Pregnancy Symptoms

T​here are various common symptoms in pregnancy. You may or may not experience every one of them. Most of these are associated with the hormonal and physical change that accompanies each pregnancy. It is important that you are aware of these symptoms so that you will not worry unnecessarily. 

Missed Periods 

This is the earliest sign that you may be p​regnant following conception. It is usually quite reliable especially if your periods have been regular. Bleeding may still occur if you are pregnant but it is typically lighter than your usual periods. If you have been sexually active and have missed a period, please take a urine pregnancy test. 

Vaginal Bleed 

At about the fifth week of pregnancy, the embryo implants itself into the lining of the womb. Some women will experience some spotting as well as cramping during this time. This is harmless but the bleeding may also signify other problems such as a miscarriage or an ectopic pregnancy which is a life threatening condition (whereby the pregnancy occurs outside the womb — frequently in the fallopian tubes). 

It is important that you seek medical advice promptly. ​

​Breast Changes / Abdominal Bloatedness 

Your breasts may become engorged and painful owing to the increase in circulating hormones. This can appear as early as a few days after conception. Throughout the pregnancy, the breast will continue to increase in size to prepare you to breastfe​ed the baby​ when it arrives. In addition, the areola (pigmented spots around the nipple) will darken. 

You may even experience some tummy bloatedness as the stomach emptying slows down in pregnancy. Wearing loose clothing and eating small frequent meals may help relieve these symptoms. 

Fatigue 

Fatigue is also an early symptom of your pregnancy. Your body works harder to prepare itself for the next few months. It is also a way of adjusting to the emotional and physical demands. Most of the fatigue will improve as the pregnancy progresses. 

Nausea / Vomiting 

This is the most well-known pregnancy symptom amongst all expecting mothers. It is related to the pregnancy hormone (Human Chorionic Gonadotrophin) which peaks at 8–10 weeks. Rest assured that in most cases, this does not harm the developing baby — even when weight is lost in the first few months of the pregnancy. In extreme cases, anti-vomiting medications and hospitalisation for intra-venous hydration may be required. ​

​​Certain conditions such as multiple pregnancies, molar pregnancies or thyroid disorders may also result in excessive vomiting, so it is important to let your doctor assess you if this happens. 

Frequent Urination 

The extra trips made to the toilet are most pronounced in the early and late trimesters of the pregnancy. Pregnancy increases your body fluids and the efficiency of your kidneys — hence the increase in urine production. 

In late trimesters, the additional weight of the womb on the bladder may also worsen this symptom. 

It is important to exclude a urinary tract infection, as treatment with antibiotics is required. This is usually accompanied with pain during urination. A simple urine test can be performed by your doctor to exclude an infection. 

Headaches / Backaches 

It is common to experience a dull backache throughout the entire pregnancy. This can worsen as the baby grows in size and weight as it adds an additional strain to your back. 

You may also experience headaches owing to the increase in hormonal production. 

Paracetamol is safe in pregnancy and may be used. 

In more severe cases, adequate bed rest and physiotherapy may be used. A referral to an orthopaedic doctor may be indicated if the backache worsens or is associated with symptoms such as sciatica — a shooting pain that runs down the back of your leg owing to nerve compression. 

Food Cravings 

This may become a predominant feature. Your taste buds may be numb and you may crave for sour foodstuffs. This is fine as long as you consume a hea​lthy and well balanced diet​. 

Fainting Spells / Giddiness 

These symptoms arise in the first 20 weeks of pregnancy as the blood pressure lowers as the blood vessels relax. Thus, if you stand for a long time or get up quickly from sitting or lying down, the flow of blood to your brain may be temporarily reduced leading to dizziness or fainting. 

Certain factors such as excess vomiting or heat may worsen this symptom. As your baby grows, the pressure that it exerts on your large vessels may reduce the flow of the blood to your brain further and cause more giddiness.​

Certain measures may be helpful in reducing this distressing condition: 

• ​​​Avoid standing for a long time.
• Getting up slowly from sitting or lying down may help in preventing a sudden reduction of blood to your brain. 
• ​​Do not go hungry. 
• ​Do not lie flat on your back after about mid-pregnancy. It is best to lie on one side with your belly supported on a small pillow. 
• If the giddiness hits you, sit or lie down. 
  

Constipation 

​It is very common to become constipated while you are pregnant as food cannot move through your intestines as quickly as before. This is aggravated by your womb putting pressure on your bowels. 

Constipation can happen at any time during pregnancy. To reduce this: 

• ​Have lots of fibre, fruits and vegetables in your diet. 
• Have adequate hydration. 
• Exercise regularly​. 
• Consult your doctor if it becomes a serious problem. 
  

Heartburn 

This symptom of a burning sensation in your chest especially after meals may cause great discomfort in pregnancy. It is caused by the slowing down of your gastrointestinal tract and the relaxation of the muscles at the opening of the stomach, resulting in the reflux of the acidic gastric juices. 

Certain measures may be employed to reduce this discomfort: 

• ​​Avoid food and beverages that cause heartburn.
• Take several small meals throughout the day. Also, take your time to eat and chew thoroughly.
• Try not to eat close to bedtime.
• Wear loose fitting and comfortable clothes.
• Do not lie flat on the bed. Propping yourself up against pillows may be useful.
• In more severe cases, antacids or medications may be prescribed by your doctor.
  

Leg Cramps 

Generally, cramping of your legs begin in the second trimester and may get​ ​worse. During an attack of the cramps, gentle stretching or massaging of the muscles may help relieve these symptoms.

It may also help to avoid sitting, standing or maintaining a fixed posture for long periods of time. 

However, the cause of leg cramps is not known for certain. Some believe cramps are caused by a calcium deficiency, and that calcium tablets may help. Others believe the cramps are caused by decreased circulation of blood.

Edema or Swelling of the Legs

This is common as your body retains more fluids and your growing womb adds pressure to your legs — causing them to swell. It is worst at the end of the day especially in the third trimester.

After the delivery of your baby, the swelling will disappear within weeks as your body eliminates the excess fluid through frequent urination.

To minimise the swelling, it helps to put your feet up whenever you can. It is also beneficial to do gentle stretching exercises and to wear comfortable shoes.

In some cases when there is a sudden increase in leg swelling and puffiness of your face, it could be a sign of pre-eclampsia or hypertension in pregnancy. Consult your doctor if this happens so that your blood pressure can be monitored. 

Hand Numbness 

This is commonly associated with a condition known as the carpal tunnel syndrome, whereby the nerve (median nerve) in the hands are compressed in a narrow space by the swelling encountered during pregnancy. Symptoms may also include tingling, burning, pain, or a dull ache in the fingers, hands or wrists. They tend to worsen in the later stage of pregnancy. 

This condition tends to be worsened by repetitive hand movements. Measures that may relieve the symptoms include having a wrist support such as a brace and avoiding excessive wrist flexion in your day to day activities. Vitamin B6 may improve the symptoms in some cases. 

Hemorrhoids / Piles / Varicose Veins 

These are engorged vessels that swell in the rectal area. They may cause itch, pain and bleeding when you pass motion. They occur as the enlarging womb puts pressure on the blood vessels causing them to enlarge. 

In most cases, they disappear after the delivery of your baby. 

In symptomatic cases, medications such as a topical anesthetic ointment, medicated suppositories or oral medications may be prescribed by your doctor. ​

For the same reason, varicosities may occur in your legs or vulva region. In cases of vulval varicosities, no treatment is needed as they will disappear after delivery. In cases of leg varicose veins​, no active treatment is also required unless they give rise to symptoms such as discomfort or heaviness. Special stockings may be worn and oral medication such as Daflon may be prescribed. 

Breathlessness in Pregnancy 

This is a common complaint in pregnant mothers especially as the pregnancy advances. There is an increased need for oxygen in pregnancy, and this demand is met by your pregnancy hormones which increase your respiration. In third trimester, the enlarging womb presses onto your diaphragm and increases this sensation of breathlessness. 

These symptoms are generally harmless to both you and your baby. However, there are certain medical conditions in pregnancy that may also cause breathlessness. They include a lung infection (pneumonia​), asthma or pulmonary embolism — a life threatening condition whereby a blood clot goes to the lungs. 

Therefore, you should seek medical attention if the breathlessness is worsening or associated with symptoms such as: 

• ​Chest pains. 
• Palpitations. 
• Faintness. 
• Fever. 
• Cough and phlegm.​ 
  

Did You Know?

At 28 weeks gestation, your baby weighs an average of 1000 grams, and is about 37cm long

Your baby's lungs are now mature enough to breathe air and your baby has a good chance of survival if born now.

The eyes are also completely formed now and your baby can blink!

Your baby may also have hiccups which you may feel as little jerks in your womb.​

Frequently Asked Questions

1. Is it common to have nose bleeds in pregnancy? 

Nose bleeds tend to occur more often due to the increased blood supply to the mucosa of the nose. This increased flow leads to increased pressure, which causes the delicate blood vessels to rupture. Nose bleeds are usually harmless and stop spontaneously. See your doctor if the bleed is massive. 

2. Is it common to have headaches in pregnancy? 

Due to the increase in hormonal production, it may be common for some to experience a mild headache during pregnancy. 

However, seek immediate medical attention if the headaches worsen despite taking common painkillers. 

Other associated neurological symptoms such as vomiting, blurring of vision or weakness of the limbs may suggest more serious conditions like bleeding or tumor in the brain. Also, headaches could be a sign of an impending eclamptic fit (read the article on Pregnancy Complications​​). 

3. Is it common to have aches and pains in pregnancy? 

During the course of your pregnancy, there is an increased elasticity of the ligaments of your birth canal to prepare you for natural vaginal delivery. However, the associated increase in motion and instability can result in pain. The affected joints commonly involve the lower back (sacro-​iliac joints) and pelvis (pubic symphysis). Occasionally, as the baby grows bigger, you may even experience some discomfort in your lower rib cage. 

Aggravating factors include having a pre-existing history of low back pain or excessive physically strenuous activities during your pregnancy. Referral to an orthopedic doctor may be necessary if the backache worsens or is associated with other neurological symptoms such as sciatica which is a shooting pain that runs down the back of your leg due to nerve compression. 

4. Is it common to have bleeding in my stools? 

It is common to experience constipation​ and develop piles during your pregnancy. Both conditions can have blood in your stools. Nonetheless, do inform your doctor of any bleeding especially if it is persistent so that an examination can be performed to ensure that the bleeding is not due to a more serious condition such as a cancer although this is rare in pregnancy.​

​5. Why is there navel (belly button) pain in pregnancy? 

Belly button (umbilical) pain is common during pregnancy. Your abdominal wall is the thinnest around the navel. This increased pressure due to pregnancy may cause sensitivity and pain in this area. This is harmless and will come and go. If it keeps getting worse, or there is noticeable bulging in that area, see your doctor. 

6. Why do some women experience retention of urine during pregnancy? 

Retention of urine can occur at about 3 to 4 months of pregnancy in some women who have retroverted wombs which tilt backwards. So if you experience difficulty in passing urine during this period, see your doctor to exclude a urinary infection or tilted womb. 

7. Is it normal to have blocked ears during pregnancy? 

There are many reasons why ears are blocked during pregnancy. As a result of pregnancy changes causing swelling of the nasal lining, the tube that connects the nose to the ears (eustachian tube) may become blocked easily. Simple measures such as decongestants or nasal sprays prescribed by your doctor may be helpful. It is also important for your doctor to exclude other common conditions such as the accumulation of earwax.

If your symptoms are worsening or persistent despite the abovementioned measures, it is advisable to seek medical attention from an Ear, Nose and Throat (ENT) specialist.

Acknowledgement

Source: Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John, The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.

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