Pregnancy usually comes with a lot of joy… but sometimes it can be pretty overwhelming! Especially the first trimester, when your body starts changing. These changes are not the same for all women, though: while some women feel great and full of energy, others feel completely miserable…

Food cravings, nausea, mood swings… You have most likely heard about these pregnancy symptoms, but… what is normal? What to do about them? When to call your doctor?

In this article you will find a list of 16 common symptoms you may experience during the first trimester of pregnancy (weeks 0 to 13), you will learn why they happen, what you can do about them, and when to call your doctor -or midwife.

1) Abdominal cramping and backache

Why it happens: one of the earliest pregnancy symptoms, this slight cramping confuses many women who believe they’re about to have their period. Abdominal and back pain are caused by normal, mild uterine contractions related to the increasing pregnancy hormones.

What can you do about it: nothing, unless pain gets intense or comes with vaginal bleeding.

When to call your doctor: if you experience strong pain, or if you have pain and bleeding, in order to rule out certain pregnancy complications (see vaginal bleeding) or other conditions unrelated to pregnancy.

2) Acne

Why it happens: this is a very common symptom -pimples appear in about 50% of women- and sometimes can be quite intense. The β-HCG hormone (beta – human chorionic gonadotrophin), which raises from the beginning of pregnancy has androgenic effect (mimics male hormones), leading to increased skin oil production and the appearance of acne.

What can you do about it: most of medications used to treat acne are not allowed throughout pregnancy -isotretinoin, one of the most effective acne medications is also one of the most dangerous during pregnancy. Be patient! pregnancy acne will resolve after childbirth.

In the meantime, just get some good medication-free skin care:

• wash your face and body with a gentle cleanser, alcohol and oil-free,
• avoid over-cleansing as it may have the opposite effect,
• shampoo regularly and avoid oily hair mousse,
• do not pop your pimples, since it may cause permanent scarring.

When to call your doctor: If your acne is severe, you may consult a dermatologist to get the most adequate care for your skin type.

3) Bloating and constipation

Why it happens: during pregnancy a hormone called progesterone relaxes the bowels wall and slows down their activity in order to allow the absorption of more nutrients to feed your growing baby. The downside: you may feel bloated, gassy and get frequently constipated.

What can you do about it: 

• increase your fiber intake,
• avoid foods that cause bloating (beans, cauliflower, etc),
• drink plenty of fluids,
• engage in physical activity.

When to call your doctor: if constipation really bothers you, ask your doctor for a laxative or stool softener that is safe for pregnancy.

4) Breast swelling and tenderness

Why it happens: your breasts, under the influence of the high hormones, start getting ready for breastfeeding, thus they engorge and receive more blood supply; this will cause tenderness and swelling.

What can you do about it:

• wear a support bra (you may need to get a bigger size),
• avoid lacy or wired bras.

When to call your doctor: if you get severe breast pain or redness, or if you palpate any lump.

5) Dizziness and fainting 

Why it happens: your blood vessels dilate to increase blood supply to the womb and to your baby, leading to a drop in blood pressure, which can make you feel dizzy, lightheaded, or even faint. Dizziness can also be due to low blood sugar, especially if you are not eating adequately.

What can you do about it:

• avoid prolonged standing,
• rise slowly when you get up from sitting or lying down,
• be especially careful if you drive or execute activities that require special concentration,
• eat healthy, frequent meals (every two to three hours),
• drink plenty of fluids to raise your blood pressure.

When to call your doctor: if your experience intense dizziness, especially if you have bleeding or intense abdominal pain, to rule out a miscarriage or an ectopic pregnancy (see vaginal bleeding).

6) Fatigue and sleepiness

Why it happens: from early pregnancy, your body has some extra work to do! Your metabolism increases and you start preparing the placenta; these changes together with the high progesterone levels are responsible for this constant feeling of drowsiness and intense fatigue. Your body reminds you that you should get some rest, so you will be stronger to carry your baby!

What can you do about it:

• take naps and rest when possible,
• eat healthy,
• drink plenty of fluids,
• avoid standing up for long periods of time.

When to call your doctor: if you feel that your drowsiness affects your daily activities, inform your doctor who can rule out other possible causes of fatigue such as anemia. If you have intense sleepiness together with negative feelings, hopelessness or sadness, inform your doctor to rule out depression.

7) Food cravings, food aversions

Why it happens: the sudden hormonal increase changes your food tastes; therefore, you may get food cravings -a sudden and intense urge to eat something in particular, which may eventually be quite unusual- or food aversion -repulsion for certain foods, even with the thought of them.

It is believed that during pregnancy our body asks for what it needs -hence cravings- and makes us reject things we don’t need or may be harmful, such as aversion to cigarette in smokers (unfortunately, this is not always the case).

What can you do about it:

Cravings:

• Go ahead and indulge yourself with what you crave, provided that you generally follow a balanced and healthy diet,
• when you crave for unhealthy foods, try to avoid excess: eat one scoop of ice cream, not the whole 1-kilo carton!
• if cravings are too frequent, try to do activities to distract yourself so that you don’t think about food all the time: go for a walk, talk to a friend, read a book, go to the movies…

Aversions:

• Most food aversions will go away after the first trimester, so most likely you will be able to eat meat or drink milk again thereafter,
• if you keep having aversion to certain foods, try to find healthy substitutes for what you can’t tolerate, e.g., have calcium-fortified cereals if you can’t drink milk.

When to call your doctor: If you crave for clay, ashes or dirt -a condition called pica– as this can be really dangerous for you and your baby; if your food aversions are too intense and followed by frequent vomiting (see Nausea and vomiting).

8) Frequent urination

Why it happens: you may notice from very early in pregnancy that you need to pee more often. As your body blood flow increases with pregnancy, more blood goes to the kidneys in order to flush more waste products out of your body; this leads to increased urine production. Urination is more frequent during the night because the fluid you had retained in your legs during the day will get reabsorbed when you lie down. In addition, as the uterus grows it starts putting pressure on the bladder.

What can you do about it:

• don’t hold you urine, as this can predispose you to urinary infections,
• avoid too much caffeine (coffee, tea, cola drinks) since they have diuretic effect,
• don’t drink too much before going to bed.

When to call your doctor: If, besides frequent urination, you feel burning or pain when you pee, or you see blood when wiping: these can be signs of a urinary tract infection.

9) Headaches

Why it happens: headaches occur frequently early in pregnancy mostly due to the increased hormone levels; but low blood pressure, low sugar, anemia or dehydration can all worsen headaches. Women who had migraines before getting pregnant may experience worsening in the first trimester, but usually improvement as the pregnancy progresses.

What can you do about it:

• drink plenty of fluids,
• eat frequent meals,
• get some rest when possible.

When to call your doctor: If headaches persist, check with your doctor whether you can take acetaminophen (Tylenol), which is usually allowed throughout pregnancy. Contact you doctor if your headaches are too intense, do not subside with Tylenol or are accompanied by visual disturbances or other symptoms.

10) Heartburn, heavy stomach

Why it happens: Again, progesterone is responsible for relaxing the sphincter (ring of muscle) that separates the stomach from the esophagus; this leads to acid reflux.

What can you do about it:

• eat small, frequent meals, don’t eat too much before going to bed,
• avoid too spicy, greasy, acidic or sweet foods,
• don’t lie flat, sleep with two or more pillows to have your head at a higher level than your body.

When to call your doctor: if you can’t cope with heartburn, ask your doctor to prescribe you an antiacid medication that is safe for pregnancy.

11) Mood swings

Why it happens: mostly because of your hormones, but eventually increased by your dizziness, nausea or other pregnancy symptoms, you may feel at times irritated or depressed, anxious or out of energy, overjoyed or panicked! Is not only hormones,  though. Pregnancy will bring major changes to your life, so it’s natural to worry about many things: whether your will make it through labor and delivery, if you baby will be fine, whether you will be a good mother, if the relationship with your partner will be affected, etc, etc… Most women will also become more forgetful; while this is normal, it may be quite frustrating…

What can you do about it:

• talk about it, find someone who can listen to you: your partner, a family member, a friend, or other mums-to-be,
• ask for understanding and support, not only psychological but also physical: if you can’t do certain activities at work or a home, let someone help you,
• get some rest: you may feel worse if you are tired or sleep-deprived,
• engage in activities that calm you down and relax you; mild exercise can also help.

When to call your doctor: if you feel constantly down or overwhelmed, if you have negative or suicidal thoughts, if you can’t go ahead with your daily life; in these situations you may need professional help.

12) Nausea and vomits

Why it happens: nausea is one of the commonest pregnancy symptoms (occurs in about 85% of pregnancies). It is not fully understood why it happens, but it seems to be related to β-HCG levels: the higher levels, the more nauseous you may feel (e.g., women carrying twins).

Nausea and vomits usually start around the 6th week of pregnancy and persist until week 13, although they may last up to the 16th – 20th week, or more rarely beyond 20 weeks. They can be of variable intensity, for some women very mild, for others very severe, leading to continuous vomiting. Nausea may be more intense during the morning -that’s why it’s called morning sickness– although this is not always the case.

What can you do about it:

• nausea gets worse when you have empty stomach, therefore, have frequent and small meals,
• foods with high starch content may relieve nausea (crackers, potatoes, rice, pasta), but each woman find which foods can tolerate and which not,
• avoid food with strong smell or taste,
• ginger can help (either raw ginger, ginger ale or ginger pills),
• accupressure, motion sickness wristbands and vitamin B6 can also be effective,
• stress and tiredness can worsen nausea, therefore try to get plenty of rest,
• keep drinking to avoid dehydration, but drink small amounts of fluids at a time, since large amounts can make nausea worse.

When to call your doctor: if nausea doesn’t allow you to eat or drink anything, or if you can’t stop vomiting, your doctor can prescribe you certain medications that may be helpful. Sometimes intense vomiting may lead to dehydration, a condition called hyperemesis gravidarum, which requires admission to a hospital for rehydration and intravenous treatment.

13) Nosebleed, stuffy nose, gum bleeding

Why it happens: blood flow increases in pregnancy, and your gums and nasal lining are very fragile and bleed easily. Gums may bleed when you brush your teeth. Nosebleeds may appear when you blow your nose; you may also notice that your nose gets more easily congested, also as a result of the increased blow flow to the nose’s mucous membranes.

What can you do about it:

• keep seeing regularly your dentist to rule out certain gums problems, which are common in pregnancy and may increase bleeding,
• switch to a softer toothbrush,
• to stop nose bleeding pinching your nose for a few minutes should help,
• for your nose congestion you may use a humidifier, or try a saline nasal spray,
• don’t use nose spays or other decongestants without checking with your doctor.

When to call your doctor: if your gum or nose bleeding are heavy or too frequent. If your nose congestion gets too intense and you can’t breathe.

14) Smell intolerance, increased sense of smell

Why it happens: many women won’t stand certain strong smells, either from food, cosmetics or others sources, triggering nausea or vomits. This sensitivity to smells is hormone-related; it is said that nature prepares you to “sense” dangerous threats in order to protect your baby.

What can you do about it:

• avoid foods with intense smell,
• you may need to stop cooking for a while -if possible,
• don’t use scented cosmetics if the smell bothers you; this is also true for laundry soap, softeners, air fresheners, etc.

When to call your doctor: in case your smell intolerance leads you to intense vomiting (see Nausea and vomits).

15) Vaginal bleeding

Why it happens: Bleeding during the first trimester is extremely common (it happens in about 25% of pregnancies) and is usually of no concern. A slight bleeding may be due to the implantation of the embryo in the uterus; sometimes a small detachment of the sac from the uterine cavity -or subchorionic bleeding- may be the reason; an inflammation of the cervix may occasionally cause slight bleeding (mainly with intercourse). Sometimes though, bleeding can be worrisome, i.e., when related to threatened miscarriage or ectopic pregnancy (a pregnancy outside the uterus).

What can you do about it:

• keep track of the amount and characteristics of the blood,
• don’t have intercourse, don’t use tampons,
• according to the cause of the bleeding, you may be asked to get some bedrest, and refrain from heavy work or heavy lifting.

When to call your doctor: If you see blood, you should inform your doctor, even if you have light bleeding, as it may not be always easy to understand when bleeding is to worry about. But you should call your doctor right away (or go to the emergency room) if you have heavy bleeding, cramps (like intense period pain), or sharp pain in your abdomen, as these can be signs of miscarriage or ectopic pregnancy.

16) Vaginal discharge

Why it happens: Your high hormones are responsible for an increase in vaginal discharge, that should be white or clear, and thin.

What can you do about it:

• you can wear panty liners, but you should not wear tampons,
• prefer cotton underwear,
• avoid string or thong underwear that may cause intense rubbing, which together with the increased discharge can favor yeast or other infections.

When to call your doctor: if you have discharge that is yellow, green or foul-smelling, or if you have intense itching or burning.

Stay tuned! More posts with symptoms to expect during the second and third trimester of pregnancy will follow…

References

• NICE: Antenatal Care- Routine Care for the Healthy Pregnant Woman. March 2008, UK
• HAS: Comment mieux informer les femmes enceintes? Avril 2005, France
• American College of Obstetrician and Gynecologists: Nausea and vomits, Vaginal bleeding

Photo credits

Cover: Getty images; 1) dornascostasnuncamais.com.br; 2) babycenter.com; 3) adriseaplanes.eu; 4) thealphaparent.com; 5) pregnancymagazine.com; 6) womenshealthcaretopics.com; 7) motherandbaby.co.uk; 8) ladycarehealth.com; 9) momjunction.com; 10) ladycarehealth.com; 11) fitbottomedmamas.com; 12) not-equal.eu; 13) womenshealthcaretopics.com; 14) health-and-parenting.com; 15) zliving.com; 16) privatepregnancy.co.uk