Pregnancy First Trimester
The first trimester (from 0-12 Weeks) will see your body undergoing many changes as it adjusts to your growing baby. It is important to understand that these are all normal events and that most of these discomforts will go way as your pregnancy progresses. Further, you may not even experience any of the symptoms listed below. Included here are some of the symptoms you may experience during your pregnancy and how best to deal with them.
The mammary glands cause the breasts to swell and become tender in preparation for breastfeeding. This is due to an increased amount of the hormones estrogen and progesterone. These changes are aimed at preparing you to feed your baby when it arrives. A supportive bra should be worn. This will minimize stretching and sagging of the breast tissue.
A woman’s areolas (the pigmented areas around each breast’s nipple) will enlarge, darken, and may become covered with small, white bumps called Montgomery’s tubercles (enlarged sweat glands that look like large goose bumps). You’ll also experience an increase in sensitivity in your breasts, but they should not remain tender to touch past the third or fourth month. In some women a network of blush lines appears under the skin as blood supply to the breasts increases. After delivery, if you breastfeed, your breasts may increase another cup size.
A woman may experience fatigue due to the physical and emotional demands of pregnancy. During your pregnancy, you might feel tired even when you’ve had a lot of sleep at night. Many women find they’re exhausted in the first trimester. Don’t worry, this is normal! This is your body’s way of telling you that you need more rest. Tiredness will pass over time and be replaced with a feeling of well being and increased energy.
When you are tired, get some rest. Try to get eight hours of sleep every night, and take a nap during the day if you can. If you feel stressed, try to find a way to relax. You might want to start sleeping on your left side, if you find it more comfortable. This will relieve pressure on major blood vessels that supply oxygen and nutrients to the fetus. Using a body pillow can help to comfortably support your body.
Once your body has adjusted to the increased demands placed upon it, you should have more energy. Until then, you may need to work fewer hours or take a few days off if you’re really fatigued. Once your body is back to some semblance of normality, there is no reason why you shouldn’t return to your job. You will probably find that you are happier and less anxious if you keep busy.
Tips to Help You Deal With Fatigue
- Get an hour or more sleep each night.
- Ensure your following a proper diet. Fatigue may be aggravated by a deficiency in iron, protein, or just not getting enough calories.
- Baby yourself and let others baby you. By getting adequate rest and relaxing while making sure your spouse is doing his fair share of chores, you will be able to focus on taking care of yourself and your baby.
- Fatigue is often worsened by your environment. Be alert of inadequate lighting, poor air circulation, poor air quality, or excessive noise and try to get them corrected.
- Get some exercise. Often a nice walk or even a slow jog can help with fatigue. Too much rest can actually heighten fatigue but be sure not to overdo the amount you exercise.
Partly due to surges in hormones, a pregnant woman may experience mood swings similar to premenstrual syndrome (a condition experienced by some women that is characterized by mood swings, irritability and other physical symptoms that occur shortly before each menstrual period). You may also experience emotions such as fear, joy or elation.
Nausea and Vomiting
Increased levels of hormones that sustain the pregnancy may cause morning sickness, which is feelings of nausea and sometimes leading to vomiting. In addition to the increased levels of hCG and estrogen, the rapid stretching of the uterine muscles, the relaxation of muscles in the digestive tract, an increase in acid in the stomach, and the enhanced sense of smell pregnant women develop can all contribute to morning sickness. Just over half of all expectant women experience the nausea and vomiting associated with morning sickness. However, morning sickness does not necessarily occur just in the morning and rarely interferes with proper maternal and fetal nutrition. Even those women that actually lose weight during the first few months of pregnancy because they have a hard time keeping any food down are not hurting their baby, as long as they make up for the lost weight later on. Also, if you are experiencing morning sickness, the symptoms usually don’t linger much beyond the third month.
Tips on Getting a Grip on Your ‘Morning’ Sickness
- Eat frequent, small meals (6 to 8 small meals a day, rather than 3 large meals). An empty stomach, as well as the low blood sugar caused by long stretches between meals can both contribute to morning sickness symptoms. Be sure to carry nutritious snacks with you for snacking.
- Eat a diet that is high in protein and complex carbohydrates, both of which help to alleviate the symptoms of morning sickness.
- Drink lots of water, especially if you’re losing liquid through vomiting.
- Carbonated drinks inbetween meels may help with your symptoms.
- A prenatal vitamin supplement may help to compensate for nutrients that you may not be getting due to vomitting. Remember, do not take any medication for morning sickness unless it is prescribed by your practitioner.
- Avoid fatty, fried or spicy foods.
- Avoid the sight, smell and taste of foods that make you nauseous.
- Try starchy foods, like toast, saltines, cheerios or other dry cereals. Keep some by your bed and eat them before you get out of bed in the morning and when you get up in the middle of the night. Also keep some with you at all times, in case you feel nauseous.
- Get some extra sleep and relaxation and take it easy in the mornings. Minimizing your daily stress will help you cope better with morning sickness. While you rest, consider listening to some specially formatted tapes that can help ease your symptoms.
- Brushing your teeth or rinsing your mouth after vomiting or after all your meals will help keep your mouth fresh and reduce nauseas. It will have the added benefit of decreasing the risk of damage to teeth or gums that can occur with vomiting.
Frequency of Urination
The uterus is growing and begins to press on the woman’s bladder, causing the need for her to urinate more frequently. Further, the increased volume of body fluids and the improved efficiency of the kidneys, help to rid the body more quickly of waste products. The pressure on your bladder is often relieved once the uterus rises into the abdominal cavity around the fourth month and doesn’t return until the third trimester when the baby “drops” back down into the pelvis in the ninth month. By leaning forward when you urinate, you will ensure that you empty your bladder completely and reduce trips to the bathroom.
It is important to remember that if you notice pain, burning, pus or blood in your urine to see your health care provider right away. You might have a urinary tract infection that needs treatment.
As the growing uterus presses on the rectum and intestines, constipation may occur. The muscular contractions in the intestines, which help to move food through the digestive tract, are slowed due to high levels of progesterone. This may, in turn, cause heartburn, indigestion and gas.
With gas, some women become so bloated that they are prevented from eating regularly and properly. By ensuring you have regular bowel movements (see below), eat many small meals instead of few big ones, and eat slowly you will avoid the risk of bloating and minimize your own discomfort. Also, be sure to steer clear of gas-producing food such as onions, cabbage, fried foods, rich sauces, sugary sweets and beans.
High levels of certain hormones circulating during pregnancy cause the muscles of the bowel to relax making bowel movements more sluggish. Also, the growing uterus puts pressure on the bowel, cramping its normal activity. The result is constipation. To prevent constipation, try to eat fresh or dried fruit, raw vegetables and whole grain cereals or breads everyday. Also, try to drink eight to ten glasses of water everyday. Some of these servings can be substituted with fruit or vegetable juice. Try to avoid caffeinated drinks (coffee, tea, colas, and some other sodas), since caffeine makes your body lose fluid and won’t help with constipation. Also, holding in bowel movements can weaken muscles that control them and lead to constipation. So when you have to go, go!
Dizziness, feeling lightheaded, and even fainting can occur at any stage of pregnancy, since there now is extra blood going down towards your uterus and legs. Thus, sometimes there’s not an adequate blood supply to fill the rapidly expanding circulatory system. This coupled with the pressure of an expanding uterus on the mother’s blood vessels can lead to dizziness and sometimes faintness. If you experience dizziness when you get up too quickly this is due to a sudden shifting of blood away from the brain as you change positions. If this is the case, be sure to get up very gradually. Another culprit might be low blood sugar levels. Ensure that you get some protein at every meal and that you eat frequent, smaller meals or try to snack between your meals. Another possible cause of your dizziness may be dehydration, so ensure that you’re getting at least eight cups a day of fluids. Sometimes just getting some fresh air by going outside or opening a window may bring some relief. You can help relieve these symptoms by lying down on your left side. Or to help prevent them, try moving around more instead of sitting or standing in one position for a long time. Be sure to let your practitioner know about your dizzy spells at your next visit as it could be a sign of an underlying problem such as anemia.
Normal veins carry blood from your extremities and organs back to your heart. The veins contain a series of valves that prevent backflow of blood. If these valves are missing or faulty, blood will pool in the viens where the pressure of gravity is greatest, usually in the legs, but sometimes in the rectum or vulva, resulting in bulging. Varicose veins are more common in those who are overweight.
During pregnancy, pressure on the large veins behind the uterus and leg veins causes the blood to slow in its return to the heart. This, coupled with the pregnant woman’s expanded blood volume and hormone-induced relaxation of the muscle tissue in the veins can lead to varicose veins in the legs and hemorrhoids (varicose veins in the vagina or around the anus). Varicose veins look like swollen veins raised above the surface of the skin. They can be twisted or bulging, and are dark purple or blue in color. They are found most often on the backs of the calves or on the inside of the leg, anywhere from the groin to the ankle. Also, veins become more prominent on the surface of the breast. There may be a mild achiness or severe pain in the legs, or a sensation of heaviness, or swelling. In sever cases; the skin overlying the veins becomes swollen, dry, and irritated. In most cases, the problem will clear up or improve spontaneously after delivery, or by the time pre-pregnancy weight is reached.
Tips to Prevent Varicose Veins and Minimize Symptoms During Pregnancy
- avoid tight knee-highs or garters
- avoid excessive weight gain
- sit with your legs and feet raised when possible. If you work at a desk, you can prop your feet up on a footstool, box or several books. Or when relaxing at home, keep your feet up on a footstool, some pillows on the couch, or another chair. Try to avoid long periods of standing or sitting.
- avoid heavy lifting
- avoid straining during bowel movements as this can lead to hypertension and hemorrhoids.
- try to exercise twenty to thrity minutes a day; this can be something like a brisk walk or a swim
- vitamin C helps to keep veins healthy and elastic
Some women get spidery purplish-red lines on their thighs called spider veins. These result from the hormone changes of pregnancy and should not be confused with varicose veins. They usually fade and disappear after delivery. If not, they can be treated easily by dermatologist.
At different times during your pregnancy, you might have cramps in your legs or feet. This is due to a change in the way your body processes, or metabolizes, calcium. One way to prevent these cramps is to make sure to get enough calcium through nonfat or low-fat milk, and calcium-rich foods. You also get some calcium in your prenatal vitamin, but you might need to take a calcium supplement if you don’t get enough through your diet. Talk with your health care provider first about taking calcium supplements.
Fatigue and fluid accumulation in the legs are also thought to be contributing factors to leg cramps. You can limit the effect of fatigue and swelling by wearing support hose during the day and alternating periods of rest with your feet up, with periods of physical activity.
You can relieve leg and foot cramps by gently stretching the muscle. If you have a sudden leg cramp, flex your foot towards your body. If you point your foot to stretch your leg, the cramp could worsen. Wrapping a warm heating pad or warm, moist towel around the muscle also can help relax the muscle.
Rectal bleeding during pregnancy can be caused by internal or external hemorrhoids. Hemorrhoids are varicose veins of the rectum, and can cause itching and pain as well as bleeding. Constipation often causes or compounds both problems. If you do have bleeding from your rectum, make sure it is evaluated by a physician.
Tips on Preventing or Alleviating Hemorrhoids Symptoms During Pregnancy
- Prevent constipation by eating plenty of fluids and getting lots of fiber in your diet.
- Decrease pressure by sleeping on your side, not standing or sitting for long periods and not straining when having a bowel movement.
- Warm sitz baths can help reduce discomfort.
- Laxatives, stool softeners, suppositories or medications should only be used if prescribed by a doctor.
- Even if you get hemorrhoids, they will probably disappear postpartum if you follow these preventative measures.
Increased Heart Rate
Cardiac volume increases by approximately 40 to 50 percent from the beginning to the end of the pregnancy, causing an increased cardiac output. An increased cardiac output may cause an increased pulse rate during pregnancy. The increase in blood volume is needed for extra blood flow to the uterus.
Early in pregnancy, it is common for women to experience overproduction of saliva. Though unpleasant, it’s harmless and normally disappears after the first few months. It is more common in those women that also experience morning sickness. To try and dry things up a bit, try brushing your teeth frequently with mint toothpaste, rinsing with a mint mouthwash, or chewing sugarless gum.
Heartburn and Indigestion
Due to large amounts of the hormones progesterone and relaxin that are produced during pregnancy, the smooth muscle lining in your gastrointestinal tract will relax, allowing food to move more slowly through your system, resulting in bloating and indigestion.
Heartburn occurs partly due to relaxation of the ring that separates the esophagus from the stomach. This allows the harsh stomach acid to come up and irritate the sensitive espophageal lining, causing a burning sensation.
Tips on How to Avoid or Minimize Heartburn Symptoms
- Avoid gaining too much weight as this puts excess pressure on the stomach contents.
- Don’t smoke.
- Eat six small meals rather than three big ones and eat slowly.
- Stay upright for several hours after eating and try not to eat big meals prior to going to bed.
- Try to minimize fatty foods, processed meats, chocolate, coffee, alcohol or spicy foods.
- Don’t wear clothing that is very constrictive around your abdomen or waist.
- Ask your practitioner to recommend an antacid. Always check with your practitioner before taking any medication or supplement, even if it is over-the-counter medication.
Appetite Increase and Cravings
Due to your body’s increase need for more nutrients and energy to sustain your growing baby, you may find that your appetite may be increased during this trimester. You will probably find that your taste in food will change somewhat during pregnancy. This is mainly due to hormone changes. It is completely normal and will probably continue until your birth. If you find yourself craving something that you know you’d probably be better off without, then seek a substitute that satisfies the craving but without filling you up on empty calories. Occasionally giving in to less nutritious cravings is fine, as long as they don’t include something risky. Most cravings disappear or weaken by the fourth month.
Revision date: June 18, 2011
Last revised: by Jorge P. Ribeiro, MD