Early pregnancy: Morning sickness, fatigue and other common symptoms

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Early pregnancy: Morning sickness, fatigue  and other common symptoms

You're delighted to be pregnant, but morning sickness, heartburn, fatigue and other early-pregnancy symptoms are making your condition less than fun. Here's what to do.

Early pregnancy has its share of discomforts. Some, such as mild nausea and fatigue, are almost universal. Others, including nosebleeds and bladder infections, are less common.

Soon after you conceive, your body begins a series of major changes that enable it to sustain your baby through 37 weeks of growth and development. The glands of your endocrine system and placenta step up hormone production. Your blood volume increases and your uterus expands.

By the fourth month of pregnancy, you'll begin to feel much more like your old self, presumably because your body has adjusted somewhat to these dramatic changes. Until then, you can rest assured that first-trimester symptoms are almost always associated with normal pregnancies that have good outcomes. Morning sickness and the other ailments that occur around this time are almost always mild enough to manage on your own. Here's a rundown of the most common first-trimester symptoms.

Morning sickness

How common is it?
Up to 70 percent of expectant mothers have nausea, sometimes with vomiting, early in pregnancy. Queasiness may be most noticeable in the morning, but it can occur at any time. Even if you aren't nauseated, you may develop aversions to certain foods, such as coffee and meat, partly because of their odors. As long as you continue to eat a healthy diet and get all the nutrients you need, food aversions aren't a cause for concern.

What causes it?
The exact cause is unclear, but pregnancy hormones that relax the stomach may play a role.

How long does it last?
It generally improves by the 13th or 14th week of pregnancy, but some women continue to feel queasy from time to time well into the second trimester.

How can you manage it?

  • Munch a few crackers before getting up in the morning.
  • Eat several small meals a day so that your stomach is never empty.
  • Avoid anything that causes nausea.
  • Drink plenty of liquids, especially if you've been vomiting. Try crushed ice, fruit juice or frozen ice pops if water upsets your stomach.
  • Try wearing a motion sickness band, which may relieve nausea by pressing on an acupressure point inside the wrist.
  • Suck on hard candy.
  • Try ginger, which has proved effective in combating morning sickness. Some ways to consume the spice include ginger soda or tea, gingersnaps or ginger in capsule form.

Constipation

How common is it?
Constipation affects at least half of all pregnant women.

What causes it?
An increase in the hormone progesterone, which slows the digestive process, is partly to blame. In addition, your colon absorbs more water, which tends to make stools harder and bowel movements more difficult.

How long does it last?
Infrequent, difficult-to-pass stool can be a problem any time during pregnancy, but it may be worst in the first 13 to 14 weeks.

How can you manage it?

  • Try to eat on a regular schedule.
  • Drink plenty of liquids — at least eight to 10 glasses a day.
  • Get some exercise every day.
  • Eat high-fiber fruits, vegetables and grains such as whole wheat and oatmeal.
  • Try fiber supplements, such as psyllium powder, Metamucil, Konsyl, Fiberall or Citrucel. A mild laxative such as milk of magnesia is safe, but don't take any other laxative without discussing it with your doctor.

Dizziness or fainting

How common are they?
Although exact numbers aren't available, perhaps as many as one in 20 women experiences some degree of lightheadedness during pregnancy. Contrary to what's often depicted in movies, pregnant women rarely faint.

What causes them?
Pregnancy results in a dramatic dilation of the blood vessels of your body. In the first half of pregnancy, however, your blood volume may not have expanded enough to fill all of this space. The result is lower blood pressure. Two conditions that are common during pregnancy — low blood sugar (hypoglycemia) and a low red blood cell count (anemia) — also can cause lightheadedness. The latter two causes may need medical attention.

How long do they last?
Dizziness or fainting can occur at any time during pregnancy, but may be especially noticeable early in the second trimester, when your blood vessels have dilated in response to pregnancy hormones but your blood volume hasn't yet expanded to fill them.

How can you manage them?

  • Arise slowly as you get up from lying or sitting down.
  • Walk at a slower pace and take frequent rest breaks.
  • Avoid prolonged standing.
  • Instead of lying flat on your back, lie on your side. A pillow tucked under your abdomen may make this position more comfortable.
  • Guard against overheating. Saunas and hot tubs may increase the chance of fainting. Take cooler baths and showers, use air conditioning when needed, and avoid warm, crowded areas.
  • Stay physically active to improve blood circulation. Good activities include walking, water aerobics and prenatal yoga.
  • Drink plenty of fluids, particularly early in the day.
  • Eat iron-rich foods such as beans, red meat, green leafy vegetables and dried fruits to help your body get the iron needed to build red blood cells.

Fatigue

How common is it?
Almost all women report increased fatigue and need for sleep in the first trimester.

What causes it?
To carry oxygen and nutrients to the fetus, your body produces extra blood and your heart works harder and faster. These early pregnancy changes make enormous demands on your circulatory system. During this time, you're also producing higher levels of progesterone, which tends to make you sleepy. These may be factors producing the fatigue of early pregnancy.

How long does it last?
Fatigue usually subsides by the second trimester, but may return in the third trimester when carrying the extra weight of the baby may be tiring.

How can you manage it?

  • Rest. Take naps during the day or after work. If you need to go to bed at 7 p.m. to feel rested, do so. This is a symptom that has no solution other than sleep.
  • Avoid taking on extra responsibilities. Cut down on volunteer commitments and social events if they're wearing you out.
  • Ask for the support you need. Get your partner or children to help out as much as possible.
  • Exercise regularly. Moderate exercise, such as walking for 30 minutes a day, can help you feel more alert and energetic.
  • Eat foods rich in iron and protein. Skimping on these nutrients can aggravate your fatigue. Foods rich in both iron and protein include red meat, seafood, poultry and eggs. Other good sources of iron include whole-grain or iron-fortified cereals, breads and pastas.
  • Avoid stimulants. Avoid caffeine, which may be harmful in high doses. Any product marketed for relieving fatigue and enhancing wakefulness is unsafe in pregnancy.

Heartburn

How common is it?
More than half of all pregnant women get heartburn, an uncomfortable sensation caused by the backward flow of stomach acids into the esophagus, the tube that carries food from your mouth to your stomach.

What causes it?
Constipation, gas and heartburn are all effects of sluggish digestion, induced by pregnancy hormones. As pregnancy progresses, a second factor — the expansion of the uterus, which can push your stomach out of its normal position — also may contribute to heartburn.

How long does it last?
Heartburn can be a problem at any time during pregnancy, but may be most noticeable during the third trimester.

How can you manage it?

  • Eat several small meals instead of two or three large ones. No matter how small the meal, eat slowly.
  • Avoid common heartburn triggers, such as fried foods, alcohol, chocolate, peppermint, garlic and onion.
  • Drink plenty of fluids, especially water.
  • Avoid coffee. Both regular and decaffeinated coffee may worsen heartburn.
  • Stay up for two to three hours after your evening meal. If your heartburn comes on when you recline, raise the head of your bed four to six inches.
  • Talk to your physician about using antacids or other medications that relieve heartburn. These products can be used safely in pregnancy, but your physician should know which ones you take and how often you take them.

Mood swings

How common are they?
Although the incidence of mood swings is unknown, some women in the first trimester and again in the weeks before delivery may experience emotional fluctuations ranging from exhilaration and joy to irritation and depression.

What causes them?
Nagging discomforts, hormonal changes and understandable anxiety about the future may all contribute to sudden shifts in your mood. You may feel better if you remind yourself that powerful emotions are normal and healthy. Simply recognizing that you're unusually moody can help you and those around you weather the storms.

How long do they last?
Mood swings may occur at any time during pregnancy. If you've typically experienced premenstrual syndrome, you may have more extreme mood swings when you're pregnant.

How can you manage them?

  • Eat regular meals and snacks that include a variety of fresh fruits and vegetables and whole grains.
  • Get plenty of sleep.
  • Rely on your network of family and friends for support, but if you feel overwhelmed, contact your physician.
  • Try relaxation techniques such as meditation, guided mental imagery and progressive muscle relaxation.

Nasal problems: Snoring, congestion and nosebleeds

How common are they?
Up to a quarter of pregnant women snore, compared with about 4 percent of women the same age who aren't pregnant. Nasal congestion and nosebleeds also are relatively common.

What causes them?
As more blood flows to your body's mucous membranes, the lining of your nose and airway swells, which can restrict airflow and cause snoring, congestion and nosebleeds. Although snoring is usually just a nuisance, it can be associated with serious conditions such as high blood pressure (hypertension) or a sleep disorder in which you stop breathing for short periods (sleep apnea). Women who snore during pregnancy are at higher risk of pregnancy-induced high blood pressure (preeclampsia).

How long do they last?
Nasal problems can develop at any time during pregnancy.

How can you prevent snoring?

  • Sleep on your side rather than your back. Sleeping on your back can cause your tongue and soft palate to rest against the back of your throat and block your airway.
  • Wear a nasal strip to open your nasal passages.
  • Avoid gaining more than the amount of weight your doctor recommends.

Vaginal discharge and vaginal infections

How common are they?
An increase in vaginal discharge is essentially universal in pregnancy as a result of marked increase in the turnover of vaginal lining cells.

What causes them?
The hormonally induced thickening of the vaginal wall can cause a thin, white and odorless discharge called leukorrhea. It's harmless and needs no treatment. Other types of discharge can be caused by bacterial or yeast infections. Bacterial vaginosis, for example, causes a foul-smelling, gray to greenish discharge. Signs and symptoms of a yeast infection include a thick, white and curd-like vaginal discharge, itching, burning and redness around the vagina and vulva, and painful urination. Neither a bacterial nor a yeast infection presents a direct hazard to your baby, and both can be treated during pregnancy. Yeast infections are more common due to the effect of pregnancy hormones on the vaginal environment. Bacterial vaginosis is no more frequent in pregnant women than in other sexually active women.

How long do they last?
A whitish vaginal discharge will likely be present throughout pregnancy. If you have symptoms of itching, odor, burning or other vaginal discomfort, it may be an infection and should be evaluated and treated by your doctor.

Douching will not help the normal increase in vaginal discharge and could cause an infection in your uterus that could actually provoke the premature delivery of your baby. Never douche during pregnancy.

Other problems

Headaches are quite frequent in early pregnancy but are rarely serious. If you get an occasional headache, ask your physician about taking acetaminophen when the pain begins. Back pain is usually a problem of later pregnancy but may arise in the first trimester, especially if you have been pregnant before.

Urinary tract infections are somewhat more common in pregnancy and must be treated when they happen. Frequency of urination is very common in pregnancy as the expanding uterus exerts pressure on your bladder. Pain with urination may be a symptom of a urinary infection and should be promptly evaluated by your care provider.

Also call your doctor immediately if you experience any of the following:

  • Moderate to heavy vaginal bleeding
  • Any amount of vaginal bleeding accompanied by pain, cramping fever or chills
  • Passing of tissue
  • A severe or persistent headache, especially with dizziness, faintness, nausea or vomiting, or visual disturbance
  • Moderate or severe pelvic pain
  • Any degree of pelvic pain that doesn't subside within four hours
  • Pain with fever or bleeding
  • Vomiting with pain or fever
  • Chills or fever (102 degrees Fahrenheit or higher)

Your morning sickness, day and evening sleepiness, heartburn and other early symptoms are strong reminders that your body is supporting your baby's growth and development. If you get enough rest and do what you can to stay comfortable, you and your baby will thrive throughout your pregnancy.

Last Updated: 03/11/2005
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