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Common Symptoms of Pregnancy

Pregnancy causes dramatic changes in a woman’s body leading to various symptoms. Knowing what these common symptoms of pregnancy are can help relieve a lot of the anxiety that is associated with them. The following is an alphabetical list of some of the more common symptoms that most women have during normal pregnancy.

Backache

BackacheThis results from immediate softening of the joints by pregnancy hormones and the tendency for the growing uterus to pull the back into an unnatural posture. Pressure of the uterus on the sciatic nerve may cause the pain to radiate into the legs. Backache is best treated by rest, warm baths and back rubs. Tylenol may be used for symptoms not relieved by other measures. Be careful not to strain the back, as the back injury will be difficult to treat during pregnancy. In severe cases, physical therapy can be helpful and safe. Your doctor can make the appropriate arrangements.

Bleeding

Some spotting and mild cramping is common in early pregnancy. In fact, about one-half of all normal pregnancies are associated with some first trimester spotting. This usually is a result of the normal process of implantation of the placenta into the uterine wall. For heavy spotting, you may want to call the office so that an ultrasound exam can be scheduled for your reassurance. If you experience first trimester spotting, you should avoid vigorous physical activity such as sports and heavy work, abstain from intercourse until you have talked to our office and be reassured by the fact that most spotting is not associated with miscarriage.

Any bleeding after the first trimester should be reported at once.

Braxton-Hicks contractions

It is normal to begin to feel occasional uterine contractions as early as the middle of the second trimester. Many people report that they are similar to menstrual cramps. Often, the feeling is described as a tightening sensation and to many women, it seems as though the baby is “rolling up into a ball”. Usually when a uterine contraction is occurring, the uterus will be hard to the touch and it will be difficult to indent the uterus with the fingertips. The discomfort associated with contractions is usually rhythmic, dull and waxes and wanes at intervals. Most contractions can be felt to last for less than one minute.

Braxton-Hicks contractions are mild contractions that occur at infrequent intervals and do not cause the cervix to change. They are a normal feature of pregnancy and should not cause undue concern. However, it is sometimes difficult to tell these harmless contractions from preterm labor. In general, contractions that occur only a few times each day are no cause for concern.

If you have contractions four times per hour or more and have not yet reached your 36th week of pregnancy, further evaluation is necessary. If you sense an increased frequency of contractions prior to the 36th week, lie down in a quiet place, place your hands on your lower abdomen and try to feel the uterus tightening. If more than four contractions are perceived while at rest for an hour, call our office number without delay.

Prevention of prematurity is one of our most important goals. Remember, it is always easier to stop premature labor in the early phases than when it has progressed. Therefore, please do not hesitate to call the office for a discussion with the nurse or doctor if premature labor is suspected.

Breast tenderness

The breasts enlarged during pregnancy under the influence of pregnancy hormones. Support from a well fitting bra is helpful, especially during exercise. The nipples sometimes become dry. If so, do not use soap on them. Moisturizing cream may be used. We do not recommend any sort of manual preparation of the nipples for breastfeeding as that can lead to premature contractions.

Constipation

Hormonal changes of pregnancy lead to sluggishness of the intestinal tract. Iron tablets may also aggravate constipation. Corrective measures include:

  1. Increasing the amount of fiber in the diet.
  2. Increasing water intake.
  3. Natural laxatives such as raisins, prunes and prune juice.
  4. Stool softeners such as Metamucil, Citrucel, Fibercon or Colace.

Dizziness

This is common throughout pregnancy because of the effect of the pregnancy hormones to relax the blood vessels. Fainting is not uncommon and can result in injury. Therefore, if dizziness occurs, quickly find a place to sit or lie down. Dehydration can worsen this tendency, so be sure to take plenty of liquids.

Edema

Swelling, particularly of the legs and feet, may begin as early as the second trimester. This is aggravated by prolonged sitting and standing. Walking is preferable to sitting since the muscular activity promotes blood return through the venous system. Lying down is the best position for treating edema since in this position, blood flow to the kidneys is maximized and excess body water cleared as urine.

Edema which occurs in the third trimester may be a warning sign of increasing blood pressure. For this reason, your clinic visits will be scheduled at shorter intervals during the third trimester and especially during the last month of pregnancy. If you notice a sudden, severe worsening of edema, or if you develop significant swelling of the hands and face, you should come by the office for a blood pressure check and urinalysis.

Fetal movement

In general, women who are pregnant for the first time usually experience fetal movement by 20 weeks from their last menstrual period. Women who have previously experienced pregnancy usually perceive movement a little earlier, about the 18th week. However, there is wide variation from one woman to the next.

There is also wide variation in how active a fetus is during gestation. Many women call with concerns that their baby seems overly active. Please be reassured that there are no known unhealthy conditions which lead a baby to be overly active. Mothers who experience a very active baby in the womb should prepare themselves for a healthy, but active, infant.

Many women call to report a decrease in their baby’s activity. Usually, a decrease in activity is simply associated with the baby’s sleep time. Once the baby emerges from its nap, it returns to its usual active pattern. However, on rare occasions, a fetus becomes less active when its oxygen supply is not good. For this reason, any woman who notices a marked decrease in fetal activity after the 24th week should call our office without delay. Fetal monitoring might be indicated.

If you aren’t sure but think the baby might be a little less active than usual, there is a good self-test:

  1. Withdraw from distractions and lie down in a quiet place.
  2. Place your hands over the uterus and count all movements over the next hour.
  3. If fewer than six movements are felt in one hour, call the office immediately.

This test is felt to be valid from 28 weeks on. We recommend you do this every day from this time until delivery.

Most women feel that their baby’s movements become less dramatic in the last month of pregnancy. The baby seems to roll or shrug, rather than punch and kick as it did when there was more room. Some drop-off in the intensity of kicks is to be expected. However, if you notice a clear decrease in fetal movement, definitely notify your doctor or nurse so that appropriate testing may be done.

Hemorrhoids

Hemorrhoids are veins in the area of the rectum which have been stretched because of pressure on them from the enlarged uterus and the effects of gravity. Avoid prolonged standing and prolonged straining with bowel movements. Stool softeners, if taken with adequate liquids, may help prevent worsening of hemorrhoids and are safe at any time during pregnancy. Metamucil, Citrucel, or Fibercon are good choices. It is also acceptable to use Preparation-H and Anusol during pregnancy. For severe cases, Preparation-H with hydrocortisone and Anusol-HC may be safely used. Iron tablets can worsen constipation, so they may be used with a stool softener listed above.

Indigestion/Heartburn

To minimize indigestion, avoid fried, fatty and spicy foods. Do not overeat but rather have small, frequent meals instead. Do not lie down soon after eating. You may be more comfortable sleeping if you prop yourself up with pillows. At any stage of pregnancy, you can treat indigestion with antacids such as TUMS or Rolaids. Many women find the liquid antacids such as Mylanta to be more effective. Indigestion related to gas may be treated at any stage of pregnancy with simethicone tablets (Mylanta-Gas or Gas-X). If heartburn is severe or it is not improved with these remedies, your doctor may recommend an “H2 Blocker” such as Tagamet, Pepcid or Zantac. Only take these after discussion with your doctor.

Nausea

This is one of the most common symptoms of pregnancy. It is usually confined to the first trimester and it is different in every pregnancy. Some women are helped by such things as peppermint candy, the smell of a fresh cut lemon or ice water. Emetrol is an over-the-counter sugar solution used to control vomiting in children. It is not a medicine and is perfectly safe for pregnancy. Emetrol may be used without consultation with a physician. Many women find relief from acupressure bracelets that are used for seasickness. There are many over-the-counter remedies that you can use for nausea:

  1. Vitamin B6 (25 mg.) taken two or three times a day.
  2. Unisom (Doxylamine 25 mg.) ½ tablet two times a day. (Vitamin B6 and Unisom can be taken together as well.)
  3. Benadryl (diphenhydramine 25 mg.) three to four times a day.

If food cannot be tolerated, clear liquids should be taken. Fruit juices, Gatorade, soft drinks and decaffeinated tea are good options. If you are unable to take at least two to three quarts over 24 hours, call the office. You may need a prescription for an anti-emetic or be admitted briefly to the hospital for intravenous hydration. Of course, dry toast, crackers and other dry and easily digested foods are helpful. Avoid rich and spicy foods.

For many women with nausea, it is difficult to tolerate prenatal vitamins in early pregnancy. It is tempting to skip the prenatal vitamins during this unpleasant early stage. However, this is one of the most crucial times of fetal development and it is very important to get enough folic acid in the first trimester. For this reason, if you can’t tolerate prenatal vitamins, get a prescription for folic acid These tablets are much smaller than a prenatal vitamin, are not as difficult to swallow and do not have an odor. They are usually much more easily tolerated than the entire prenatal vitamin. Take the folic acid faithfully until you can tolerate the complete prenatal vitamin.

Nosebleeds

These are related to increased blood volume and the presence of fragile blood vessels in the nose. Nosebleeds are common in pregnancy. They are treated simply by compressing the nose just below the bridge for about five minutes. Placing a humidifier very close to the head of the bed while you sleep may help prevent this problem. Similarly, many women suffer with bleeding gums and this is also very common and of no concern.

Round ligament pain

This is an aching or sharp pain on the side of the lower abdomen or groin caused by enlargement of the uterus and stretching of its supportive ligaments. It begins around the early second trimester of pregnancy but may continue throughout the pregnancy. It is best treated by lying down with the side that is aching against the bed. Also, heating pads, rest and gradual standing and sitting can be helpful. Round ligament pain is usually constant and sharp and usually on the right side. Dull rhythmic pain might represent uterine contractions and should be evaluated as outlined above.

Vaginal discharge

Hormonal changes of pregnancy normally cause an increase in mucous discharge. Vaginal infections occur more easily. Yeast infections lead to a white discharge, usually associated with itching. After the first trimester, yeast infections may be treated with over-the-counter Monistat or Gyne-Lotrimin using a vaginal applicator. Cotton undergarments maximize evaporation of excess moisture and help prevent yeast infections. Application of cornstarch to the skin around the vagina promotes dryness and comfort. Douching is not necessary and is potentially dangerous, so it should be avoided during pregnancy. A heavy discharge which is yellow or green in color or associated with irritation of the skin should be reported to the doctor.

Varicose veins

Varicose veins are veins which have been damaged by overstretching causing them to stand out. They are common during pregnancy because of increased blood volume and because of pressure on the veins from the growing uterus. They are best treated by lying down as much as possible and by using support hose (either panty hose or at least hose to mid-thigh). Avoid wearing knee-high stockings in the third trimester, as they can impair blood flow. Women with significant varicose veins are at risk for deeper blood clots in the legs. Since this is a dangerous complication, call your doctor immediately if you develop swelling of one leg greater than the other, especially if there is tenderness in the calf, behind the knee or in the thigh.

Pregnancy Safety

Most normal work and recreational activities can be continued during pregnancy. Some jobs that require prolonged standing or lifting might call for early maternity leave. If you are concerned about the physical activity required in your job, be sure to discuss this with the doctor at your visit.

Exercise

Structured exercise programs are available for women who are interested. Fit Beginnings is an approved weigh training and aerobic fitness program available through Northport Medical Center. A fee is paid to the center for this program. Free child care is provided. DCH Regional Medical Center offers a low impact, pregnancy aerobics class which is also approved. For those not interested or unable to participate in a structured exercise program, approved exercises may be found in the book provided in your prenatal packet. Walking 20 to 30 minutes per day is one of the best exercises. Vigorous sports activities which pose the risk for abdominal trauma such as horseback riding, water skiing, snow skiing and softball should be avoided after the first trimester.

Sexual activity

Sexual activity during pregnancy is safe in the absence of bleeding or premature labor. If a woman has had premature labor in a previous pregnancy or has risk factors for premature labor, she should discuss this issue with the doctor. For many women, sexual intercourse is uncomfortable in the third trimester and the woman should let her own feelings guide her in this area. If there are no complications, no risk factors and no discomfort, intercourse may be continued until labor.

Travel

In most cases, travel need not be restricted during pregnancy, at least up until about the 34th week. After 34 weeks, we would suggest that our patients stay within 90 minutes of the hospital. If there has been any premature labor or other complication such as placenta previa or toxemia, the patient may need to stay closer. Each individual situation should be considered separately.

The mode of travel is unimportant. When traveling in a car, we suggest stopping every one or two hours and walking around for ten minutes or so. This improves blood return from the legs and prevents blood clots in the legs. A maximum of six hours per day in the car is also advised. Air travel is considered safe but should be avoided after the 34th week of pregnancy.

Travel throughout pregnancy to underdeveloped areas should be avoided. The diseases that one might be exposed to and the immunizations that are recommended are both best avoided while pregnant.

Seatbelts in pregnancy

A pregnant woman should always wear a seatbelt when traveling by car, no matter how far along she is in pregnancy. This has been shown to dramatically decrease injuries to both the mother and baby if an accident occurs. Wear the seatbelt as low as possible, across the lower hip area. As for everyone, an expectant mother should sit as far back from an air bag as is comfortable.

Sleeping

As the fetus grows within the uterus, lying on your back is not recommended due to pressure on the inferior vena cava, a major blood vessel that returns blood from the lower body to the heart. Sleeping on the stomach DURING PREGNANCY ALSO SHOULD BE AVOIDED BECAUSE OF THE PRESSURE ON THE BABY. The best position for sleeping for a pregnant woman is on her side, especially the left side. This allows for maximum blood flow to the baby and improves the kidney function of the mother. Improved kidney flow helps to reduce swelling. Placing a pillow between the knees can help a pregnant woman sleep more comfortably on her side.

Exposures to avoid during pregnancy

The overwhelming majority of babies are born perfectly normal, regardless of their developmental environment. Nonetheless, there are some guidelines to optimize the environment for the baby. Many of you will have already had some of these exposures prior to your first visit with us, but you should not be overly concerned. This list should be used as a guide and is certainly not meant to cause you anxiety.

Smoking

This can cause a higher rate of miscarriage, stillbirth, bleeding complications, fetal distress in
labor, cesarean section and definitely retards the growth of the baby because of decreased oxygen available to the baby. Even second-hand smoking can be harmful. STOP AS SOON AS POSSIBLE. Your doctor can suggest smoking cessation aids to assist you. We cannot overemphasize the importance of the need to stop smoking. Exposing a newborn baby to cigarette smoke may cause breathing difficulties, ear infections and Sudden Infant Death Syndrome.

Alcohol

There is absolutely no safe amount of alcohol in pregnancy, especially in early pregnancy. We would prefer that you consume no alcohol while pregnant. Excessive drinking can lead to Fetal Alcohol Syndrome (FAS), which includes mental retardation, birth defects and growth restriction.

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Nutrition in Pregnancy

In general, a healthy diet during pregnancy is not much different from a healthy diet at any other time of life. We suggest the following guidelines:

  1. Although salt should never be used to excess, restriction of salt is not necessary in pregnancy.
  2. Adequate fluid intake is important.You should strive to drink six to eight glasses of liquids daily including water and milk. Fruit juices are high in sugar and should be consumed in moderation.
  3. You need approximately 1,200 milligrams of calcium per day while pregnant. If your dietary intake of calcium in inadequate, you will need to take a daily calcium supplement. Whole milk dairy products are not nutritionally superior to skim or low fat milk or other low fat dairy products. A list of good dietary sources of calcium is available through the nurses.
  4. Strive to increase good dietary sources of iron. If iron supplements are prescribed, they are best taken on an empty stomach with a citrus juice. Vitamin C helps your body absorb and utilize iron.
  5. Even though a small amount of caffeine has not been shown to be harmful, we suggest avoiding caffeine as much a possible. Certainly, we recommend no more than a maximum of three caffeinated beverages in the course of a day.
  6. NutraSweet (Equal) and Splenda are both artificial sweeteners that are allowed during pregnancy. They are felt to be safe but should be used in moderation.

You need an average of 300 more calories each day than when you are not pregnant. Studies show that the ideal average weight gain in pregnancy is about 30 pounds. This means 3 to 5 pounds in the first trimester, 10 to 12 pounds in the second trimester and 12 to 14 pounds in the last trimester.

A woman who begins pregnancy significantly overweight does not need to gain this much, and should talk with a dietitian about what would be best for her. The chief problems associated with excessive weight gain are excessive fetal growth, leading to the possibility of difficult labor and delivery, low blood sugar in the baby immediately after delivery, and difficulty in regaining pre-pregnancy weight.

You should never try to lose weight during pregnancy, even if you are overweight. Weight loss can lead to inadequate fetal growth. Nausea and vomiting often associated with the first trimester of pregnancy often leads to a small weight loss at first. As long as the weight gain is normal in the second and third trimester, there does not seem to be any harmful effect to the baby from unintended first trimester weight loss.

Your weight gain and the baby’s growth will be monitored closely throughout your pregnancy. If you have questions or anxieties about these matters, please bring them up with the doctor for discussion.