Why is folic acid important.

The U.S. Public Health Service recommends that all women of childbearing age consume 400 micrograms (0.4 mg) of folic acid each day. Folic acid, a nutrient found in some green leafy vegetables, most berries, nuts, beans, citrus fruits, fortified breakfast cereals, and some vitamin supplements can help reduce the risk for birth defects of the brain and spinal cord (called neural tube defects). The most common neural tube defect is spina bifida, in which the vertebrae do not fuse together properly, causing the spinal cord to be exposed. This can lead to varying degrees of paralysis, incontinence, and sometimes mental retardation.

Folic acid is most beneficial during the first 28 days after conception, when most neural tube defects occur. Unfortunately, many women do not realize they are pregnant before 28 days. Therefore, folic acid intake should begin prior to conception and continue through pregnancy. Your healthcare provider or midwife will recommend the appropriate amount of folic acid to meet your individual needs.

Most healthcare providers or midwives will prescribe a prenatal supplement before conception, or shortly afterward, to ensure all of the woman's nutritional needs are met. However, a prenatal supplement does not replace a healthy diet.

Exercise during Pregnancy

Regular exercise, with the approval of your physician or midwife, can often help to minimize the physical discomforts of pregnancy and help with the recovery after the baby is born. There is evidence that physical activity may be especially beneficial for women with gestational diabetes.

According to the American College of Obstetricians and Gynecologists, women who exercised and were physically fit before pregnancy can safely continue exercising throughout pregnancy. Women who were inactive before pregnancy or who have medical or pregnancy complications should consult with their physician or midwife before beginning any exercise during pregnancy.

All women should be evaluated by their physician or midwife before beginning or continuing an exercise program during pregnancy.

Exercise may not be safe if the pregnant woman has any of the following conditions:

• Preterm labor in current or past pregnancies
• Vaginal bleeding
• Cervical problems
• Leaking of amniotic fluid
• Shortness of breath
• Dizziness and/or fainting
• Decreased fetal activity or other complications
• Increased heart rate (tachycardia)
• Certain health problems, such as high blood pressure or heart disease

Types of exercise and strenuous activities to avoid during pregnancy include:

• Horseback riding
• Water skiing
• Scuba diving
• High altitude skiing
• Contact sports
• Any exercise that can cause a serious fall
• Exercising on your back after the first trimester (because of reduced blood flow to the uterus)
• Vigorous exercise in hot, humid weather, as pregnant women are less efficient at exchanging heat
• Exercise involving the Valsalva maneuver (holding one's breath during exertion), which can cause an increased intra-abdominal pressure

intrauterine life

The first trimester

The first trimester lasts for the first 12 weeks of the pregnancy and is crucial for the baby's development. At conception, the egg and sperm combine to form a zygote, which will implant in the uterine wall.

The zygote becomes an embryo as the cells divide and grow. All of the major organs and structures begin to form.

At 4–5 weeks, the embryo is only 0.04 inches long but will grow to around 3 inches long by the end of the first trimester. The embryo is now looking a lot more like a human baby.

The fetus's heart rate can be heard as early as 8 weeks on a doppler in the doctor's office, but more likely closer to 12 weeks. During the eighth week the eyelids remain closed to protect its eyes. The fetus can also make a fist at this stage. Also, external genitalia will have formed and may be visible during an ultrasound, meaning that a doctor can tell someone whether the fetus is male or female.

A woman will experience many changes during the first trimester, too. Many women will start to feel morning sickness, or nausea and vomiting due to pregnancy, at 6–8 weeks.

Despite its name, this nausea does not just occur in the morning. Some pregnant women get sick at night, while others are sick all day.

A pregnant woman might also feel very tired and notice that she is more emotional than usual due to hormonal changes.

Many also report experiencing food cravings or aversions during early pregnancy, alongside a stronger sense of smell. Breast tenderness is also very common.

The second trimester

The second trimester lasts between week 13 and 26 of pregnancy. The fetus will go through a lot of changes during this time and grow from approximately 4–5 inches long to around 12 inches long.

During the second trimester, the fetus will also go from weighing about 3 ounces to weighing 1 pound (lb) or more.

In addition to the major structures and organs, other important parts of the body will also form during the second trimester, including:

• the skeleton
• muscle tissue
• skin
• eyebrows
• eyelashes
• fingernails and toenails
• blood cells
• taste buds
• footprints and fingerprints
• hair

If the fetus is male, the testes begin to drop into the scrotum. If the fetus is female, the ovaries begin to form eggs.

The fetus now has regular sleeping and waking patterns. They can also hear sounds from outside the womb, and they will begin to practice swallowing, which is an important skill after delivery.

The woman will also likely begin to feel better. In most cases, morning sickness and fatigue start to go away at the beginning of the second trimester. Food cravings and aversions can continue, however.

A woman may notice that her belly is starting to grow and that she is beginning to "look pregnant." She should also start to feel the baby moving, which is called "quickening."

Braxton–Hicks contractions may start toward the end of the second trimester.

A woman may also begin to experience other symptoms in the second trimester, including:

• round ligament pain
• nipple changes, such as darkening
• stretch marks

The third trimester

Share on Pinterest

During the third trimester, a growing fetus will move more regularly.

The third trimester lasts from week 27 until delivery, which is usually around week 40. During this trimester, a developing baby will grow from around 12 inches long and 1.5 lbs in weight to about 18–20 inches long and 7–8 lbs in weight.

Most of the organs and body systems have formed by now, but they will continue to grow and mature during the third trimester.

The fetus's lungs are not fully formed at the beginning of this trimester, but they will be by the time of delivery.

A growing baby will start practicing breathing motions to help prepare for life after birth. Kicks and rolls become stronger, and a pregnant woman should feel the baby move regularly.

A pregnant woman may also begin to feel uncomfortable during this trimester, as her belly starts to grow. Most women start to feel Braxton–Hicks contractions getting stronger, and they may have back pain from carrying a heavy belly.

Other symptoms that a pregnant woman may experience during the third trimester include:

• heartburn
• swollen feet
• insomnia
• mood swings
• leakage of milk from the breasts
• other breast and nipple changes
• frequent urination

As the woman gets closer to the delivery, the baby should turn in to a head-down position to make birth easier.

Motor neuron disease

·         Motor neuron diseases are a group of conditions that cause the nerves in the spine and brain to lose function over time. They are a rare but severe form of neurodegenerative disease.Motor neurons are nerve cells that send electrical output signals to the muscles, affecting the muscles' ability to function.

·         Motor neuron disease (MND) can appear at any age, but symptoms usually appear after the age of 40 years. It affects more men than women.

·         The most common type of MND, amyotrophic lateral sclerosis (ALS), probably affects up to 30,000 Americans at any given time, with over 5,600 diagnoses each year, according to the ALS Association.

·         The renowned English physicist Stephen Hawking lived with ALS for many decades until his death in March 2018. Guitar virtuoso Jason Becker is another example of someone who has been living with ALS for several years.

Types

·         There are several types of MND. Doctors classify them according to whether they are hereditary or not, and which neurons they affect.

·         ALS, or Lou Gehrig's disease, is the most common type, affecting both the upper and lower motor neurons (neurons in the brain and spinal cord). It affects the muscles of the arms, legs, mouth, and respiratory system. A person with ALS will live, on average, another 3–5 years, but, with supportive care, some people live 10 years or more.

·         Primary lateral sclerosis affects the neurons in the brain. It is a rare form of MND that advances more slowly than ALS. It is not fatal, but it can affect a person's quality of life. Juvenile primary lateral sclerosis can affect children.

·         Progressive bulbar palsy (PBP) involves the brain stem. People with ALS often have PBP too. The condition causes frequent choking spells, difficulty speaking, eating, and swallowing.

·         Progressive muscular atrophy (PMA) is a rare condition that affects the lower motor neurons in the spinal cord. It causes slow but progressive muscle wasting, especially in the arms, legs, and mouth.

·         Spinal muscular atrophy (SMA) is an inherited MND that affects children. There are three types, all caused by a genetic change known as SMA1. It tends to affect the trunk, legs, and arms. The long-term outlook depends on the type.

·         The different types of MND share similar symptoms, but they progress at different speeds and vary in severity.
Symptoms

·         MND has three stages — early, middle, and advanced.

·         Early stage signs and symptoms

·         In the early stage, symptoms develop slowly and can resemble those of other conditions. The symptoms will depend on the type of MND a person has and which part of the body it affects.

·         Typical symptoms begin in one of the following areas:

• the arms and legs
• the mouth
• the respiratory system

·         They include:

• a weakening grip, which makes it hard to pick up and hold things
• fatigue
• muscle pains, cramps, and twitches
• slurred speech
• weakness in the arms and legs
• clumsiness and stumbling
• difficulty swallowing
• trouble breathing or shortness of breath
• inappropriate emotional responses, such as laughing or crying
• weight loss, as muscles lose their mass

·         Middle stage signs and symptoms

condition progresses, the early symptoms remain and become more severe.

·         People may also experience:

• muscle shrinkage
• difficulty moving
• joint pain
• drooling due to problems with swallowing
• uncontrollable yawning, which can lead to jaw pain
• changes in personality and emotional state
• difficulty breathing

·         Studies suggest that up to 50% of people with ALS may experience brain involvement, including memory and language problems. Around 12–15% of people with ALS may develop dementia.

·         Some people also develop insomnia, anxiety, and depression.

·         Advanced stage signs and symptoms

·         Eventually, a person in the advanced stage of ALS will need help to move, eat, or breathe, and the condition can become life-threatening.

· Breathing problems are the most common cause of death.Causes

·         Motor neurons instruct the muscles to move by sending signals from the brain. They play a role in both conscious and automatic movements, such as swallowing and breathing.

·         Experts believe that around 10% of MNDs are hereditary. The other 90% happen randomly.

·         The exact causes are unclear, but the National Institute of Neurological Diseases and Stroke (NINDS) note that genetic, toxic, viral, and other environmental factors may play a role.
  Risk factors

·         MNDs can occur in adults or children, depending on the type. They are more likely to affect men than women. Inherited forms of the condition may be present at birth. They are most likely to appear after the age of 40 years.

·         The various types may have different risk factors. SMA is always hereditary, but this is not true for all forms of MND.

·         According to NINDS, around 10% of ALS cases in the United States are hereditary. It is most likely to appear at the age of 55–75 years.

·         They also note that veterans appear to have a 1.5–2 times higher chance of developing ALS than non-veterans. This may indicate that exposure to certain toxins increases the risk of having ALS.

·         A 2012 study found that footballers have a higher risk of dying from ALS, Alzheimer's disease, and other neurodegenerative diseases, compared with other people. Experts think that this could indicate a link with recurrent head trauma.

Diagnosis

·         Doctors often find it difficult to diagnose MND in the early stages as it can resemble other conditions, such as multiple sclerosis (MS).

·         If a doctor suspects someone has MND, they will refer them to a neurologist, who will take a medical history, do a thorough examination, and may suggest other tests, such as:

·         Blood and urine tests: These can help a doctor rule out other conditions and detect any rise in creatinine kinase, a substance that muscles produce when they break down.

·         MRI brain scan: An MRI cannot detect an MND, but it can help rule out other conditions, such as stroke, brain tumor, or unusual brain structures.

·         Electromyography (EMG) and nerve conduction study (NCS): An EMG tests the amount of electrical activity within muscles, while a NCS tests the speed at which electricity moves through muscles.

·         Spinal tap, or lumbar puncture: A doctor will look for changes in the cerebrospinal fluid, which surrounds the brain and spinal cord. It can help rule out other conditions.

·         Muscle biopsy: This can help detect or rule out a muscle disease.

·         The doctor will normally monitor the individual for some time after the tests before confirming that they have MND.

Treatment

There is no cure for MND, but treatment may slow progression and maximize the individual's independence and comfort.

·         Techniques include the use of supportive devices and physical therapy.

·         The correct choice will depend on factors such as:

• the type of MND a person has
• the type and severity of symptoms
• personal choice
• the availability and affordability of drugs

·         Slowing disease progression

·         Drugs appear to be effective at slowing the progress of some types of MND.

·         For example, the Food and Drug Administration (FDA) have approved Radicava (Edaravone) for the treatment of ALS and Spinraza and Zolgensma to treat SMA.

·         Muscle cramps and stiffness

·         Medications, such as botulinum toxin (Botox) injections. Botox blocks the signals from the brain to the stiff muscles for about 3 months.

·         Baclofen, a muscle relaxer, may help relieve muscle stiffness, spasms, and yawning. A doctor can surgically implant a small pump outside the body to deliver regular doses to the space around the spinal cord, from where it can reach the nervous system.

·         Some people may find physical therapy helps alleviate cramps and stiffness.

·         Pain relief

·         A non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, will help with mild to moderate pain from muscle cramping as spasms.

·         A doctor may prescribe stronger pain relief medication for severe joint and muscle pain in the advanced stages.

·         Other options

·         Scopolamine, worn as a patch, can help manage drooling.

·         Antidepressants