20 Weeks Pregnant: Baby Development, Body Changes & What to Expect

How Big Is My Baby at 20 Weeks?

At 20 weeks pregnant, your baby weighs approximately 280 grams (about 10 ounces) and measures around 24 centimeters (approximately 10 inches) from head to heel. This is roughly the size of a banana. Your baby has developed eyelashes and may have fine hair on their head.

Week 20 marks an exciting transition in your baby's development. Until this point, all fetuses have grown at remarkably similar rates, following nearly identical developmental timelines. However, from week 20 onward, individual variations in growth become more pronounced. Some babies will be naturally larger, others smaller, and these differences are completely normal as long as the baby continues to grow consistently.

Your baby's sensory systems are developing rapidly at this stage. The sense of touch has become fully functional, and your baby can now feel sensations throughout their body. Importantly, your baby has also developed the ability to perceive pain, which represents a significant neurological milestone. This development is why healthcare providers take special care during any procedures involving the fetus after this point.

The motor development at 20 weeks is impressive. Your baby can perform complex movements including somersaults, stretches, and coordinated limb movements. These acrobatic maneuvers are made possible by the ample amniotic fluid surrounding your baby, which provides buoyancy and space for movement. As your baby grows larger in coming weeks, these dramatic movements will become more constrained.

Physical Development Highlights

Your baby's physical features are becoming increasingly refined at 20 weeks. Delicate eyelashes have formed, adding definition to the face. Many babies also develop a fine coating of hair on their scalp, though the amount varies significantly between individuals. Some babies are born with full heads of hair, while others remain nearly bald until well after birth.

The sweat glands have completed their development during week 20, though your baby won't actually produce sweat until after birth. This is because the warm, aquatic environment of the womb maintains a constant temperature, eliminating the need for temperature regulation through sweating. Once born, these fully-formed sweat glands will help your baby regulate their body temperature in the outside world.

• Weight: Approximately 280 grams (10 ounces)
• Length: About 24 centimeters (10 inches) head to heel
• Size comparison: Similar to a banana
• Eyelashes: Now present and visible
• Hair: Fine hair may be developing on the scalp
• Sweat glands: Fully formed but inactive until birth

When Will I Feel My Baby Move?

Many pregnant people begin feeling fetal movements around week 20, though this can vary widely. First-time mothers often feel movements later (between weeks 18-22), while those who have been pregnant before may notice movements earlier. The sensations typically feel like flutters, bubbles, or gentle sweeping motions in the lower abdomen.

One of the most anticipated experiences of pregnancy is feeling your baby move for the first time, often called "quickening." Around week 20, many pregnant people experience this remarkable sensation. However, it's important to understand that there's considerable variation in when quickening occurs, and not feeling movement by week 20 is often completely normal.

The timing of when you first perceive movement depends on several factors. The position of your placenta plays a significant role; an anterior placenta (located at the front of the uterus) can cushion your baby's movements, making them harder to detect. Your body type can also influence perception, with those who have less abdominal fat sometimes feeling movements earlier. Additionally, a busy lifestyle with many distractions may mean you simply haven't noticed subtle movements that have already occurred.

First-time mothers typically feel movements later than those who have been pregnant before. This isn't because the baby is moving differently, but because experienced mothers know what to look for. They can distinguish fetal movements from other abdominal sensations like gas or digestive activity. If this is your first pregnancy, don't be concerned if you haven't felt clear movements by week 20—many first-time mothers don't recognize movements until weeks 22-24.

What Do Fetal Movements Feel Like?

Early fetal movements are often described using various analogies, as the sensation is unlike anything else you've experienced. Many people describe the first movements as feeling like:

• Fluttering: Similar to butterfly wings gently moving inside your abdomen
• Bubbles: Like small bubbles rising and popping in your belly
• Sweeping: A gentle brushing or sweeping sensation across your lower abdomen
• Popcorn: Light, popping sensations that come and go
• Muscle twitches: Brief, localized movements that feel like small muscle spasms

As your pregnancy progresses, these subtle sensations will become more pronounced. By the third trimester, you'll feel unmistakable kicks, punches, and rolls that are visible through your abdomen. For now, enjoy these gentle first communications from your baby.

What Changes Happen to My Body at 20 Weeks?

At 20 weeks, your uterus has grown to the level of your navel, and your belly is becoming noticeably larger. From this point forward, belly growth becomes more regular and predictable. You may experience increased appetite, skin changes, mild swelling in the extremities, and back discomfort as your center of gravity shifts.

Your body undergoes remarkable changes at 20 weeks to accommodate your growing baby. The uterus, which started pregnancy roughly the size of a pear, has now expanded to reach your belly button. This growth pushes your abdominal organs upward and outward, creating the characteristic pregnant belly that becomes increasingly visible to others.

It's worth noting that belly size varies enormously between pregnant individuals at the same gestational age. Factors influencing belly size include your height, torso length, muscle tone, whether you've been pregnant before, the position of your baby, and the amount of amniotic fluid. Comparing your belly to others at 20 weeks serves little purpose—what matters is that your healthcare provider confirms your baby is growing appropriately.

From week 20 onward, your belly will grow more predictably and steadily. Many healthcare providers begin measuring fundal height (the distance from your pubic bone to the top of your uterus) at prenatal appointments, as this measurement roughly correlates with gestational age in centimeters. At 20 weeks, your fundal height should be approximately 18-22 centimeters.

Common Physical Changes

The second trimester is often called the "honeymoon phase" of pregnancy because many uncomfortable first-trimester symptoms have resolved while third-trimester discomforts haven't yet begun. However, you may experience various changes at 20 weeks:

• Increased appetite: Your body needs additional calories to support your baby's growth, typically 300-350 extra calories per day during the second trimester
• Skin changes: The linea nigra (a dark line running down your abdomen) may appear, and some people develop melasma (darkened patches on the face)
• Stretch marks: As your belly expands, pink or purple stretch marks may develop, particularly on your abdomen, breasts, and thighs
• Nasal congestion: Pregnancy hormones cause increased blood flow and swelling of mucous membranes, leading to a stuffy nose
• Back discomfort: Your growing belly shifts your center of gravity forward, straining lower back muscles
• Leg cramps: Often occurring at night, these can be related to mineral imbalances or circulation changes

Emotional Changes

Many people find their emotional state more stable during the second trimester compared to the first. The initial anxiety about pregnancy establishment has often resolved, and the physical reality of your growing baby becomes more tangible. However, emotional fluctuations remain normal throughout pregnancy.

As you reach the halfway point, you may find yourself thinking more concretely about parenthood and the changes ahead. This is an excellent time to discuss parenting philosophies with your partner, consider practical preparations like nursery setup, and begin thinking about birth preferences.

What Happens at the 20 Week Anatomy Scan?

The 20-week anatomy scan (mid-pregnancy ultrasound) is a detailed examination lasting 30-45 minutes. It evaluates your baby's brain, spine, heart, kidneys, limbs, and other organs. The scan also checks placental position, amniotic fluid levels, and umbilical cord. You can usually learn your baby's sex at this appointment if desired.

The anatomy scan, typically performed between weeks 18-22, is one of the most comprehensive ultrasound examinations of your pregnancy. Unlike earlier ultrasounds that primarily confirm pregnancy and dating, the anatomy scan provides a systematic evaluation of your baby's structural development. This scan is sometimes called the "anomaly scan" because one of its purposes is to identify any structural abnormalities.

During the examination, the sonographer will methodically assess each part of your baby's anatomy. They examine the brain structures, including the ventricles and cerebellum. The spine is checked from top to bottom for proper formation. The heart is evaluated in detail, with the four chambers, valves, and major blood vessels being assessed. Internal organs including the stomach, kidneys, and bladder are visualized. The limbs are measured, and fingers and toes are counted when visible.

Beyond evaluating your baby, the anatomy scan provides important information about the pregnancy environment. The placental location is documented; if the placenta is lying low (placenta previa), additional monitoring may be needed as pregnancy progresses. Amniotic fluid volume is assessed, as both too much and too little fluid can indicate potential concerns. The umbilical cord is examined to confirm it contains two arteries and one vein.

What to Expect During the Scan

The anatomy scan typically takes 30-45 minutes, though it may take longer if your baby is in a difficult position or if additional views are needed. You'll lie on your back while a sonographer applies gel to your abdomen and moves a transducer across your belly. The procedure is painless, though you may feel mild pressure.

For the best images, you may be asked to arrive with a partially full bladder. Some facilities allow partners or support people to attend, while others have restrictions—check with your provider beforehand. Many centers provide printed images or digital files of your baby as keepsakes.

If Concerns Are Identified

The vast majority of anatomy scans show normal development. However, if the sonographer identifies any concerns, you may be referred for a more detailed scan with a maternal-fetal medicine specialist. Some findings require additional monitoring but don't indicate serious problems. Others may warrant further investigation through additional testing.

Remember that ultrasound is a screening tool, not a diagnostic test. Some conditions cannot be detected on ultrasound, while other apparent findings resolve or turn out to be normal variations. If concerns are raised, try not to panic before speaking with a specialist who can provide context and guidance.

What Should I Eat at 20 Weeks Pregnant?

At 20 weeks, focus on iron-rich foods to support your increasing blood volume. Good sources include lean meat, fish, eggs, legumes, leafy greens, nuts, and seeds. Avoid drinking coffee, tea, or milk with iron-rich meals as they inhibit absorption. Continue taking prenatal vitamins and discuss iron supplementation with your healthcare provider if needed.

Nutrition becomes increasingly important as your baby grows rapidly during the second half of pregnancy. Your blood volume has increased significantly to supply your baby with oxygen and nutrients, and this places increased demands on your iron stores. Iron deficiency anemia is common during pregnancy and can cause fatigue, weakness, and other complications if severe.

Iron from animal sources (heme iron) is more easily absorbed than iron from plant sources (non-heme iron). If you eat meat, lean red meat, poultry, and fish are excellent iron sources. Organ meats like liver are particularly iron-rich, though they should be consumed in moderation during pregnancy due to high vitamin A content. For vegetarians and vegans, combining plant iron sources with vitamin C-rich foods enhances absorption.

Certain foods and beverages can interfere with iron absorption and should be consumed separately from iron-rich meals. Coffee, tea, and calcium-rich foods (including milk and dairy products) all inhibit iron uptake. Try to consume these at different times than your iron-rich foods—for example, have your coffee an hour after your iron-fortified breakfast cereal rather than with it.

Iron-Rich Foods to Include

• Meat: Lean beef, lamb, pork, and dark poultry meat
• Seafood: Clams, oysters, sardines, and other fish
• Legumes: Lentils, chickpeas, black beans, kidney beans
• Vegetables: Spinach, kale, Swiss chard, broccoli
• Nuts and seeds: Pumpkin seeds, sesame seeds, cashews
• Fortified foods: Iron-fortified cereals, breads, and pastas
• Eggs: Particularly the yolks

Other Nutritional Priorities

While iron is particularly important at this stage, other nutrients remain essential throughout pregnancy:

• Protein: Aim for 70-100 grams daily to support your baby's tissue development
• Calcium: Essential for bone development; aim for 1000mg daily from dairy or fortified alternatives
• DHA: An omega-3 fatty acid crucial for brain and eye development; found in fatty fish or supplements
• Folate: Continue taking 400-800mcg daily through prenatal vitamins
• Fiber: Helps prevent constipation, which is common during pregnancy
• Water: Aim for 8-12 cups daily to support increased blood volume and amniotic fluid

What Symptoms Are Normal at 20 Weeks?

Common symptoms at 20 weeks include increased energy compared to the first trimester, growing belly and breast changes, mild swelling in feet and ankles, occasional round ligament pain, heightened appetite, and pregnancy-related skin changes. Most first-trimester symptoms like nausea have typically resolved by this point.

The second trimester is often considered the most comfortable period of pregnancy. For many people, the debilitating nausea and fatigue of the first trimester have subsided, while the physical heaviness and discomfort of the third trimester haven't yet begun. However, every pregnancy is unique, and your experience may differ from this generalization.

Your energy levels have likely improved significantly since the early weeks of pregnancy. The intense fatigue that characterizes the first trimester—caused by hormonal surges and the enormous energy demands of early fetal development—typically eases during the second trimester. You may find yourself feeling more like yourself again, able to enjoy activities and engage with daily life more fully.

Despite the relative comfort of this period, various symptoms remain common at 20 weeks. Understanding what's normal can help you distinguish expected pregnancy changes from concerns that warrant medical attention.

Physical Symptoms

• Round ligament pain: Sharp or aching pain in the lower abdomen or groin, especially with sudden movements, caused by stretching ligaments supporting the uterus
• Braxton Hicks contractions: Irregular, painless tightening of the uterus; these "practice contractions" are normal and become more noticeable as pregnancy progresses
• Shortness of breath: Your expanding uterus begins pushing against your diaphragm, and increased blood volume demands more oxygen
• Heartburn: Hormones relax the valve between stomach and esophagus, allowing acid reflux
• Swollen feet and ankles: Increased fluid retention and pressure from the growing uterus can cause mild edema
• Varicose veins: Increased blood volume and pressure from the uterus can cause veins in the legs to become enlarged and visible
• Skin changes: Darkening of nipples, linea nigra appearance, and possible stretch marks

What Prenatal Care Do I Need at 20 Weeks?

Prenatal care at 20 weeks typically includes the anatomy scan ultrasound, routine blood pressure and weight checks, urine testing, and listening to the fetal heartbeat. Your healthcare provider may order blood tests to check for anemia. This is also a good time to discuss birth planning and any questions about the coming months.

Regular prenatal care throughout pregnancy helps ensure both you and your baby remain healthy. During the second trimester, appointments are typically scheduled every four weeks, though this may vary based on your individual circumstances and any risk factors identified. The 20-week mark usually coincides with or falls near an important appointment that includes the anatomy scan.

At your prenatal appointments, your healthcare provider performs several routine assessments. Blood pressure monitoring helps identify early signs of preeclampsia, a serious pregnancy complication. Weight tracking ensures appropriate pregnancy weight gain. Urine tests screen for protein (another preeclampsia indicator) and sugar (which might suggest gestational diabetes). Measuring your fundal height assesses your baby's growth, and listening to the fetal heartbeat confirms your baby's wellbeing.

Around this time, many providers order blood tests to check for anemia. As discussed earlier, iron deficiency becomes more common as pregnancy progresses due to increased blood volume and your baby's growing iron needs. If your hemoglobin levels are low, your provider may recommend iron supplements in addition to dietary changes.

Questions to Ask Your Provider

The 20-week appointment is an excellent opportunity to discuss various aspects of your pregnancy and prepare for the months ahead. Consider asking about:

• Results from the anatomy scan and what they mean for your pregnancy
• Whether you need any additional tests or monitoring
• Exercise recommendations and activities to avoid
• Travel considerations for the coming months
• Signs of preterm labor to watch for
• When to start thinking about birth plans and preferences
• Childbirth education classes available in your area

Tips for Week 20 of Pregnancy

At 20 weeks, focus on establishing healthy habits that will support you through the second half of pregnancy. Stay active with appropriate exercise, prioritize sleep, maintain good posture to prevent back pain, stay hydrated, and begin thinking about preparations for your baby's arrival.

Reaching the halfway point of pregnancy is an excellent time to reflect on habits that will support your health and your baby's development through the remaining weeks. The second trimester's relative comfort provides an opportunity to establish routines that will serve you well as your belly grows larger and daily tasks become more challenging.

Practical Recommendations

• Stay active: Regular moderate exercise improves energy, mood, sleep, and can ease common pregnancy discomforts. Walking, swimming, prenatal yoga, and stationary cycling are excellent options. Aim for 150 minutes of moderate activity per week unless advised otherwise.
• Practice good posture: As your belly grows, the tendency to arch your lower back increases strain on back muscles. Focus on standing tall with shoulders back and pelvis tucked slightly. Sit with lower back support.
• Sleep on your side: While sleeping position becomes more critical later in pregnancy, beginning to side-sleep now helps establish the habit. The left side is often recommended as it improves blood flow, though either side is fine.
• Stay hydrated: Adequate fluid intake supports increased blood volume, amniotic fluid production, and helps prevent constipation and urinary tract infections.
• Wear supportive footwear: Your center of gravity is shifting, and pregnancy hormones loosen ligaments throughout your body. Supportive shoes help maintain balance and reduce foot and leg discomfort.
• Begin pelvic floor exercises: Kegel exercises strengthen the pelvic floor muscles, which support your growing uterus and can aid recovery after birth.

Looking Ahead

While there's no rush, the second trimester is an excellent time to begin thinking about practical preparations for your baby's arrival. Many people find this period—when energy levels are higher and mobility is still relatively unimpeded—ideal for tasks like setting up a nursery, researching baby gear, and taking childbirth education classes.

This is also a good time to consider your preferences for labor and delivery. While rigid birth plans often need flexibility, thinking through your preferences helps you communicate with your healthcare team and feel more prepared for the experience ahead.