First trimester (up to 13 weeks)
Pregnancy is different for every woman. Some women glow with good health and vitality during those first three months; others feel absolutely miserable. Here are some of the changes you might experience, what they mean, and which signs warrant a call to your doctor.
- Bleeding: About 25% of pregnant women experience slight bleeding during their first trimester. Early in the pregnancy, light spotting may be a sign that the fertilized embryo has implanted in the uterus. However, if you have significant bleeding, cramping, or sharp pain in your abdomen, call your doctor. These could be signs of a miscarriage or ectopic pregnancy (a pregnancy in which the embryo implants outside of the uterus).
- Breast tenderness (pain): Sore breasts are one of the earliest signs of pregnancy. They're triggered by hormonal changes, which are preparing your milk ducts to feed your baby, and will probably last through the first trimester. Going up a bra size (or more) and wearing a support bra can make you feel more comfortable.
- Constipation: During pregnancy, the muscle contractions that normally move food through your intestines slow down because of higher levels of the hormone progesterone. Add to that the extra iron you're getting from your prenatal vitamin, and the result is uncomfortable constipation and gas that can keep you feeling bloated throughout your pregnancy. Increase your fiber intake and drink extra fluids to keep things moving more smoothly. Physical activity can also help. If your constipation is really bothering you, talk to your doctor about what mild laxative or stool softeners are safe to use during pregnancy.
- Vaginal Discharge: It's normal to see a thin, milky white discharge (called leukorrhea) early in your pregnancy. You can wear a panty liner if it makes you feel more comfortable, but don't use a tampon because it can introduce germs into the vagina. If the discharge is foul-smelling, green, or yellow, or if there's a lot of clear discharge, call your doctor.
- Fatigue: Your body is working hard to support a growing fetus, which can wear you out more easily than usual. Take naps or rest when you need to throughout the day. Also make sure you're getting enough iron (too little can lead to anemia, which can cause excess fatigue).
- Food cravings and aversions: Your tastes can change while you're pregnant. More than 60% of pregnant women experience food cravings, and more than half have food aversions, according to research. Giving in to cravings from time to time is OK, provided you are generally eating healthy, low-calorie foods. The exception is pica -- a craving for non-foods like clay, dirt, and laundry starch, which can be dangerous for you and your baby. If you experience this kind of craving, report it to your doctor right away.
- Frequent urination: Your baby is still pretty small, but your uterus is growing and it's putting pressure on your bladder. As a result, you may feel like you constantly have to go to the bathroom. Don't stop drinking fluids your body needs them but do cut down on caffeine (which stimulates the bladder), especially before bedtime. When nature calls, answer it as soon as you can. Don't hold it in.
- Heartburn: During pregnancy, your body produces more of the progesterone hormone which relaxes smooth muscles -- including the ring of muscle in your lower esophagus that normally keeps food and acids down in your stomach. This muscle relaxation can lead to acid reflux, otherwise known as heartburn. To avoid the burn, eat frequent, smaller meals throughout the day; don't lie down right after eating; and avoid greasy, spicy, and acidic foods (like citrus fruits). You can also try raising your pillows when you sleep.
- Mood swings: Increased fatigue and changing hormones can put you on an emotional roller coaster that makes you feel alternately elated and miserable, cranky and terrified. It's OK to cry, but if you're feeling overwhelmed, try to find an understanding ear, if not from your partner, then from a friend or family member.
- Morning sickness: Nausea is one of the universal pregnancy symptoms, affecting up to 85% of pregnant women. It's the result of hormone changes in the body, and it can last through the entire first trimester. For some pregnant women, nausea is mild; others can't start their day without vomiting. Nausea is usually worst in the morning (hence the name, "morning sickness"). To calm your nausea, try eating small, bland, or high-protein snacks (crackers, meat, or cheese) and sipping water, clear fruit juice (apple juice), or ginger ale. You may want to do this before getting out of bed. Avoid any foods that make you sick to your stomach. Nausea itself isn't anything to worry about, but if it persists or is severe, it can affect the amount of nutrition getting to your baby, so call your doctor if you can't stop vomiting or can't keep down any food.
- Weight gain: Pregnancy is one of the few times in a woman's life when weight gain is considered a good thing, but don't overdo it. During the first trimester, you should gain about 3 to 6 pounds (your doctor may recommend that you adjust your weight gain up or down if you started your pregnancy underweight or overweight). Although you're carrying an extra person, don't go by the adage of "eating for two." You only need about an extra 150 calories a day during your first trimester. Get those calories the healthy way, by adding extra fruits and vegetables, milk, whole-grain bread, and lean meat to your diet.
Red Flag Symptoms
Any of these symptoms could be a sign that something is seriously wrong with your pregnancy. Don't wait for your prenatal visit to talk about it. Call your doctor right away if you experience:
Second Trimester (14-28 weeks)
As you enter your second trimester of pregnancy, the morning sickness and fatigue that plagued you during the last three months should be fading, leaving you feeling more energetic and like your old self again.
The second trimester is, for many women, the easiest three months of pregnancy. Take the time now, while you're feeling better and your energy is up, to start planning for your baby's arrival.
- Backache: The extra weight you've gained in the last few months is starting to put pressure on your back, making it achy and sore. To ease the pressure, sit up straight and use a chair that provides good back support. Sleep on your side with a pillow tucked between your legs. Avoid picking up or carrying anything heavy. Wear low-heeled, comfortable shoes with good arch support. If the pain is really uncomfortable, treat yourself to a pregnancy massage.
- Bleeding gums: About half of the pregnant women develop swollen, tender gums. Hormone changes are sending more blood to your gums, making them more sensitive and causing them to bleed more easily. Your gums should go back to normal after your baby is born. In the meantime, use a softer toothbrush and be gentle when you floss, but don't skimp on dental hygiene. Studies show that pregnant women with gum disease (periodontal disease) may be more likely to go into premature labor and deliver a low-birth-weight baby.
- Congestion and nosebleed: Hormonal changes cause the mucous membranes lining your nose to swell, which can lead to a stuffy nose and make you snore at night. These changes may also make your nose bleed more easily. Before using a decongestant, check with your doctor. Saline drops and other natural methods may be safer ways to clear congestion during pregnancy. You can also try using a humidifier to keep the air moist. To stop a nosebleed, keep your head up straight (don't tilt it back) and apply pressure to the nostril for a few minutes until the bleeding stops.
- Frequent urination: Your uterus will rise away from the pelvic cavity during the second trimester, giving you a brief break from having to keep going to the bathroom. Don't get too comfortable, though. The urge to go will come back during the last trimester of your pregnancy.
- Hair growth: Pregnancy hormones can boost hair growth and not always where you want it. The hair on your head will become thicker. You may also be seeing hair in places you never had it before, including your face, arms, and back. Shaving and tweezing might not be the easiest options, but they're probably your safest bets right now. Many experts don't recommend laser hair removal, electrolysis, waxing, or depilatories during pregnancy, because research still hasn't proven that they are safe for the baby.
- Headache: Headaches are one of the most common pregnancy complaints. Try to get plenty of rest, and practice relaxation techniques, such as deep breathing. Aspirin and ibuprofen shouldn’t be taken during pregnancy, but your doctor may say it's OK for you to take acetaminophen if you're really uncomfortable.
- Heartburn and constipation: These are caused by your body making more of a hormone called progesterone. This hormone relaxes certain muscles, including the ring of muscle in your lower esophagus that normally keeps food and acids down in your stomach, and the ones that move digested food through your intestines. To relieve heartburn, try eating more frequent, smaller meals throughout the day and avoid greasy, spicy, and acidic foods (such as citrus fruits). For constipation, get more fiber and drink extra fluids to keep things moving more smoothly. Physical activity will also help move things along.
- Hemorrhoids: Hemorrhoids are actually varicose veins -- swollen blue or purple veins that form around the anus. These veins may enlarge during pregnancy because extra blood is flowing through them and there is increased pressure on them from the growing uterus. Varicose veins can be itchy and uncomfortable. To relieve them, try sitting in a warm tub or sitz bath. Ask your doctor whether you can use an over-the-counter hemorrhoid ointment.
- Quickening: By the midpoint of your pregnancy (18-20 weeks), you will probably have started to feel the first delicate flutters of movement in your abdomen, which is often called "quickening." If you aren't feeling your baby move yet, don't worry. Some women don't experience quickening until their sixth month of pregnancy.
- Skin changes: Pregnant women often look as though they are "glowing" because changing hormone levels make the skin on the face appear flushed. An increase in the pigment melanin can also lead to brown marks on the face (often called the "mask of pregnancy") and a dark line (linea nigra) down the middle of the abdomen. All of these skin changes should fade after the baby is born. In the meantime, you can use makeup to conceal them. Your skin is also more sensitive to the sun right now, so make sure to wear a broad-spectrum (UVA/UVB protection) sunscreen with an SPF of at least 30 whenever you go outside. You may also notice thin, reddish-purple lines on your abdomen, breasts, or thighs. These stretch marks emerge as your skin expands to accommodate your growing belly. Although many creams and lotions claim to prevent or eliminate stretch marks, there is little evidence that they actually do. Using a moisturizer can help soften your skin and reduce itchiness. Most stretch marks should fade on their own after you deliver.
- Spider and varicose veins: Your circulation has increased to send extra blood to your growing baby. That excess blood flow can cause tiny red veins, known as spider veins, to appear on your skin. These veins should eventually fade once your baby is born. Pressure on your legs from your growing baby can also slow blood flow to your lower body, causing the veins in your legs to become swollen and blue or purple. These are called varicose veins. Although there's no way to avoid varicose veins, you can prevent them from getting worse by getting up and moving throughout the day and propping up your legs on a stool whenever you have to sit for long periods of time. Wear support hose for extra support. Varicose veins should improve within three months after you deliver.
- Weight gain: Morning sickness usually diminishes by the end of the first trimester. After that, your appetite should return, and will probably grow. Although food is looking much more appetizing, be aware of how much you're eating. You only need about an extra 300 to 500 calories a day during the second trimester, and you should be gaining about 1/2 to 1 pound a week.
Third Trimester of Pregnancy (29 weeks-delivery)
- Bleeding: Spotting may sometimes be a sign of a serious problem, including placenta previa (the placenta grows low and covers the cervix ), placental abruption (separation of the placenta from the uterine wall), or preterm labor. Call your doctor as soon as you notice any bleeding.
- Braxton Hicks contractions: You might start to feel mild contractions, which are warm-ups to prepare your uterus for the real labor to come. Braxton Hicks contractions often aren't as intense as real labor contractions, but they may feel a lot like labor and can eventually progress to it. One main difference is that real contractions gradually get closer and closer together -- and more intense. If you're red in the face and out of breath after your contractions, or they're coming regularly, call your doctor.
- Breast enlargement: By the end of your pregnancy, your breasts will have grown by as much as 2 pounds. Make sure you're wearing a supportive bra so your back doesn't suffer. Close to your due date, you may start to see a yellowish fluid leaking from your nipples. This substance, called colostrum, will nourish your baby in the first few days after birth.
- Discharge: You might see more vaginal discharge during the third trimester. If the flow is heavy enough to soak through your panty liners, call your doctor. Close to your delivery date, you might see a thick, clear, or slightly blood-tinged discharge. This is your mucus plug, and it's a sign that your cervix has begun dilating in preparation for labor. If you experience a sudden rush of fluid, it may mean that your water has broken (although only about 8% of pregnant women have their water break before contractions begin). Call your doctor as soon as possible after your water breaks.
- Fatigue: You might have been feeling energetic in your second trimester, but are weary now. Carrying extra weight, waking up several times during the night to go to the bathroom, and dealing with the anxiety of preparing for a baby can all take a toll on your energy level. Eat healthy food and get regular exercise to give yourself a boost. When you feel tired, try to take a nap, or at least sit-down and relax for a few minutes. You need to reserve all your strength now for when your baby arrives and you're really not getting any sleep.
- Shortness of breath: As your uterus expands, it rises up until it sits just under your rib cage, leaving less room for your lungs to expand. That added pressure on your lungs can make it more difficult to breathe. Exercising can help with shortness of breath. You can also try propping up your head and shoulders with pillows while you sleep.
- Swelling: Your rings might be feeling tighter these days, and you may also notice that your ankles and face are looking bloated. Mild swelling is the result of excess fluid retention ( edema ). To reduce swelling, put your feet up on a stool or box whenever you sit for any length of time and elevate your feet while you sleep. If you have a sudden onset of swelling though, seek medical attention immediately as it may be a sign of preeclampsia, a dangerous pregnancy complication.
- Weight gain: Aim for a weight gain of 1/2 pound to 1 pound a week during your third trimester. By the end of your pregnancy, you should have put on a total of about 25 to 35 pounds (your doctor may have recommended that you gain more or less weight if you started out your pregnancy underweight or overweight ). The extra pounds you've put on are made up of the baby's weight, plus the placenta, amniotic fluid, increased blood and fluid volume and added breast tissue. If your baby seems to be too small or too big based on the size of your belly, your doctor will do an ultrasound to check his growth.
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