Pregnancy Calendar at Week 20

What's Happening with the Baby

By the 20th week of pregnancy, the baby develops a blinking reflex. If you're lucky, you might catch a glimpse of the baby "winking" during an ultrasound. Facial expressions become more pronounced: the baby tightly squeezes their eyes shut, frowns, lowers the corners of their mouth, and smiles.

Photoreceptors appear on the retinas. Bright light now causes the baby to move.

The lungs are actively developing. The little one now makes rhythmic breathing movements more frequently (over 40 per minute). The baby's intestines are fully operational, and the first bowel movements (meconium) start to form.

At 20 weeks, numerous folds and wrinkles continue to appear on the baby's skin. This happens because the skin grows faster than the subcutaneous fat underneath it.

What's Happening with Mom

At 20 weeks pregnant, many first-time moms start to feel their baby move (this usually happens between 18 and 21 weeks). Experienced moms and women with a slender build might feel it even earlier.

Some expectant mothers notice that a yellowish-white fluid occasionally leaks from their nipples. This is colostrum – a substance that will serve as food for the newborn in the first few days after birth. Its appearance indicates that the breasts are beginning to prepare for breastfeeding.

Weight

By the end of week 20, your weight will have increased by 3–5 kg (about 6.6–11 lbs). If you've gained more than 5 kg (11 lbs) since the start of your pregnancy, let your obstetrician-gynecologist know. Excessive weight gain increases the strain on all your organs and can complicate the pregnancy.

Belly

With each passing week, your belly rises higher and becomes rounder. Don't forget about skincare products to prevent stretch marks. Olive, coconut, and almond oils are ideal for this – they have natural ingredients and rarely cause allergic reactions. You can also buy special creams, ointments, oils, and sprays at the pharmacy or a specialized store. When using a new product, do an allergy test. Apply a small amount to a small area of your body, wait 24 hours, and if there's no adverse reaction, you can use it. The key to moisturizing your skin is consistency.

Uterus

Every week, it continues to grow in size. The bottom of the uterus is approximately at the level of the belly button, and it's considered normal if the measurements vary slightly up or down. At the 20th week, pregnant women may start experiencing false contractions (Braxton-Hicks contractions) – uterine contractions that pose no threat to the mom-to-be or the baby. Some women don't feel these false contractions at all. There's still plenty of room in the uterus, and the baby changes its position several times a day.

Pain

Back pain, especially in the lower back, is quite common. To alleviate lower back pain, it's advisable to avoid wearing high heels or platform shoes; if you have a desk job, take breaks to do some exercises (this will help relieve your back).

Abdominal Pain

These are still related to the growing uterus and the shifting of internal organs. This pain is not constant and not intense. If the pain is sharp and prolonged and is accompanied by bloody discharge, you should see a doctor immediately.

To reduce the likelihood of calf muscle cramps, frequently take the "legs up" position, and during rest, elevate your legs above the level of your head (for example, on a pillow); use a cool shower for your legs. To quickly relieve cramps, lie down, straighten your legs, and pull your toes towards you.

Discharge

Normally, discharge should be light in color (slightly yellowish, clear, or whitish) and should not have a strong odor. Moms should be concerned if the discharge has an unpleasant smell, an uneven consistency (foamy, curd-like, with lumps or mucus), or changes in color. Spotting or bloody discharge can occur if there is erosion, and it is more common after a gynecological exam or sexual intercourse. In any case, any change in discharge requires a doctor's consultation, especially if accompanied by itching, burning, or lower abdominal pain.

Medical Check-Up

Starting from the 20th week, you'll need to visit your doctor more frequently – every two weeks.

Doctors

Consulting an obstetrician-gynecologist is necessary if the pregnant woman has any complaints.

Tests

The "triple test" (second trimester prenatal screening, second trimester biochemical screening), if not done between the 16th and 19th weeks, should be done now. This test provides information about the genetic health of the baby. Blood is drawn from a vein in the morning on an empty stomach to determine the levels of human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP), and estriol (E3). The results can help identify certain chromosomal abnormalities (such as Down syndrome) or the risk of heart defects. However, don't panic if the results show deviations from the norm. There is always a 9%-10% margin of error. Additionally, a "bad" result from the triple test can only be considered if all three indicators are significantly off from the norm.

Examinations

During an ultrasound, they determine the condition of the fetus, its size, the development process of internal organs; the maturity level of the placenta (normally at this stage, it should be zero); the condition of the uterus and appendages; and the amount of amniotic fluid. The main goal of the screening is to ensure there are no pathologies or abnormalities in the fetus.
At this stage, you can also have a 3D or 4D ultrasound and capture the first photos with clear outlines of the baby.

Pregnancy Challenges

Missed Miscarriage

A missed miscarriage is most commonly diagnosed in the first trimester, though it can occur less frequently at later stages. Causes of a missed miscarriage at this stage can include hormonal imbalances, viruses (like the flu), infections (such as sexually transmitted infections), genetic and chromosomal abnormalities in the fetus, and abdominal trauma. Sometimes, even specialists can't pinpoint the exact cause of fetal demise. After a missed miscarriage, both partners should undergo thorough testing for various infections and viruses in their bodies. Only after identifying and addressing the exact cause can you plan for another pregnancy.

Primary Placental Insufficiency

This condition is characterized by morphofunctional changes in the placenta. These changes can arise due to improper functioning of certain organs and systems, acute infectious diseases, pregnancy pathologies, as well as external factors like harmful habits, poor nutrition, and micronutrient deficiencies. Placental insufficiency might not initially cause any discomfort for the expectant mother, but over time, the pathology can lead to hypoxia, intrauterine growth restriction, fetal demise, and pregnancy loss.

Placental Abruption

If you experience abdominal pain, back pain, and bleeding, you should call an ambulance immediately. Timely medical assistance significantly increases the chances of preserving the pregnancy, even with a large area of detachment.

TORCH Infections

TORCH is an acronym for a group of infections: TOxoplasma (toxoplasmosis), Rubella (German measles), Cytomegalovirus (CMV), and Herpes. These infections are particularly dangerous if contracted for the first time during pregnancy, as they can lead to fetal developmental defects and miscarriage. They are often an indication for pregnancy termination. Reducing the risk of infection can be achieved by following hygiene and preventive measures, including getting vaccinated six months before conceiving a child.

What You Can and Can't Do

At 20 weeks pregnant, a mom-to-be's belly is noticeably larger. The middle of pregnancy is a crucial stage in the baby's development, so it's important to take good care of your body. Pay attention to your diet, avoid strenuous physical activities, take prescribed medications, spend plenty of time outdoors, and focus on disease prevention.

What a Mom-to-Be CAN Do:

Stay physically active. Walking, yoga, and swimming help prevent congestion in the pelvic area and improve blood flow.
Take vitamin complexes and medications prescribed by your doctor. These support bodily functions and help prevent unwanted complications.
Get out of bed slowly, first lowering your legs to the floor and then sitting up. This helps prevent nausea and dizziness.
Try to lift heavy and awkward objects from a squatting position. This reduces strain on your spine.
It's better to sleep on a firm surface. A firm orthopedic mattress relieves back strain and allows for a good night's rest.
Entertainment and sports are allowed during pregnancy if there are no contraindications. Be cautious and listen to your body.
Intimate relations in comfortable positions help strengthen the pelvic muscles. Sexual activity improves blood circulation and promotes the release of the happiness hormone.

What an Expectant Mother SHOULD NOT Do:

Avoid eating fatty, overly salty foods, as well as products with preservatives and colorings. They negatively affect the kidneys and gastrointestinal tract. Excessive consumption of sweets can lead to gestational diabetes.
Forget about engaging in professional sports. Excessive physical exertion, grueling workouts, and heavy lifting strain the cardiovascular system, spine, and increase uterine tone.
Do not take any medications or dietary supplements without consulting your doctor. Even a simple aspirin for a headache can cause unwanted reactions and lead to pregnancy complications.
Avoid sudden movements and changes in body position. They can cause rapid fluctuations in blood pressure, dizziness, and increased uterine tone.
Refrain from intense activities and intimacy if recommended by your doctor. With increased uterine tone, placental insufficiency, cervical insufficiency, and other conditions, it's important to lead a calm lifestyle and maintain physical, emotional, and mental peace.

Proper Nutrition

At 20 weeks, your diet should be varied and nutritious. Your daily meals need to replenish any missing vitamins and minerals. Proteins, fats, carbohydrates, and a sufficient amount of fiber ensure the proper functioning of your body and the well-being of the expectant mother.

At 20 weeks of pregnancy, it is recommended to:

Protein – is the building block for muscle tissue. It is essential for the fetus at 20 weeks as active growth begins. It is recommended to include lean meats and fish in your diet. Meat products also help replenish vitamin B and iron deficiencies, which are necessary for the proper formation and growth of the future baby.
Healthy fats and calcium for the fetus's bone growth can be obtained from meat, poultry, fish, eggs, cheeses, yogurts, cottage cheese, nuts, and vegetable oils. They aid in the proper absorption of vitamins and trace elements, nourish the body's tissues and make them stronger, serve as a source of protein and amino acids, and have antioxidant effects.

Carbohydrates are the main source of energy and strength that a woman needs at 20 weeks of pregnancy. For the proper growth of the baby during this period, it's important to choose complex carbohydrates – whole grains, pasta made from durum wheat, and potatoes.
Vegetables and fruits should be consumed at least 2-3 times a day. They are the primary source of vitamin C and help replenish micronutrient deficiencies. Additionally, vegetables and fruits ensure proper gastrointestinal function due to their fiber content.

Water is essential for the expectant mother, with a recommended intake of up to 2 liters per day. It's important to maintain a proper hydration routine for the correct functioning of the excretory system. It's recommended to drink water between meals to prevent a feeling of heaviness in the stomach.
Frequent small meals are a key rule for a woman's diet at 20 weeks of pregnancy. During this period, the uterus begins to "press" against the stomach, which can cause heartburn, acid reflux, and other unpleasant symptoms. Eating small portions up to 5 times a day can help avoid these discomforts.

Vitamin A comes in two forms: retinol (animal-based products) and carotene (plant-based products). It's important not only for vision, as commonly believed, but also for skin health and healthy cell growth.

Need for Vitamins and Essential Nutrients

At 20 weeks of pregnancy, the fetus is already fully formed. This marks the beginning of its active growth and muscle mass development. The nutrients and beneficial substances for natural biological processes are taken from the mother's body by the future baby. Therefore, a woman at 20 weeks of pregnancy and beyond needs an increased daily intake of vitamins and micronutrients compared to her non-pregnant state.

Vitamin B1 or Thiamine

This is fundamental for the proper transmission of genetic information during cell division. It is necessary for expectant mothers at 20 weeks to ensure normal nerve impulse transmission to the brain, as well as to maintain proper muscle and uterine tone. You can get it from:

spinach;
dried apricots;
nuts;
cabbage;
carrots;
grains;
sprouted grains;
potatoes.

Vitamin B2 or Riboflavin

It participates in the formation of red blood cells. Adequate intake ensures the prevention of placental insufficiency and increased nervous excitability. It regulates adrenal function and supports a healthy pregnancy. The main sources are animal products, and riboflavin can also be synthesized in the intestines with sufficient intake of other B vitamins.

Vitamin B3 or Niacin

Plays a role in regulating cholesterol and carbohydrate metabolism, ensuring proper vascular function, including placental vessels. It supports the level of sex hormones, which is very important at 20 weeks. You can get niacin (B3) from:

fish;
eggs;
meat;
organ meats.

Vitamin B5 or Pantothenic Acid

Ensures proper regenerative processes. It is directly involved in the formation of antibodies and affects the immune response. Pantothenic acid reduces anxiety, stabilizes stress levels, and ensures proper biosynthesis of neurotransmitters. You can get it from:

eggs;
nuts;
meat;
poultry;
cauliflower;
green vegetables.

Vitamin B6 or Pyridoxine

Participates in the organization of all metabolic processes occurring in the body of the expectant mother. At 20 weeks, it ensures the establishment of the child's innate immunity, prevents cardiovascular pathologies, and regulates placental function. Sources of this vitamin include:

citrus fruits;
grains;
tomatoes;
carrots;
nuts;
potatoes.

Vitamin B7 or Biotin

Helps prevent neonatal diabetes by regulating blood sugar levels. It's also known as Vitamin H. It plays a role in transporting carbon dioxide and alleviates muscle cramps. At 20 weeks, it helps strengthen hair and nails, which can become brittle due to a lack of calcium and other nutrients. You can get it from:

bananas;
liver;
peas;
oranges;
apples;
milk;
sea fish.

Vitamin B9 or Folic Acid

The most important vitamin for pregnant women. At 20 weeks and beyond, it helps in the formation of the spinal cord and brain, ensures proper development of the musculoskeletal system, and regulates cell division. Sources of folic acid include:

tomatoes;
greens;
vegetables;
nuts;
legumes;
beets;
bananas;
egg yolks.

Vitamin B12 or Cyanocobalamin

Ensures the proper formation of the protective sheath around nerve endings in the fetus, which develop at 20 weeks. It also plays a role in the formation of the blood system and helps reduce high cholesterol levels. You can get it from:

sea fish;
seafood;
organ meats;
poultry;
eggs.

Vitamin C or Ascorbic Acid

Ensures proper calcium absorption. Stimulates the immune properties of both mother and child. At 20 weeks, it participates in metabolic processes and influences the future metabolism of the baby. Sources of ascorbic acid include green vegetables and citrus fruits.

Vitamin A or Retinol

Plays a role in the formation of hearing and vision organs. At 20 weeks of pregnancy, due to the active increase in blood volume, its deficiency is noted. Daily intake of this vitamin reduces the risk of stillbirth. Sources of Vitamin A:

chicken and quail eggs;
hard cheeses;
butter;
fish oil;
fresh carrots.

Vitamin D or Cholecalciferol

A special substance that can self-reproduce under the influence of ultraviolet light. A deficiency of this vitamin leads to improper development of the musculoskeletal system and the formation of rickets, so from 20 weeks of pregnancy, it is necessary for daily intake if there is insufficient exposure to sunlight. Dietary sources:

sea fish;
butter;
low-fat cheese;
animal and fish offal;
chicken eggs.

Vitamin E or Tocopherol

Considered one of the most beneficial vitamins for women in early pregnancy and at 20 weeks. It has antioxidant properties and protects the body's cells. It supports progesterone levels, which are necessary for a healthy pregnancy at 20 weeks and beyond. It ensures the proper functioning of the placenta. Sources of tocopherol:

eggs;
oils;
liver;
milk;
cottage cheese.

Vitamin K

includes subgroups of natural substances K1 and K2, as well as the artificially synthesized K3. These vitamins are involved in the formation of the circulatory system and ensure its function, which is necessary for the fetus after 20 weeks. They support normal blood clotting and, if necessary, participate in its thinning. Sources of vitamin K:

vegetables;
fruits;
juices;
milk;
kefir;
veal;
chicken.

Calcium

is essential for women at 20 weeks and beyond, as this is when the baby's active growth begins. Its systems and organs are already formed. For proper bone growth and the development of a healthy musculoskeletal system, daily calcium replenishment is needed. Signs of deficiency may include brittle nails, split ends, and deteriorating dental health. Sources of calcium:

sesame;
almonds;
garlic;
cheeses;
cottage cheese;
meat;
poultry;
fish;
milk;
eggshells.

Magnesium

Magnesium plays a role in the development of the fetal nervous system. After 20 weeks, it supports placental function, relieves muscle spasms, and helps prevent premature labor. Magnesium also stabilizes the pregnant woman's sleep, which is crucial for the proper development of the fetus. The primary sources of magnesium are leafy plants and green vegetables. You can also get it from:

legumes;
nuts;
grains;
seeds;
whole grain bread.

Phosphorus

At 20 weeks of pregnancy, this trace element ensures the proper formation of the baby's brain, heart, kidneys, and liver. It also contributes to the development of future teeth and influences bone growth. Phosphorus ensures the proper absorption of B vitamins, without which women may face complications. Sources of phosphorus include:

seafood;
fish;
nuts;
seeds;
cheese;
meat;
soy;
eggs;
cottage cheese.

Potassium

This trace element for pregnant women is on par with magnesium. Potassium ensures the proper functioning of the cardiovascular system, regulates blood pressure, and controls the functioning of the placenta and uteroplacental blood flow. For the baby, this is crucial because nutrients and oxygen are delivered through the blood flow. Sources of potassium:

bananas;
potatoes;
melon;
prunes;
oranges;
spinach;
raisins.

Sodium

This trace element plays a key role in intercellular and intracellular exchange. It is essential for both the baby and the mother at 20 weeks of pregnancy. A lack or deficiency of this trace element can lead to muscle atrophy and impaired cardiovascular function. Every day, the expectant mother gets the necessary amount of sodium from table salt.

Chromium

Chromium is the overseer of carbohydrate and energy metabolism. From 20 weeks, the developing baby needs an adequate level of this trace element because the formation of the thyroid gland begins. Chromium is responsible for this process and also regulates the body's response to increased insulin levels. Sources:

eggs;
tomatoes;
mushrooms;
oatmeal;
salads.

Cobalt

The trace element is closely linked with vitamin B12, so these substances cannot exist independently. Cobalt regulates metabolic processes in the body of the expectant mother, and after 20 weeks, it becomes crucial for the fetus. It helps break down proteins, fats, and carbohydrates, and aids in the absorption of nutrients. Cobalt ensures the normal function of the thyroid gland and the adrenal glands. Sources:

fish;
squid;
eggs;
sardines;
soy;
tomato;
quail.

Copper

From the 20th week, the body's need for copper significantly increases. A deficiency greatly raises the risk of cancer, diabetes, heart and vascular diseases, as well as obesity. Dietary sources of copper:

veal;
lamb;
horse meat;
seafood;
nuts;
buckwheat;
oats;
parsley.

Iron

Iron-deficiency anemia is a common problem for women at 20 weeks. This issue is accompanied by weakness and apathy, pale skin, and headaches. All of this leads to hypoxia and delayed embryo development. Sources of iron:

meat;
offal;
caviar;
pomegranates;
buckwheat.

Selenium

An important antioxidant that removes harmful substances from a woman's body and prevents them from reaching the baby. It supports the function of the placenta and protects the fetus. Selenium also promotes normal bone tissue growth and prevents developmental delays in the embryo. Sources:

bran;
seeds;
fish;
cottage cheese;
eggs;
beans;
oats;
lentils;
garlic;
cheese.

Silicon

As the pregnancy progresses, the load on the blood vessels and heart increases. Silicon cleanses the blood vessels from cholesterol plaques and normalizes uteroplacental blood flow. It is essential for the fetus for the proper development of the cardiovascular system and the prevention of congenital vascular diseases. Sources:

beans;
mineral water;
oatmeal;
buckwheat;
corn;
peas;
lentils.

Zinc

At 20 weeks, the fetus gains weight daily. Proper weight gain is ensured by zinc. A deficiency in women can lead to issues such as low birth weight and intrauterine growth retardation. Sources of zinc:

shrimp;
sesame seeds;
garlic;
rice;
almonds.

Important! The multivitamin complex should be chosen based on the recommendation of your doctor – your obstetrician-gynecologist and/or therapist.

Helpful Tips

If colostrum is leaking, you shouldn't try to squeeze it out of your breasts. Nipple stimulation can increase uterine contractions and potentially trigger a risk of miscarriage. Just dab the white droplets with a tissue or use special pads in your bra to absorb the colostrum.

Now is the perfect time to take a trip before the baby arrives, to gather strength before the crucial stage (after the baby is born, you both will hardly have any time to rest). Doctors recommend not changing climates, but if you want to "soak up the sun" in warmer countries, you should choose places that are safe in every sense.

Overall, if the pregnancy is going well, flights are even allowed from the 12th to the 32nd week. So, the future father can plan a vacation for his partner to enjoy some peace and recharge with positive emotions.

Exercises for Expecting Moms

With each passing week of pregnancy, the baby grows more and more, and the load on the future mom's organs also increases. That's why it's so important during this period to give the body manageable physical activity, so it can learn to relax on one hand, and be in good shape for childbirth on the other.

In the ranking of the most beneficial sports activities are prenatal yoga (and generally specialized programs), swimming, walking, muscle relaxation exercises, and proper stretching.

It's worth avoiding exercises that target the abdominal muscles, routines that involve lying on your back, and high-impact activities that sharply raise blood pressure.

Discomforts During Pregnancy

Heaviness in the Abdomen and a Feeling of Hardness

Abdominal cramps starting from the 20th week are a normal occurrence. Through Braxton Hicks contractions, the uterus is practicing and preparing for labor. If the heaviness is short-lived and not accompanied by additional complaints, there is no reason for concern.

Gastrointestinal Issues

Starting at 20 weeks, women often experience constipation. This is due to the pressure of the uterus on the intestines and specific hormonal changes. To help regulate the digestive system, it's recommended to consume more fiber and water. If there's no improvement, consult a doctor for medication options.

Cystitis

Inflammation of the bladder at 20 weeks is often caused by impaired kidney function. At the first signs of cystitis, it's necessary to get an ultrasound of the kidneys and bladder, and to take a urine test. After that, you should see a urologist for appropriate treatment. To ease your symptoms, it's recommended to drink more water, reduce salt intake, and do exercises to relieve the strain on your kidneys.

Yeast Infection

Vaginal candidiasis at 20 weeks occurs in more than 50% of women. It can be asymptomatic or accompanied by severe itching and heavy discharge. Treating a yeast infection at 20 weeks is necessary because the condition lowers local immunity and increases the risk of dangerous infections. A doctor selects the therapy for vaginal candidiasis based on the results of a swab test.

Back Pain

Increased strain on the spine is often accompanied by painful sensations. To alleviate this, it's recommended to rest more frequently, do some exercises, and sleep on a firm surface. If self-care measures don't bring relief, you should see a doctor who can prescribe the necessary treatment.

Leg Pain

At 20 weeks, a woman gains about 6 to 8 kg (13 to 18 lbs). This affects the blood vessels in her lower extremities. By the end of the workday, the expectant mother feels heaviness and notices swelling. Compression garments, prescribed by a phlebologist after an examination, can help manage the situation.

Heartburn

By the 20th week of pregnancy, the uterus expands, and its top reaches the stomach. When the expectant mother eats a lot, she feels heartburn. Medications that reduce stomach acidity can help manage the problem. It's important to choose remedies that are safe during pregnancy. It's not recommended to eat a big meal before bedtime. Reducing portion sizes can help prevent discomfort.

Checklist

Revise your diet. Your daily menu should include healthy foods and an adequate amount of water.
Continue to lead an active lifestyle. This will ease your preparation for childbirth and the process itself.
Take the medications and vitamins prescribed by your doctor. Without them, the risk of complications increases.
Update your wardrobe. By the end of the 5th month, the size of your belly no longer allows you to wear your usual everyday clothes.
Get your second screening if it hasn't been done in the past 1-2 weeks. This test helps identify the risk of congenital anomalies.
Have an ultrasound to determine the baby's gender. From 20 weeks onwards, the diagnosis is almost always accurate.
Pay attention to how you feel and consult your doctor if you have any complaints. Identifying issues early can prevent dangerous consequences.