Women's Healthcare Topics
James Brann, MD. Ob/Gyn

4 Weeks Pregnant

In This Article

Pregnant Belly Changes

By now you would normally expect your period to arrive. If it does not, there is a good chance you might be pregnant! Even without any of the symptoms of pregnancy, you may just "know" that you are pregnant.

Mom's Belly at 4 Weeks

You might start feeling a little bit pregnant now. The most common symptom women experience this early in pregnancy (aside from a missed period) is increasing fatigue. That's no surprise given the work your body is performing to create a new life! Other women feel some mild abdominal cramping in early pregnancy while some report increasing breast tenderness.

Some women are very in tune with their body and may notice subtle changes associated with pregnancy. If you are one of these women, keep in mind that our minds can often play tricks on us, and the only sure fire way to tell is with a pregnancy test.

Home Pregnancy Test

Wait until after a missed period before taking a pregnancy test

By 4 weeks pregnant you should be able to take a home pregnancy test. You should call your healthcare provider as soon as you get a positive result to schedule your first prenatal visit. Most healthcare providers won't see patients until they are eight to ten weeks pregnant (unless they are in a high risk category) but you may need to schedule your appointment a few weeks in advance. Your doctor can also prescribe prenatal vitamins for you and ensure you are taking important steps to protect your health and that of your babies during your early pregnancy weeks.

Most over-the-counter pregnancy tests work by detecting the levels of hCG (human Chorionic Gonadotropin) in your urine. This pregnancy hormone is produced as soon as your baby implants into your uterine lining. If you take a pregnancy test too early, you can have a negative result, even if you are indeed pregnant, because your levels of hCG are not high enough yet.

In some unfortunate cases, taking a pregnancy test early can lead to false hopes. Some women experience a "chemical pregnancy," or a very early miscarriage in which the fertilized egg did not embed properly into the uterine lining. With a chemical pregnancy, you may take a pregnancy test and get a positive result, but then you get your period (miscarriage).

If you have missed your period, but it's been a week and you still test negative with an over-the-counter pregnancy test, call your doctor for a blood pregnancy test.

Pregnancy Symptoms

Mom's symptoms at 4 Weeks

Before you miss your period, you'll want to be on the lookout for any signs that you could be pregnant. Some symptoms might show up this early, while others won't start until a week or two later. Here are a few signs of pregnancy you'll want to pay attention to:

  • Fatigue - It's common for women to experience fatigue. You may feel super exhausted all of a sudden. Experts aren't quite sure what causes this early sign of pregnancy, but the rising levels of the hormone, progesterone, may play a role.

  • Nausea or vomiting - can start as early as now in some women, but it's more common at 6 weeks. You may find that you're feeling slightly queasy this week, and the smells of certain foods might make you gag.

  • Abdominal bloating - In early pregnancy, you may experience abdominal bloating. This sensation is similar to what you might have noticed prior to your regular menstrual period. Abdominal bloating is due to hormonal changes in your expectant body.

  • Tender, swollen breasts - Tender, swollen breasts are an uncomfortable pregnancy symptom to expect. Even before you miss your period, your breasts may enlarge and be sore to touch. Many pregnant women describe the sensation as similar to how your breasts feel right before your period – only it's 10 times worse.

  • Cramping - now is normal, and it's usually a sign of implantation. Some women describe this cramping akin to a light menstrual cramps.

  • Light spotting - can also be normal, and it's due to implantation bleeding. The spotting is typically pink or light brown. It should never be heavy, or bright red like your regular menstrual period.

Baby Section

Your Baby at 4 Weeks of Pregnancy

Week 4 embryo

During pregnancy week 4 your baby starts implanting into the lining of your uterus. The uterus will safely and securely house your baby for the remaining weeks of your pregnancy. Your baby will start resembling a tiny tadpole more than a ball of cells now. This week your baby's amniotic cavity starts to form. From this cavity the placenta will grow and nourish your baby throughout your pregnancy.

At this point in development, your "baby" is only an embryo that consists of two cell layers, which are dividing rapidly to form your baby's body. This early stage of pregnancy is often noted as the beginning of the embryonic period.

The placenta is in its earliest stage of development. Until it is mature and ready to function, your baby receives his or her nutrition from the yolk sac, which is also forming. The yolk sac also produces blood cells until your baby's liver is mature enough to do this. The yolk sac completely disappears by the end of the first trimester, when both the liver and placenta are mature enough to take over its job.

The amniotic cavity is forming. This cavity will eventually develop into the fluid-filled amniotic sac (bag of water) where your baby will grow and develop for the next nine months. The amniotic sac protects your baby from bumps and injury.

Pregnancy Health Section

Video: Pregnancy Week 4

Top Five Fears of New Moms

Mom's fears of being a good mom at 3 Weeks

Becoming a mother for the first time is unquestionably the biggest change of a woman’s life. Yes, marriage, losing your virginity, graduating and other firsts is right up there, but there is truly nothing that is so drastically life altering than bringing a new human being into the world. Indeed, motherhood comes with major responsibility, anxiety, happiness, stress, excitement and fear.

With all of the extra hormones a pregnancy woman has to deal with, sometimes these fears can kick in at the worst of times. One minute you are happily shopping for onesies, pacifiers and crib sheets, and the next you are spacing out in the middle of the aisle, trying to get a grip over your thoughts.

Rest assured, these thoughts are normal. Often, they are unwarranted, but at the same time, irrational fears can be scary for any new mother-to-be. Although there may be more things not on this list, the following 5 fears of expectant mothers are also fears faced by many new parents:

  • 1. Fear of never being able to do anything personal again.
    We’ve all seen moms who look tired, stressed, or who complain about never being able to go out and do things after the baby is born. Even simple things, such as going to the hair salon or going out to dinner with a friend, often fall by the wayside in exchange for changing poopy diapers, sleepless nights and breastfeeding. A pregnant mom might even feel guilty about thinking this way, wondering if she is just plain too selfish for parenthood.

    While it is true that your schedule drastically changes once the baby comes, it does not mean that you should stop being you or doing things that you enjoy. If you like jogging, for example, you could invest in a jogger stroller. If you want to visit a friend and it seems like too much of a hassle to bring the baby along, find help to relieve you for a couple of hours a week. A grandparent, aunt or uncle of the child, or even a reliable babysitter will do wonders for your sanity and make you feel like you can still be “you” and not just “mommy”.

  • 2. Fear of body changes, such as stretch marks, weight gain, pot belly, etc.
    You worked hard to keep your curvy, girlish figure. Now the baby is coming along, and you wonder, “Will my body ever look the same?” The simple answer is, no. However, your body can look as good as it does pre-pregnancy, if not better, if you are committed and do not give up on yourself.

    There are many ways you can overcome the imperfections, but if you ask any woman if she would trade her child in for the body she used to have, 99.9% of all moms would say, “No way.” Embrace your imperfections and be confident that you will be a wonderful mother!

  • 3. Fear of baby being born with defects or health issues.
    It happens, and there is nothing you can do about it. Taking care of you during pregnancy is the best precaution against any birth defects or health issues. Try not to worry or becoming obsessed with the “what-ifs” because these negative thoughts will drive you crazy. Remember that positive thoughts lead to positive outcomes, so worrying about something you have no control over is just a waste of your time and energy.

  • 4. Fear of inexperience leading to accidental injury of your child.
    This fear can keep you tossing and turning all night long! Newborn babies are so fragile, and if you are a mother who has not been around babies all that much or feel inexperienced with children, this fear is perfectly understandable! Some mothers with this fear worry they will drop the baby, or trip and fall while holding it, or pick it up the wrong way and somehow hurts its floppy little head, or that they won’t put the right blankets in the crib, or feed the baby wrong, and the list goes on!

    Rest assured, none of these things are likely to happen. You will make a mistake or two as a mother, but you are given the right instincts to protect your baby naturally. Nature will kick in after you have your child, and the love you have will be enough to protect your baby from most anything, even from your own clumsiness.

  • 5. Fear of childbirth.
    Women swap stories with new mothers about their own labor pains, which can actually lead to these anxieties. If a mother tries to tell you about her labor that lasted 36 hours and how excruciatingly painful it was, politely bow out of the conversation. The last thing you need are people “stoking the fire” and making your fears even more terrifying.

    Some women only experience mild discomfort during childbirth, and there are ways you can increase your odds of having a less painful delivery. Taking care of yourself during pregnancy, chiropractic care or massages, yoga, exercise and other types of methods can help you deliver a healthy baby. As many women will tell you, the pain of childbirth will soon be forgotten by the very moment you hold your newborn in your arms for the first time. So take a deep breath and relax. You will survive and get through it like a champion.

A Spotlight on Nutrition in Pregnancy

So, it's been confirmed. You have a bun in the oven. Now that you're with child, you have to evaluate your diet. Everyone knows that eating a balanced and healthy diet is best ... but what if you're addicted to junk food? After all, it is very delicious and satisfying.

Junk Food during Pregnancy
Junk food may taste great, but do you want to risk your baby's chance of developing weight problems later in life? Or get diabetes? Plus, when you're pregnant, you have to watch your weight. Being overweight can lead to a high-risk pregnancy, and you will be more likely to need a cesarean section. You are also more prone to gestational diabetes and high blood pressure; both of which can cause harm to your baby.

You can stray from a balanced diet occasionally, as long as it's in moderation. Think about your baby's future first, before reaching for that French fry or Starbucks Frap.

Mom's symptoms at 4 Weeks

Caffeine during Pregnancy
Addicted to coffee? If you want to reduce your risk of miscarriage, it's best to give up the java for nine months. The American Dietetic Association recommends that caffeine consumption in pregnancy should be limited to not more than 300 mg each day, or approximately three, 5-oz cups of coffee.

When you drink even more coffee, over 5 cups each day (500mg of caffeine), you have a slightly increased risk of miscarriage. Also, caffeine use throughout pregnancy can decrease your baby’s birth weight (fetal-growth restriction).

In summary, moderation of coffee drinking, less than 3 cups each day, does not increase your risk for miscarriage or a small birth weight baby. Now you might be asking, what about decaffeinated coffee? Decaf drinks can raise your cholesterol, but it will not increase your miscarriage risk.

Food to Avoid during Pregnancy
Foods to Avoid during Pregnancy

During pregnancy, you will also need to avoid certain foods. For the best outcome, you should start avoiding these foods now, instead of waiting until later in the pregnancy.

  • Raw and undercooked meats, which can contain harmful bacteria (such as salmonella, listeria, and toxoplasmosis), which can create pregnancy complications.
  • Undercooked and raw eggs can also contain salmonella. This bacteria can lead to miscarriage and stillbirths. Avoid any food products that may contain eggs, such as eggnog and Caesar dressing. Read package labels carefully.

  • Deli meats and imported soft cheeses can sometimes carry listeria. If you love prepared deli meats, make sure that you heat them until steaming hot to avoid getting infected. For cheese lovers, avoid imported, unpasteurized cheeses (such as blue cheese or feta). You can eat soft cheeses that are pasteurized with milk.

  • Certain types of fish should be avoided during pregnancy, as they may have a high mercury content. Several types of large fish, notably tuna, swordfish, shark, king mackerel, and tile-fish, absorb and retain mercury from the water or ingest it when they eat smaller fish. Because these contaminated fish when eaten during pregnancy may expose your unborn baby to unsafe mercury levels, the Environmental Protection Agency and the Food and Drug Administration (2008) currently recommend that pregnant women not eat more than 6 ounces of albacore tuna (large fish) or 12 ounces of small size fish or shellfish a week.

    Mercury exposure for your baby is harmful. It affects the developing nerve cells of the baby’s brain and can cause problems from developmental delays to severe brain damage.

How to Achieve a Balanced Diet
For a balanced diet, you may want to aim to try to get two or three portions of protein every day (lean meats or fish), three servings of dairy (low-fat milk, yogurt, or cheese), several servings of whole grain carbohydrates (rice, bread, or pasta), five servings of vegetables, three or four servings of fresh fruit, and at least one portion of iron-rich food (such as dark leafy green vegetables).

To avoid getting sick of eating one thing, change your menu up. Don't over eat the same thing every day. If you eat chicken and broccoli one day, choose a hearty salad the next day.

If you're struggling with morning sickness, you may want to break up your meals. Instead of three meals, eat smaller meals and snack throughout the day.

If you are overweight and pregnant, don't diet to lose weight. Dieting can lead to undernourished babies, premature delivery, and underweight birth weight.

Eating a balanced diet, along with your prenatal vitamins, will have the best outcome – a happy and healthy baby at the end of 40 weeks!

Pregnancy Weight Gain at 4 Weeks

Your weight at week 4

Your pregnancy weight gain at 4 weeks pregnant is less than a pound. By the end of your pregnancy, underweight women will gain approximately 34 pounds, normal weight women 25 to 35 pounds and for overweight women 15 to 20 pounds.

Harmful Substances in Pregnancy

Substance abuse in pregnancy has many harmful effects.

The early weeks of pregnancy are considered a critical time of development. Any exposure to harmful substances now and later in the first trimester is most likely to cause damage to or harm your developing baby. It is extremely important that you do everything possible to try to avoid exposure to any potential pollutants or toxins during this time.

Remember that a common substance implicated in fetal deformities or malformations is alcohol. If you have an addiction, you should talk with your healthcare provider immediately so they can help you determine the best way to proceed.

Many harmful effects have been associated with smoking. The nicotine and carbon monoxide found in cigarette smoke can cause:

  • Low Birth Weight Babies

  • Preterm Delivery

  • Premature Rupture of Membranes (PROM)

  • Placental abnormalities/problems

Did you know that environmental pollutants are just as harmful as other toxins you might ingest during pregnancy? It is important that you are aware of any environmental toxins and pollutants that may harm your fetus during pregnancy. Some of the more common pollutants that can affect fetal development include: lead, mercury, pesticides and PCBs. PCBs are mixtures of chemical compounds. Some women are exposed to certain PCBs at work. If you work in an environment where a variety of chemicals are used, you might check in with your healthcare provider to ensure that your work environment is safe.

Doctor's Corner

Pregnancy Week by Week - Women's Healthcare Topics

Signs and Symptoms of Pregnancy

The cardinal early sign of pregnancy is a missed period. Suspicion of pregnancy is increased if you had unprotected intercourse a week or two earlier than your expected period.

When it comes to pregnancy symptoms, no two women or even pregnancies are alike. Many times, symptoms will vary greatly. However, women commonly develop certain symptoms during a healthy, normal pregnancy. The top four reported symptoms are going to the bathroom all the time to urinate (52 percent), feeling exhausted (46 percent), not sleeping well (28 percent), and backache (20 percent) [Reference].

Sixty percent of pregnant moms experience some symptoms of pregnancy as early as five to six weeks after their last menstrual period [LMP]) and almost everyone has symptoms of pregnancy after the eight week [Reference].

What are the Common Early Pregnancy Symptoms? They are:

  • Morning sickness - This includes nausea with vomiting or without. Morning sickness may last at any point of the day, but for many women it only occurs during the beginning months of pregnancy.

  • Increasing breast size and painful breasts

  • Unusual tiredness

  • Increased urination

  • Cramping in the lower belly which is mild

What are the Common Later Pregnancy Symptoms? They may include:

  • Difficulty with bowel movements (constipation)

  • Nosebleeds and a stuffy nose

  • Indigestion or heartburn - You may feel pain in your chest or stomach, or burning in your throat or chest.

  • Itchy or painful swollen veins in your rectum (hemorrhoids)

  • Cramping in your legs

  • Pain in your lower back

  • Shortness of breath - As pregnancy proceeds, this may become more of a problem.

  • More headaches

  • Difficulty sleeping

  • Increased urination, including at night

  • Gum bleeding

  • Thicker hair

  • Tingling or numbness in your leg, foot or hand

  • Increasing tiredness

  • Twisted and swollen veins (varicose veins)

  • Ankle or feet swelling (mild)

  • Contractions which are “false” - This is when your uterus tightens. It may make your belly feel harder or cause some pain. Also referred to as “Braxton Hicks”, these contractions do not signify you’re in labor. With “true” contractions, you are actually in labor, but these are different.

  • Changes in your skin - This is common during a pregnancy.

Areas of Concern

There are certain symptoms, though, that may be areas of concern. Give a call to your doctor of midwife if you notice any of these things

  • Leaking vaginal fluid

  • Belly or back pain that does not decrease with a change of positioning or resting

  • Heartburn that isn’t relieved by antacid medicine

  • Vaginal bleeding

  • Dizziness or feeling faint

  • Headaches which aren’t relieved by resting in a quiet, dark room for an hour

  • Blurry vision, flashes of light or seeing dark spots

  • Painful breathing

(next week)