 weeks , your baby's lungs are developing fast, and your baby's storing minerals like iron for their first 6 months of life. Your baby's weight at 32 weeks is 4.30 pounds, and their length is 16.93 inches, about the size of a jicama.

At 33 weeks , things are getting snug in there! Your baby's skin is becoming less wrinkled as they fill in – your baby's weight at 33 weeks is about 4.77 pounds. At 17.36 inches, your baby is now about the size of a pineapple.

At 37 weeks , your baby's brain and lungs are still maturing, and they're still moving a lot, despite the close quarters. Your baby's weight at 37 weeks is about 6.68 pounds, and they're about the length of a bunch of Swiss chard, 19.02 inches.

Once your baby is born, they'll be weighed and measured, and your provider will continue to monitor their growth. While the average newborn weight is a little over 7 pounds, most newborns lose about 5 to 10 percent of their weight in the first days. No worries – they gain it back by the time they're about 2 weeks old, and by 4 months they usually double their birth weight.

Learn more:

• To-do lists for the first , second , and third trimesters
• Pregnancy Due Date Calculator

Pregnancy Weight Gain Calculator

• How to understand pregnancy weeks, months, and trimesters

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BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

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Grantz KL et al. 2016. Fetal growth standards: the NICHD fetal growth study approach in context with INTERGROWTH-21st and the World Health Organization Multicentre Growth Reference Study.  American Journal of Obstetrics and Gynecology  218(2): S641-S655.e28.  https://www.sciencedirect.com/science/article/abs/pii/S0002937817324419 Opens a new window  [Accessed November 2022]

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Kiserud T et al. 2017. The World Health Organization fetal growth charts: A multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight . PLoS Medicine  14(1): e1002220.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5261648/ Opens a new window  [Accessed November 2022]

Martins JG et al. 2020. Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction. Practice Guideline.  American Journal of Obstetrics & Gynecology  223(4): B2-B17.  https://pubmed.ncbi.nlm.nih.gov/32407785/ Opens a new window  [Accessed November 2022]

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Where to go next

• Open access
• Published: 15 May 2024

Associations between anxiety, sleep, and blood pressure parameters in pregnancy: a prospective pilot cohort study

• Hayley E. Miller 1 ,
• Samantha L. Simpson 1 ,
• Janet Hurtado 1 ,
• Ana Boncompagni 2 ,
• Jane Chueh 1 ,
• Chi-Hung Shu 3 ,
• Fiona Barwick 4 ,
• Stephanie A. Leonard 1 ,
• Brendan Carvalho 3 ,
• Pervez Sultan 3 ,
• Nima Aghaeepour 3 ,
• Maurice Druzin 1 &
• Danielle M. Panelli 1  

BMC Pregnancy and Childbirth volume  24 , Article number:  366 ( 2024 ) Cite this article

Metrics details

The potential effect modification of sleep on the relationship between anxiety and elevated blood pressure (BP) in pregnancy is understudied. We evaluated the relationship between anxiety, insomnia, and short sleep duration, as well as any interaction effects between these variables, on BP during pregnancy.

This was a prospective pilot cohort of pregnant people between 23 to 36 weeks’ gestation at a single institution between 2021 and 2022. Standardized questionnaires were used to measure clinical insomnia and anxiety. Objective sleep duration was measured using a wrist-worn actigraphy device. Primary outcomes were systolic (SBP), diastolic (DBP), and mean (MAP) non-invasive BP measurements. Separate sequential multivariable linear regression models fit with generalized estimating equations (GEE) were used to separately assess associations between anxiety (independent variable) and each BP parameter (dependent variables), after adjusting for potential confounders (Model 1). Additional analyses were conducted adding insomnia and the interaction between anxiety and insomnia as independent variables (Model 2), and adding short sleep duration and the interaction between anxiety and short sleep duration as independent variables (Model 3), to evaluate any moderating effects on BP parameters.

Among the 60 participants who completed the study, 15 (25%) screened positive for anxiety, 11 (18%) had subjective insomnia, and 34 (59%) had objective short sleep duration. In Model 1, increased anxiety was not associated with increases in any BP parameters. When subjective insomnia was included in Model 2, increased DBP and MAP was significantly associated with anxiety (DBP: β 6.1, p  = 0.01, MAP: β 6.2 p  < 0.01). When short sleep was included in Model 3, all BP parameters were significantly associated with anxiety (SBP: β 9.6, p  = 0.01, DBP: β 8.1, p  < 0.001, and MAP: β 8.8, p  < 0.001). No moderating effects were detected between insomnia and anxiety (p interactions: SBP 0.80, DBP 0.60, MAP 0.32) or between short sleep duration and anxiety (p interactions: SBP 0.12, DBP 0.24, MAP 0.13) on BP.

Conclusions

When including either subjective insomnia or objective short sleep duration, pregnant people with anxiety had 5.1–9.6 mmHg higher SBP, 6.1–8.1 mmHg higher DBP, and 6.2–8.8 mmHg higher MAP than people without anxiety.

Peer Review reports

Hypertensive disorders occur in approximately 10% of all pregnancies in the United States [ 1 ]. Elevated blood pressure in pregnancy poses maternal and fetal risks, including preterm birth, placental abruption, cerebral hemorrhage, hepatic failure, and acute renal failure. Societies including American College of Obstetricians and Gynecologists (ACOG), Society for Maternal–Fetal Medicine, and California Maternal Quality Care Collaborative focus on mitigating these risks by implementing guidelines and toolkits to reduce the incidence of hypertensive disorders of pregnancy and treat elevated blood pressure appropriately [ 1 , 2 , 3 ]. Mood disorders and sleep disturbances are known modifiable risk factors for hypertension [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. However, the degree to which these conditions affect specific blood pressure parameters in pregnancy is less well described in the literature. There are limited data on the specific impact of these conditions on specific blood pressure parameters in pregnancy. Understanding and addressing modifiable risk factors for elevated blood pressure in pregnancy may improve maternal and fetal outcomes and can be implemented as a public health priority.

Sleep disturbances such as difficulty falling asleep, increased nighttime awakenings, and shorter total sleep time are more common in pregnant people compared to the general population, with an incidence ranging between 46–78% [ 17 ]. Clinical insomnia is suggested using validated patient-reported questionnaires such as the Insomnia Severity Index (ISI), which rely on subjective assessment of a person’s sleep. Clinical insomnia is characterized by the subjective perception of sleep disturbance, including problems falling asleep and staying asleep, and it can be assessed by validated self-report measures such as the Insomnia Severity Index. It has been associated with adverse perinatal outcomes, including preterm birth and elevated blood pressure [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 18 , 19 ]. Objective short sleep duration is defined as the total number hours of sleep and can be measured using physiological data as recorded by actigraphy, which is a wrist-worn triaxial accelerometer. Sleep duration measured objectively, and clinical insomnia measured subjectively can be distinct phenomena, as evidenced by the common discrepancy between these two methods of assessment [ 20 , 21 ]. Like subjective insomnia, objective short sleep duration has also been associated with adverse outcomes, including hypertension, cardiovascular disease and neurocognitive impairment [ 20 , 21 , 22 , 23 ]. Sleep abnormalities such as clinical insomnia and objective short sleep duration can have a bidirectional relationship with potentiating effects on anxiety [ 24 ].

Similar to insomnia, clinical anxiety is linked to increased risk of hypertensive disorders of pregnancy and is also prevalent in pregnancy, with an overall incidence of 15%, and is also associated with multiple adverse birth outcomes [ 11 ]. The relationship between anxiety and hypertensive disorders of pregnancy is complex and not well studied, with several proposed biologically plausible pathways, including alterations to inflammatory, autonomic, hypothalamic–pituitary–adrenal activity physiologic processes [ 12 , 13 , 14 , 15 , 24 ].

Despite the overlap between clinical insomnia, objective short sleep duration, and anxiety impacts on the risk of hypertensive disorders of pregnancy, little is known about how the effects of these conditions on specific blood pressure parameters. Our aims were to evaluate the relationship between anxiety, insomnia, and short sleep duration, as well as any moderating effects between these variables, on blood pressure during pregnancy. We hypothesized that anxiety would increase all blood pressure parameters, and that insomnia and short sleep duration would have an additive effect when co-occurring with anxiety.

This was a pilot prospective cohort study of pregnant people between ages 22 and 42 at a single academic institution between November 2021 and July 2022. Participants were between 23 to 36 weeks’ gestation with a viable singleton or multiple pregnancy without life-limiting fetal anomalies and with planned delivery at Lucile Packard Children’s Hospital (LPCH), Stanford. Participants were matched by gestational age by inpatients and outpatients within two weeks of gestation. Participants were screened for eligibility using electronic medical records in the LPCH antepartum unit and obstetrics clinics. Only participants who confirmed their interest to participate in research by LPCH screening were approached for enrollment. Participants were excluded if they had an indication for delivery within the next seven days at the time of eligibility screening, had an allergy to rubber or steel, were unable or unwilling to remove other activity monitors during the study period, had been placed on bedrest, or had implanted electronic medical devices. Study participation lasted seven days. This study was approved by the Stanford Institutional Review Board (IRB Protocol 59752) and all participants confirmed and signed informed consent.

Study participants completed a baseline questionnaire that included demographic, health, and socioeconomic information, as well as questions related to mental health, exercise, and sleep. At the time of enrollment, participants completed validated self-report questionnaires of insomnia (ISI) and anxiety [State-Trait Anxiety Inventory (STAI)] [ 25 , 26 ]. The ISI is a 7-item measure assessing the frequency and severity of both nighttime and daytime symptoms of insomnia. The range of scores is between 0 and 28. Our study used a cut-off score ≥ 15 to identify moderate to severe insomnia symptoms [ 25 ]. The STAI consists of 40 items measured on a 4-point Likert scale, with subscales reflecting separate components of state versus trait anxiety [ 24 ]. We defined clinical anxiety by STAI-State (STAI-S) score ≥ 40 [ 26 ].

Separately, to measure objective short sleep duration, study participants wore an ActiGraph watch (ActiGraph Corp, Pensacola, FL) for one week, a commercially available and FDA 510(k)-cleared Class II medical device. To be included, participants were required to wear the watch for at least 24 h and up to seven days. Participants were contacted by research coordinators or registered nurses at least two times per week on day three and day seven during the study to confirm compliance with study procedures. Downloaded 60-s epoch AGD files were processed using ActiGraph Software (version 6.13.4). Total sleep duration in minutes, defined as the period from estimated sleep onset to estimated sleep offset, was extracted from the Actigraph device. Our study used a sleep duration < 5 h as the marker for objective short sleep duration based on previous data suggesting adverse health and pregnancy outcomes associated with total sleep duration < 5 h [ 27 , 28 , 29 ]. We used the average of total sleep time per day throughout the study duration to classify a participant as short sleep duration. The 7-day study timeline is also consistent with or longer than prior studies using ActiGraph watches, some of which only include 1–3 days of sleep data [ 30 , 31 , 32 ]. Participants who delivered < 24 h after initiation of the ActiGraph watch were excluded from analyses.

Sociodemographic and clinical characteristics of study participants that were not otherwise collected from study questionnaires were extracted from electronic health records. Perinatal mental health and hypertensive disorders of pregnancy are influenced by sociodemographic characteristics and social determinants of health, including maternal age, insurance status, and marital status [ 33 ]. Race and ethnicity were included given the adverse effects that structural racism and discrimination have been shown to have on perinatal health. The category “other/more than one race” was used for pregnant people who did not self-identify with one of the pre-specified categories, and the category “unknown” was used for those who chose not to report their status. Clinical characteristics abstracted included any medical history (hypertension, antihypertensive use, pre-existing diabetes, kidney disease, epilepsy, pre-existing anxiety or mood disorders, autoimmune disease, infectious diseases), parity, body mass index (BMI; kg/m 2 ) at time of enrollment, medication use in current pregnancy, and history of preeclampsia in previous pregnancies.

The independent variables were anxiety and either insomnia or short sleep duration, as well as the interaction between anxiety and insomnia or sleep duration. The dependent variables of the study were systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). All blood pressure parameters were measured using a Philips Model non-invasive blood pressure device and collected upon enrollment into the study as a one-time measurement.

Statistical analysis

Baseline sociodemographic and clinical characteristics were compared between participants with and without anxiety using Student’s t-test, Wilcoxon rank sum test, or Fisher’s exact test where appropriate. Separate sequential linear regression models were conducted and we fit the models with generalized estimating equations (GEE) to account for matching by gestational age. First, the base model (Model 1) evaluated the association between anxiety (independent variable) and each BP parameter (dependent variable), adjusting for age, BMI, and antihypertensive medications as potential confounders. Next, Model 2 was conducted replicating Model 1 plus clinical insomnia and an interaction term between insomnia and anxiety as covariates. Lastly, Model 3 was conducted replicating Model 1 plus short sleep duration and an interaction term between short sleep and anxiety as covariates. Models were done with an identity link and a normal distribution accounting for gestational age matching within the cohort because participants were recruited from different clinical settings including high-risk and low-risk outpatients and admitted inpatients.

Among 263 participants who were eligible based on electronic medical record screening, 168 were approached for enrollment. Of those approached, 67 participants were enrolled. Among those, 7 withdrew from the study and 2 withdrew less than 24 h after enrollment, leaving 60 participants included in the analysis using self-reported insomnia data and 58 participants using ActiGraphic sleep data (Fig.  1 ). Baseline sociodemographic characteristics between those with and without clinical levels of state-anxiety symptoms were not significantly different (Table  1 ).

Study population

Of note, our cohort included 6 people with chronic hypertension, 3 with gestational hypertension, and 2 with preeclampsia (one with and one without severe features).

Among the 60 participants, 15 (25%) had clinical anxiety, 11 (18%) had clinical insomnia, and 34 (59%) had objective short sleep duration. A total of 6 (10%) had concurrent anxiety and clinical insomnia, while 10 (17%) had concurrent anxiety and short sleep duration. Clinical insomnia and anxiety were significantly associated ( p  = 0.02), but objective short sleep duration and anxiety were not ( p  = 0.22) (Table  1 ). Among those with clinical insomnia, the mean ISI score was 17.5 ± 3.3. Among those with short sleep duration the mean total sleep time was 233.5 ± 33.7 min and among those with anxiety, the mean STAI-S score was 48.9 ± 6.7.

Model 1 demonstrated no baseline association between anxiety and any BP parameter after adjusting for demographic covariates and use of antihypertensive medications (SBP: β 1.3, p  = 0.67, DBP: β 4.6, p  = 0.07, MAP: β 3.6, p  = 0.15). In Model 2, after additionally adjusting for clinical insomnia (based on ISI score), anxiety was significantly associated with increased DBP (β 6.1, p  < 0.01) and MAP (β 6.2, p  < 0.01) but not SBP (β 5.1, p  = 0.07). There was no significant moderating effect between clinical insomnia and anxiety on BP parameters (p-interaction SBP 0.80, DBP 0.60, and MAP 0.32) (Table  2 , Fig.  2 ).

State anxiety inventory score and blood pressure parameter associations stratified by clinical insomnia.  Clinical insomnia defined as Insomnia Severity Index ≥ 15

SBP is not shown as it was not statistically significant

When short sleep duration was additionally included in Model 3, anxiety was significantly associated with all BP parameters (SBP: β 9.6, p  = 0.01, DBP: β 8.1, p  < 0.001, and MAP: β 8.8, p  < 0.001). Similar to Model 2 results, no significant statistical moderating effect was detected between short sleep duration and anxiety on BP (p-interaction SBP 0.12, DBP 0.24, and MAP 0.13) (Table  2 , Fig.  3 ).

State anxiety inventory score and blood pressure parameter associations stratified by short sleep duration

This prospective pilot study demonstrated the degree of blood pressure parameter elevations in pregnant people with anxiety after accounting for sleep disturbances including positive screening for clinical insomnia and objective short sleep duration. Pregnant people with anxiety had 5.1–9.6 mmHg higher systolic, 6.1–8.1 mmHg higher diastolic, and 6.2–8.8 mmHg higher mean arterial pressures than people without anxiety after accounting for potential confounders, including both subjective and objective measures of sleep. There was no evidence of statistical interaction between anxiety and either subjective insomnia or objective short sleep duration on any of the BP parameters. These results highlight the importance of accounting for sleep when studying the relationship between anxiety and blood pressure, as blood pressure elevations were only revealed in models adjusting for sleep.

Previous studies have not simultaneously assessed the potential interplay between anxiety and sleep problems on BP parameters [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 22 , 23 , 34 , 35 ]. Our results demonstrate that sleep is an important confounder to consider when evaluating the effect of anxiety on blood pressure; in this case, adjusting for sleep revealed an association. Given that small increases in SBP, MAP, and DBP are known to increase cardiovascular risks, our results showing nearly 10 mmHg increases in these parameters with anxiety is alarming. Our results support the prioritization of universal screening and treatment of anxiety as a strategy to reduce maternal morbidity from hypertensive disorders. The impact of insomnia, short sleep duration and other sleep problems on this relationship as well as on overall health outcomes in pregnancy requires further study [ 14 ].

This study adds to efforts to identify modifiable risk factors for adverse cardiovascular outcomes in pregnancy [ 5 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. A bidirectional relationship between anxiety and sleep problems has previously been described, along with their respective link to hypertensive disorders, yet the specific impact of these potential risk factors, both separately and together, on blood pressure parameters is understudied, especially in pregnancy [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 19 , 34 ]. Our simultaneous examination of anxiety, clinical insomnia, and short sleep duration addresses this knowledge gap. First, consistent with previous studies, we found overlaps between anxiety, insomnia, and short sleep duration in our study [ 24 ]. Second, when examining anxiety and blood pressure in pregnancy, we found that anxiety alone was not significantly associated with elevation in blood pressure. This relationship was revealed only in models adjusting for insomnia or short sleep duration, especially in the latter case. Our results suggest that anxiety and sleep are potential modifiable risk factors influencing hypertensive disorders of pregnancy, and therefore interventions to target these specific factors are critically warranted [ 35 ].

Given the significant burden that hypertensive disorders pose on maternal morbidity and mortality, identifying potentially modifiable risk factors and initiating timely interventions for these conditions is vital [ 1 , 2 , 3 ]. The results of our study demonstrate the effects on blood pressure in pregnant people with two commonly underdiagnosed disorders in pregnancy: anxiety and sleep problems. Anxiety is often underdiagnosed, and screening tools may be underutilized, despite ACOG’s recommendation for anxiety screening during pregnancy and US Preventative Task Force recommendation for universal anxiety screening [ 36 , 37 , 38 ]. Healthcare professionals may overlook screening for anxiety, representing a missed opportunity to offer counseling on modifiable risk factors that can impact cardiovascular health. In our study, 25% of the cohort screened positive for anxiety, which is slightly higher than the previously reported 15% in the literature, which we attribute to screening all patients for anxiety using a validated tool that is often underutilized in pregnancy care [ 11 , 36 ]. Notably, the observed prevalence of clinical insomnia, 18%, was well below the 40–72% national prevalence among pregnant people estimate reported by other studies, which may have reduced power to find any effects of insomnia on the association between anxiety and blood pressure [ 17 ]. Similar to previous studies, however, 61% of participants met the criterion for objective short sleep duration, a result that is consistent with increased sleep disturbance during the final trimester of pregnancy. Despite the unexpectedly low incidence of insomnia and high rates of short sleep duration, clinical insomnia but not objective short sleep duration was significantly associated with anxiety. Previous studies are mixed on the strongest associations between anxiety with insomnia and short sleep duration, however in our study the significant association might be explained by anxiety that is focused on perinatal concerns rather than sleep [ 9 ].

Our study adds to the growing body of literature on anxiety in pregnancy that demonstrates a relationship between anxiety and individual blood pressure parameters. However, our study also attempted to account for potential additive or interactive effects between anxiety and insomnia or short sleep duration [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. It is interesting that we demonstrated an association between anxiety and blood pressure only after adjusting for sleep disturbances and may be explained by known sleep disturbances activating the hypothalamic–pituitary–adrenal axis resulting in hypertension [ 13 ]. A bidirectional relationship between anxiety and sleep problems such as insomnia and short sleep duration has previously been described, and their respective effect on the diagnosis of hypertensive disorders has been demonstrated, yet the specific impact of these potential risk factors, both separately and together, on blood pressure parameters is understudied [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Interventions to address modifiable risk factors influencing hypertensive disorders of pregnancy, which can serve as markers for adverse lifelong cardiovascular health outcomes, are imperative, highlighting the importance of further investigation of the impact of anxiety, insomnia and short sleep duration as potentially modifiable risk factors for improving overall health outcomes in pregnancy [ 36 , 38 ]. For example, the benefits of cognitive behavioral therapy based interventions for patients with hypertension have been recognized and can serve as an intervention to address the relationship between mood disorders, sleep problems, and hypertension [ 39 ]. Studies are also needed to assess whether interventions that reduce anxiety or sleep disturbance in pregnancy might lower the risk of hypertensive disorders.

Our study has several strengths. We were able to utilize both subjective insomnia and objective total sleep time as data to better understand the impact of sleep on anxiety and blood pressure. We used a validated insomnia questionnaire, recorded objective sleep data using actigraphy, and collected key blood pressure parameters for ascertainment of variables. As our study was prospective, we were able to account for potential confounding factors influencing anxiety, insomnia and short sleep duration, including gestational age, body weight, physical health status, and mental health status [ 36 , 38 ].

However, our study has several limitations. We included clinical insomnia as a diagnosis, which is suggested by subjective measures of sleep and can be influenced by self-report bias. We could not identify acute or chronic insomnia disorder using criteria from Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, as the study duration was short and we did not use a structured clinical interview, for example, the Structured Clinical Interview for Sleep Disorders [ 40 ]. We included participants with chronic hypertension because this is an exploratory study assessing a small cohort, however, we included use of antihypertensives as a proxy for hypertension severity. We did not collect more than one blood pressure measure for each participant, which does not meet rigorous longitudinal, repeated blood pressure measurement for optimally evaluating relationship trends. Inferences from our analyses were hindered by our relatively small sample size, especially when determining the effects of any additive or interactive effects of anxiety and insomnia on BP parameters. Larger prospective studies are needed to better understand how anxiety and sleep disturbance might impact hypertensive disorders of pregnancy and whether interventions could mitigate these effects. Additionally, our study was advertised as a study investigating sleep and anxiety which could ultimately impact those who selected to enroll in the study and subsequent generalizability of the study.

In our prospective study, when adjusting for insomnia or short sleep duration, state-anxiety was associated with up to a 9.6 mmHg increase in blood pressure parameters. Models adjusting for objective short sleep duration based on Actigraphy data had the largest magnitude of association between anxiety and elevated blood pressure. Our results support the growing movement towards assessing and treating anxiety and sleep problems as a potential strategy to reduce maternal and fetal morbidity from hypertensive disorders [ 38 ].

Availability of data and materials

The dataset analyzed during the current study is available from the corresponding author on reasonable request.

Abbreviations

American College of Obstetricians and Gynecologists

• Blood pressure

Body mass index

• Diastolic blood pressure

Generalized estimating equations

Insomnia Severity Index

Lucile Packard Children’s Hospital

Mean arterial pressure

State Trait Anxiety Inventory-State

• Systolic blood pressure

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Acknowledgements

Not applicable.

No financial support of this study and no funding received.

Pervez Sultan is an Arline and Pete Harman Endowed Faculty Scholar of the Stanford Maternal and Child Health Research Institute.

Nima Aghaeepour receives funding from NIH grant: R35GM138353.

Danielle Panelli receives funding from NIH grant K12HD103084.

Stephanie Leonard was supported in part by NIH K01HL171699.

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Chi-Hung Shu, Brendan Carvalho, Pervez Sultan & Nima Aghaeepour

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All authors contributed to study design. HEM, SS, JH, AB, DP recruited participants. CS, SL, NA, DP completed data analysis. HEM, DP wrote the main manuscript text and prepared all tables and figures. HEM, DP, JC, FB, BC, PS, MD helped design study and reviewed the manuscript.

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Miller, H.E., Simpson, S.L., Hurtado, J. et al. Associations between anxiety, sleep, and blood pressure parameters in pregnancy: a prospective pilot cohort study. BMC Pregnancy Childbirth 24 , 366 (2024). https://doi.org/10.1186/s12884-024-06540-w

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Received : 23 January 2024

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DOI : https://doi.org/10.1186/s12884-024-06540-w

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