Pregnancy Health Article

Causes and symptoms

The first sign of pregnancy is usually a missed menstrual period. A little bleeding or spotting may occur, due to implantation of the fertilized egg. Some women experience no early symptoms of pregnancy during the first few weeks, while others may experience all of them. A woman's breasts usually seem larger and feel tender as the mammary glands prepare for eventual breastfeeding. Nipples begin to enlarge and the veins over the surface of the breasts become more noticeable. Morning sickness (i.e., nausea and vomiting) is somewhat common, and can happen at any time—day or night. Extreme sensitivity to smell may worsen nausea. It is normal to feel bloated and more tired than usual. Frequent urination is common, and the pregnant woman may find herself getting up during the night to urinate. There may be a creamy white discharge from the vagina; that is normal. Food cravings may occur. Most women gain about 2–4 pounds (0.7-1.8 kg) by the end of the first trimester (0–13 weeks), and their clothes begin to feel tight.

In the second trimester (14–26 weeks), morning sickness usually ends and a woman's appetite may increase. There is a weight gain of about 12–15 pounds (5.4-6.75 kg) during this trimester. Most women begin to look pregnant and feel more energetic. Heart rate increases, as does the volume of blood in the body. This increase may cause a woman to feel flushed and warm at times. Some women experience constipation, heartburn and indigestion, backache, sleeplessness, or swollen feet during the second trimester. Physical activity, such as swimming and walking, will help constipation as well as drinking plenty of fluids (i.e., at least eight glasses of water a day) and eating high-fiber foods (i.e., fruits, vegetables, and whole grains). For backaches, it is important to maintain good posture, avoid lifting very heavy objects, and wear low-heeled shoes. Eating smaller amounts of food more frequently and avoiding fried or spicy food will help to relieve heartburn or indigestion. When the woman sits down to rest, her feet should be elevated to prevent swelling of the ankles. Pregnant women should not try to stand for long periods of time.

By the third trimester (27–40 weeks), many women begin to experience a range of common symptoms. As the baby grows larger and begins to press against internal organs, a woman may feel somewhat breathless at times. Lying on her left or right side, not on her back, and using pillows to lean on in a semi-propped position can relieve this. Leaking of urine may occur with coughing or sneezing, and frequent urination begins again. As the pelvis widens and the joints become looser, discomfort may be felt in the pelvic joints. Some women feel as if their legs cannot support their weight. This is the body's way of preparing for birth. The joints are loosening so that the baby can fit through the pelvis. Stretch marks may develop on the abdomen, breasts and thighs, and a dark line may appear from the navel to the pubic hair. A thin fluid called "colostrum" may be expressed from the nipples. Hemorrhoids may develop. Gums may become sensitive and bleed more easily, and eyes may dry out, making contact lenses uncomfortable to wear. Pica (a craving to eat substances other than food) may occur. Varicose veins may be a problem in the second half of pregnancy. This can be alleviated to a certain degree by wearing support hose, not standing for long periods of time, and resting with the feet up. Chloasma (a brown pigment) may appear on the face. This is due to the hormones of pregnancy and will disappear some time after delivery. Weak, irregular, painless tightenings of the uterus become more intense as the body practices for labor. These are called Braxton-Hicks contractions, and feel as if the baby is balling up. In most women, genuine labor consists of regular contractions that increase in intensity. Kicks from an active baby may cause sharp pains, and lower backaches are common. It is important for women in the third trimester to rest often and avoid straining themselves. When resting or sleeping, it may be more comfortable to lie on the left or right side with one leg bent, placing pillows under the stomach and between the knees. Weight gain will continue as it did in the second trimester.

In a woman's first pregnancy (later in repeat pregnancies), the baby's head drops down low into the pelvis by the last four weeks. This change may relieve pressure

on the upper abdomen and the lungs, allowing a woman to breathe more easily. This new position, however, does place more pressure on the bladder.

Total weight gain recommended in pregnancy is 25–35 pounds (12-16 kg) for women of normal weight for their height. Underweight women should possibly gain up to 40 pounds (18 kg), and overweight women should limit weight gain to 15–25 pounds (7-11 kg). Increased fluid volume makes up 2–3 pounds (0.9-1.4 kg); breast enlargement provides 1–2 pounds (0.45-0.9 kg); 2 pounds (0.9 kg) comes from enlargement of the uterus; and amniotic fluid is about 2 pounds (0.9 kg). At term, an infant weighs about 6–8 pounds (2.7–3.6 kg), and the placenta weights 1–2 pounds (0.45-0.9 kg). Usually 4–6 pounds (1.8-2.7 kg) are due to maternal stores of fat and protein that are important for breast feeding.

While many of the symptoms mentioned are considered normal, there are others that may indicate the presence of complications. A pregnant woman experiencing any of the following should contact her doctor or midwife immediately:

• abdominal pain
• rupture of the amniotic sac or fluid leaking from the vagina
• bleeding from the vagina
• no fetal movement for 24 hours (after the sixth month)
• continuous headaches
• marked, sudden swelling of eyelids, hands, or face
• dim or blurry vision

• persistent heartburn (unrelieved by antacids) or a burning sensation in the chest area
• persistent vomiting