Week 24 of pregnancy: Lungs Begin Making Surfactant

This week small amounts of surfactant, the substance that will help the air sacs stay open, begin to appear in your baby's lungs. The lungs are still far from mature, and a baby born now would need intensive breathing support. For you, the window for the second gestational diabetes test opens: in India, everyone is offered a 75 g glucose test between 24 and 28 weeks if the first one was normal, and you do not need to fast. Movements also start to become a key sign of your baby's wellbeing from now on.

Head to heel, babies are typically around 30 cm now. Reference charts put the median weight near 670 g, with a normal range of roughly 510–830 g, so the 600 g figure is one point in a wide band. Indian babies are often a little smaller than Western charts. An ear of corn is only a rough guide.

Every pregnancy is different - you may have some, all or none of these.

Stronger movements

Kicks and rolls are becoming more regular. Learn your baby's pattern. If movements slow down, change or stop, contact your maternity unit straight away, even at night.

Swollen feet

Gradual swelling by evening is common. Rest with your feet up. Sudden swelling of the face, hands or feet needs a same-day check.

Heartburn

The uterus presses higher now. Eat smaller meals and avoid lying down soon after eating. Pain under the right ribs is not heartburn and needs urgent review.

Braxton Hicks

Irregular, painless tightenings are normal. Regular or painful tightenings before 37 weeks need checking at hospital.

Thirst or tiredness

Usually part of normal pregnancy. Gestational diabetes often causes no symptoms at all, so the glucose test matters far more than how you feel. Mention unusual thirst at your visit.

• Glucose test for gestational diabetes (India)

  Routine

  24 to 28 weeks

  India tests everyone twice: at the first visit and again at 24–28 weeks if the first was normal. You drink 75 g of glucose dissolved in water, fasting or not, and blood is taken two hours later. A value of 140 mg/dL or more means gestational diabetes. If you first come for care after 28 weeks, you are tested once.

• Glucose testing elsewhere

  Varies by provider

  UK 24+0 to 28+0 weeks; US from 24 weeks

  In the UK a glucose tolerance test is offered only if you have risk factors. In the US everyone is screened, usually with a two-step test.

• If gestational diabetes is found

  Only if needed

  From diagnosis

  You will get diet and activity advice, learn to monitor your sugar, and may need medicine or insulin. India's guidance adds growth scans at 28–30 and 34–36 weeks and a repeat glucose test six weeks after birth.

• Fundal height and movements

  Routine

  From 24 weeks

  In the UK, uterus size is measured and movements discussed at each appointment after 24+0 weeks. If growth seems off track, a scan may be arranged.

Test methods and cut-offs differ between countries and some private laboratories. Follow the instructions your own doctor or health centre gives you for the test.

• 🌿Carbohydrate quality is this week's focus. Choose whole wheat roti, jowar, bajra or ragi, brown or parboiled rice and dalia over maida, white bread and large helpings of white rice.
• 🌿Build each meal with half a plate of vegetables, a portion of dal, chana, rajma, paneer, curd, or egg, fish or chicken if you eat them, and a moderate serving of grains.
• 🌿Keep sweets, mithai, sugary tea, cold drinks and packaged juice for occasional treats. ICMR-NIN advises keeping added sugar under 5% of energy and avoiding non-calorie sweeteners in pregnancy.
• 🌿No home remedy treats gestational diabetes. Do not rely on concentrated juices, powders or supplements to lower sugar; follow the plan your doctor or dietitian gives you.

• •Regular activity is linked with a lower risk of gestational diabetes. Aim for about 150 minutes a week of moderate activity, such as brisk walking, if your doctor agrees.
• •Short walks spread across the day are a good option if long sessions feel tiring. Keep the talk test in mind: you should still be able to hold a conversation.
• •Stop and seek advice for bleeding, fluid leaking, regular painful tightenings, dizziness, chest pain or calf pain.

• •Book your glucose test and ask whether you need to do anything beforehand; in India's national method you do not need to fast.
• •Get to know your baby's usual pattern of movements. Some doctors in India suggest a daily count; follow your own doctor's instructions, and act on any change rather than a number.
• •Do not use a home Doppler or phone app to reassure yourself about movements; hearing a heartbeat does not show that your baby is well.
• •If your baby were to arrive early, the best place is a hospital with a neonatal intensive care unit. Ask your doctor which centre you would be referred to.

• ?When and where should I have my 24–28 week glucose test?
• ?Do I need to fast or do anything differently before the test?
• ?If I have gestational diabetes, who will help me with diet and monitoring?
• ?Which hospital would care for my baby if they were born early?
• ?How should I keep track of my baby's movements?

• Glucose test booked for 24–28 weeks
• Refined grains swapped for whole grains at most meals
• Maternity unit number saved for any change in movements
• Home Doppler put away
• About 150 minutes of activity planned for the week