Common pregnancy symptoms

Pregnancy symptoms are related to the changes in a woman's body that occur as pregnancy progresses. The changes in physiology in pregnancy is usually the reason for these symptoms- you have learnt about these changes in the Year 3 curriculum. If you would like a brief review of pregnancy physiology, this video is a good place to start: 

Nausea and vomiting 

Nausea and vomiting of pregnancy is common- 90% of pregnant women suffer from some degree of nausea and vomiting in pregnancy. In most cases, it is mild and self limiting, but 6% of women have severe nausea and vomiting. This is called "hyperemesis gravidarum" and you will learn about this condition in depth in Case 3. Nausea and vomiting of pregnancy is likely due to two mechanisms- the rise of ßhCG and the changes that occur in the gastrointestinal system with changes in gastrointestinal motility and gastric emptying and increasing intra-abdominal pressure. 

Dietary advice includes frequent small meals, frequent sipping of liquids, and avoiding "triggers" such as spicy foods and strong odours. Ginger can be used if the symptoms are mild, but other antiemetics may also be needed. 

Breast tenderness 

Breast tenderness and paresthesias usually occur in the first trimester, as pregnancy hormones rise rapidly. Increased vascularity of the breast and growth of the secretory elements can cause tenderness, pruritis, and pain. During later pregnancy, a thick yellow fluid (colostrum) can be expressed from the developing breast. The areola also become larger, more pigmented, and Montgomery tubercules develop- these are small glands that produce sebum to moisturise the skin. As pregnancy progresses, breast tenderness and pruritis often lessens.  

Constipation 

Constipation is common in pregnancy as pregnancy hormones cause relaxation of smooth muscle and thus there are changes in gut motility. This is more common in the first trimester and often improves as the pregnancy progresses. Dietary changes are recommended as first-line treatment including exercise, adequate hydration, and increasing fibre intake. Fibre supplements may also be useful. Some women may require laxatives if constipation becomes severe, and bulk-forming laxatives and stool softeners are preferred if laxatives are required. 

Haemorrhoids 

Haemorrhoids are common in pregnancy and are caused by constipation and elevated venous pressure in pelvic vessels and decreased venous tone. They usually resolve after pregnancy. Women should be advised to keep stools soft, wash and dry the perianal area after defecation, and use analgesic ointment if required. 

Heartburn 

Heartburn is common in pregnancy and is usually caused by gastrooesophageal reflux. Relux is more common in pregnancy due to relaxation of the lower oesophageal pressure, decreased oesophageal peristalsis, and changes in intraabdominal pressure. This usually worsens during pregnancy as the uterus enlarges. Antacids can be used safely in pregnancy if they are required. 

Vaginal discharge 

There is an increase in the volume of secretions from the cervix and vagina in pregnancy, which relate to increased vascularity and hypertrophy of the uterus, cervix, and vagina, and increased production of lactic acid by lactobacilli. Normal vaginal discharge in pregnancy is clear to cream in colour and is non-irritant. Due to the hormonal changes, pregnant women are also 10-20x more likely to develop vulvovaginal candidiasis- this should be treated if it develops. STIs also need to be treated in pregnancy and women should be tested for these if they are high-risk or if there is a change in their normal discharge. 

Back and pelvic pain 

This occurs mainly in the third trimester. As the uterus enlarges anteriorally, lumbar lordosis is accentuated and the centre of gravity changes. Increased joint laxity also occurs in pregnancy and this affects the sacroiliac, sacrococcygeal, and pubic joints in particular. Changes in joints and the centre of gravity can cause discomfort and difficulty with movement. Antenatal physiotherapy is very beneficial if this occurs, as can be a supportive pregnancy belts. 

Peripheral swelling 

This usually occurs in the lower limbs after 34 weeks of pregnancy. The growing uterus causes venous congestion in the lower limbs. This, in combination with the haemodilution of pregnancy, results in oedema of the feet and ankles. This swelling is usually mild. Women should be advised to wear comfortable shoes and avoid standing for long periods of time. 

Varicose veins

Varicose veins also occur as a result of venous congestion in the lower limbs and the pressure of the uterus on the pelvic vessels. They can be uncomfortable. Women should be advised to wear graded compression stockings and to be aware of the signs and symptoms of deep vein thrombosis (DVT). Varicose veins are a risk factor for DVT and so should be considered as part of antenatal and postnatal assessments for thrombosis risk.  

Cramps and numbness 

Cramps in the legs and feet are common and they are no associated with calcium deficiency. These are usually self limiting. Palmar numbness can be due to carpal tunnel syndrome- this is more common in pregnany due to oedema within the carpal tunnel. Most cases resolve after birth, but can be treated with wrist splints or steroid injections if necessary.  

Urinary symptoms 

Increased urinary frequency is common in pregnancy. There are changes throughout the renal tract in pregnancy, including changes in kidney size and GFR, dilatation of the ureters, and stretching of the bladder. The changes to the bladder and renal tract also contributes to urinary stasis and pregnant women are more susceptible to UTIs. This is the reason that asymptomatic bacteruria in pregnancy is always treated.