Pregnancy week by week: a trimester-by-trimester guide

01Pregnancy, a journey across three trimesters#

Human pregnancy lasts on average 40 weeks of amenorrhoea (WA), counted from the first day of the last menstrual period, i.e. about 9 calendar months or 280 days. This duration is classically divided into three trimesters, each of which has distinct physiological characteristics, specific bodily transformations in the mother, and a precise medical follow-up calendar defined by the Moroccan Ministry of Health in line with the international recommendations of WHO and HAS.

In Morocco, around 600,000 pregnancies are registered each year according to data from the High Commission for Planning, with an overall fertility rate that has stabilised around 2.1 children per woman, the generation replacement threshold. Maternal mortality, a major indicator of the quality of the health system, has decreased considerably in recent decades thanks to advances in obstetric medicine and the widespread use of antenatal monitoring: it has fallen from around 359 deaths per 100,000 live births in 1980 to 72 per 100,000 in 2018 according to Ministry of Health data. The national target set for 2030 is to fall below 50 per 100,000, which involves in particular improving antenatal monitoring and access to emergency obstetric care in rural areas.

Understanding the stages of your pregnancy allows you to live it better, anticipate the medical examinations to be carried out, recognise the warning signs that require a quick consultation, and fully enjoy this unique period. However, all women do not experience pregnancy the same way — some go through it almost without symptoms, others experience significant discomfort. There is no "typical pregnancy", and each experience is unique.

02The first trimester (weeks 1 to 14)#

The first trimester is probably the most intense in terms of transformation, both for the baby who goes from a few cells to an almost complete fetus, and for the mother whose body adapts rapidly to the new hormonal and metabolic demands.

The first weeks (WA 4 to 6)

This period immediately follows conception and implantation of the embryo in the uterine wall. Late period is generally the first sign that alerts the woman, gradually accompanied by the first characteristic symptoms: morning sickness sometimes severe and reaching vomiting, painful breast tension with progressive darkening of the areolas, intense and unusual fatigue, frequent urination, increased emotional sensitivity and mood changes, aversion to certain odours or foods. This is the time to take a pregnancy test, either urinary (available at the pharmacy for 30 to 60 MAD, reliable from the first day of missed period), or blood (beta-HCG dosage in a laboratory, earlier and more precise, around 80-150 MAD).

Embryologically, this is a crucial period of organogenesis when all the essential organs are put in place. It is precisely during these first weeks that the embryo is most sensitive to external aggressions (alcohol, tobacco, teratogenic medications, viral infections), hence the importance of taking care of yourself from the moment pregnancy is suspected, ideally from the conception project itself.

Pregnancy declaration (WA 7 to 9)

Towards the end of the second month, the baby's heart beats regularly (visible on ultrasound), all organs are sketched, arms and legs are recognisable. This is the time of the first mandatory antenatal consultation with your gynaecologist or midwife. This consultation includes a complete medical interview (personal and family history, current treatments, lifestyle), a general and obstetric clinical examination, a dating ultrasound which confirms the pregnancy, its intrauterine location, and specifies the exact term. The administrative declaration is made to your health insurance fund (CNOPS, CNSS, AMO Tadamon) to open the right to ALD coverage throughout the pregnancy and the 6 months following childbirth.

The first biological assessment is prescribed, including: blood group and Rhesus, search for irregular antibodies, serologies (toxoplasmosis, rubella, syphilis, hepatitis B, HIV with your consent), fasting blood glucose, full blood count, ferritinaemia, urinary strip. These examinations help detect possible risk factors and adapt follow-up.

The end of the first trimester (WA 10 to 14)

The embryo officially becomes a fetus from the 10th week. Its size goes from 3 cm to 9 cm in 4 weeks, the face takes shape, fingers and toes differentiate. Morning sickness gradually decreases in the majority of women (but sometimes persists longer). Fatigue begins to decrease.

The first-trimester ultrasound (ideally performed between 11 and 13 WA + 6 days) is a capital examination that performs several essential measurements. Precise dating of the pregnancy by measurement of the crown-rump length (CRL). Measurement of nuchal translucency, a crucial parameter for the screening of trisomy 21 (T21) and other chromosomal anomalies. Early morphological examination to visualise certain major anomalies (anencephaly, cystic hygroma, severe cardiac malformations). T21 screening combines this ultrasound with maternal blood tests (PAPP-A, free β-HCG) to calculate a combined risk. If this risk is high, a fetal DNA test on maternal blood (NIPT) can be proposed, a non-invasive examination with very high accuracy (sensitivity 99%), available in Morocco in several laboratories for 800 to 1,500 MAD, not reimbursed by basic AMO but sometimes covered by complementary mutuelles.

03The second trimester (weeks 15 to 28)#

The second trimester is often described by women as the most pleasant period of pregnancy: nausea has disappeared, energy returns, the belly begins to round visibly, and the baby's first movements are felt.

Serologies and T21 screening (WA 15 to 18)

Several biological examinations are prescribed at this period. If you are not immune to toxoplasmosis (a serious parasitic infection for the fetus), monthly serology is required until delivery, accompanied by strict hygiene rules (complete cooking of meats, washing of fruits and vegetables, avoiding contact with unfamiliar cats and their litters, gardening gloves). Serologies for rubella, CMV, syphilis are checked or completed. For those who did not perform T21 screening in the first trimester, a second-trimester alternative exists in the form of the combined serum test (HT21).

The morphological ultrasound (WA 20 to 22)

This is probably the most awaited examination of pregnancy, both for its medical interest and for the moment of emotion it represents. This morphological ultrasound systematically examines the complete fetal anatomy: head (brain, face, intracranial structures), spine, heart (4 chambers, large vessels), lungs, abdomen (stomach, liver, kidneys, bladder), limbs and extremities (presence and length of all long bones, fingers, toes). Also checked are fetal biometry (growth measurements), placenta (location, structure), amniotic fluid (quantity), umbilical cord. This ultrasound, reimbursed by AMO, can detect about 60-80% of major malformations, which can lead to early specialist care. It is also when the baby's sex is generally identifiable, provided that the baby is in a favourable position and that the parents wish to know.

Gestational diabetes screening (WA 24 to 28)

Gestational diabetes affects about 10 to 12% of pregnancies in Morocco, a higher frequency than in European countries due to the genetic predisposition of Maghreb populations. Its screening is now systematic between 24 and 28 WA by 75g OGTT (oral glucose tolerance test) with measurement of fasting blood glucose, at 1 hour and 2 hours after ingestion of a glucose solution. The diagnosis is made if a single one of the three values exceeds the thresholds (0.92 g/L fasting, 1.80 g/L at 1 hour, 1.53 g/L at 2 hours). In case of positive diagnosis, strict nutritional management is established, with dietary follow-up, glycaemic self-monitoring, and insulin therapy if necessary.

It is also at this period that fetal movements become perceptible by the mother, generally between 18 and 22 WA for a first pregnancy, earlier (16-18 WA) in multiparous women. These movements, initially tenuous like "bubbles" or "butterflies", gradually become more pronounced and recognisable.

04The third trimester (weeks 29 to 40)#

The third trimester is marked by the rapid growth of the baby who gains an average of 1 kg per month, by the increasing discomfort of the mother related to the size of the uterus, and by active preparation for childbirth.

The growth ultrasound (WA 32)

This third ultrasound, reimbursed by AMO, checks several essential parameters before delivery. Fetal biometry estimates the baby's weight and compares with reference curves to detect growth retardation or macrosomia. Fetal presentation (cephalic, breech, transverse) is evaluated — at 32 WA, the baby can still spontaneously turn. Placenta location is confirmed — a low-lying placenta (praevia) may justify particular recommendations. Quantity of amniotic fluid and haemodynamic profile (uterine, umbilical, fetal cerebral Doppler) complete the assessment.

Preparation for delivery (WA 36 to 37)

At this stage, several practical steps are organised. Vaginal swab for group B streptococcus is performed: this germ, frequently carried asymptomatically in the vagina (15-25% of women), can contaminate the baby during childbirth with risk of neonatal sepsis. Antibiotic prophylaxis during labour prevents this risk. Childbirth preparation classes (8 sessions reimbursed by AMO) cover techniques for managing pain (breathing, postures), the physiology of labour, breastfeeding, newborn care. These sessions can be done with a midwife or in groups at the maternity hospital. The birth plan specifies your preferences (epidural or not, delivery position, presence of partner, immediate breastfeeding, etc.) — it is discussed with the obstetric team to prepare for D-day.

Term delivery (WA 37 to 41)

The baby is considered at term from 37 WA. Delivery can occur spontaneously at any time after this threshold. In Morocco, delivery takes place mainly in maternity hospitals (public or private), with an overall caesarean section rate of about 25-30% (variable depending on facilities), close to WHO recommendations which cap medically justified caesareans at 15%. The choice of maternity hospital should take into account several criteria: proximity to home, level of neonatal care (level 1, 2 or 3 depending on the availability of neonatal intensive care), available team, epidural practice (which is not systematically available everywhere in Morocco).

Beyond 41 WA exceeded, this is prolonged pregnancy which justifies enhanced monitoring (regular fetal monitoring, follow-up ultrasounds) and consideration of induction between 41 and 42 WA to limit the risks of fetal distress.

05The schedule of medical examinations#

Here is the summary of recommended examinations and their reimbursement by Moroccan AMO.

The total reimbursement by AMO is between 70 and 80% of the National Reference Tariff (TNR), the rest is borne by the patient unless complementary health insurance applies. For beneficiaries of AMO Tadamon or for pregnancies followed in the public sector (CHU, public maternity hospitals), coverage is almost total.

06Nutrition and lifestyle during pregnancy#

Nutrition during pregnancy follows precise rules that are neither excessive restrictions nor unrestricted permissions. The golden rule is diversity and quality without major caloric excess — pregnancy increases needs by only 200-300 kcal per day in the second trimester and 300-450 kcal in the third, contrary to the popular idea of "eating for two".

To favour

Fruits and vegetables carefully washed under running water (important sources of vitamins, minerals, fibres). Meats well cooked to the core (at least 70°C, with no pink) to eliminate the risks of toxoplasmosis and listeriosis. Fish several times a week for their omega-3, except predator fish rich in mercury (red tuna, swordfish, shark, marlin) which should be limited to once a month. Pasteurised dairy products provide calcium and protein. Whole-grain starches (wholemeal bread, brown rice, wholemeal semolina) at every meal. Abundant hydration of 1.5 to 2 litres per day, more in summer.

To strictly avoid

Alcohol in any form and any quantity throughout pregnancy — there is no safe consumption threshold, and alcohol can cause fetal alcohol syndrome with severe mental retardation. Tobacco (active and passive), responsible for growth retardation, prematurity, sudden infant death — quitting at any point in pregnancy provides benefit. Raw or rare meats (steak tartare, carpaccio, raw cured meats) due to toxoplasmosis and listeriosis. Raw milk cheeses (camembert, raw milk brie, roquefort, blue cheeses) due to listeriosis — prefer cooked-curd and pasteurised cheeses. Raw or undercooked eggs (homemade mayonnaise, chocolate mousse, artisanal tiramisu) due to salmonella. Medications without medical advice — always check pregnancy compatibility. Risky sports (horse riding, alpine skiing, contact sports, diving).

Systematic supplementation

Several nutrients require systematic supplementation. Folic acid (vitamin B9) at 0.4 mg per day is recommended ideally one month before conception and throughout the first trimester, for the prevention of neural tube closure anomalies (spina bifida, anencephaly). Iron is often supplemented in case of confirmed biological deficiency (iron-deficiency anaemia very common in women of childbearing age). Vitamin D is recommended at a single dose of 100,000 IU in the seventh month to optimise fetal bone mineralisation, particularly in the Moroccan context where vitamin D deficiency is common. Iodine can be supplemented in case of regional deficiency.

07AMO coverage and social rights#

Pregnancy is on the list of 41 long-term diseases (ALD) recognised by ANAM, which entitles to enhanced coverage throughout the pregnancy and 6 months after delivery. This status covers antenatal consultations (7 minimum), the 3 mandatory ultrasounds, serologies, biological assessments, delivery (vaginal or caesarean), neonatal care. To benefit from this enhanced coverage, you must declare the pregnancy to your fund from the first antenatal consultation.

The indicative cost of a complete pregnancy in the Moroccan private sector, excluding complications, is between 15,000 and 30,000 MAD (consultations + ultrasounds + assessments), to which is added the cost of delivery (about 8,000 to 15,000 MAD for vaginal delivery, 15,000 to 30,000 MAD for caesarean). In the public sector (CHU, public maternity hospitals), care is almost entirely free for AMO beneficiaries, with satisfactory quality of care in most facilities.

On the professional level, employees affiliated with CNSS benefit from a maternity leave of 14 weeks (98 days), of which a minimum of 7 weeks must be taken after delivery. These 14 weeks are compensated at 100% of salary (within the CNSS ceiling) after 54 days of contribution. Paternity leave also exists but remains limited to 3 days in Morocco, below international standards. Protection against dismissal is guaranteed during pregnancy and the maternity leave period by the Moroccan Labour Code.

08When to consult urgently#

Several situations require urgent medical consultation or a call to 141 without delay. Heavy vaginal bleeding, particularly in the first trimester (suspicion of miscarriage, ectopic pregnancy) or in the third trimester (placenta praevia, retroplacental haematoma). Regular and painful contractions before 37 WA, which may be a sign of threatened preterm labour. Loss of fluid through the genital tract, suspect of premature rupture of membranes (water breaking), particularly before term. Marked decrease or stoppage of fetal movements after 28 WA, which may reflect chronic fetal distress requiring rapid evaluation by monitoring.

A fever above 38.5°C persistent should be evaluated as it may reflect an infection (urinary, gynaecological, listeriosis) with risk to mother and fetus. Violent headaches, particularly associated with visual disturbances (black spots, blurred vision), sudden oedema of the face and extremities, bar-like pains in the upper abdomen are signs of pre-eclampsia, a serious pregnancy complication requiring urgent hospital management. Severe and persistent abdominal pain may reflect numerous complications (appendicitis, cholecystitis, haematoma, placental abruption) and justifies rapid consultation.

Beyond these emergencies, never hesitate to call your gynaecologist or midwife for any question — pregnancy is a period when worry is legitimate and the doctor prefers a hundred times to be called for nothing rather than miss a real emergency.