Early pregnancy symptoms

Early pregnancy symptoms include loss of periods (obviously), nausea, vomiting and increased urine production causing you to pass water more often. The pregnant uterus may cause some pressure effects on your bladder as it grows giving discomfort or difficulty passing water. Your breasts engorge and may become painful; the nipples enlarge, develop small glandular nodules and darken around 12 weeks. Your temperature may rise a little to about 37.8°C.

Headaches, palpitations and fainting

These are common in pregnancy, as are sweating and feeling hot. Make sure that you drink plenty of fluids and see if taking regular showers makes you feel more comfortable. If headaches are troublesome, paracetamol is safe to take and will not harm the baby. Avoid hot stuffy surroundings like tube trains during the rush hour. If necessary, "use your bump"; ask people to give up their seat for you if you are feeling unwell. Let your employer know if the symptoms are troublesome-most people are very sympathetic if you tell them.

Abdominal pains

Abdominal pains might always represent the onset of labour. Bear this in mind if you are in the latter third of your pregnancy and the pain is coming at regular intervals! Often abdominal pains up the sides of the womb are due to ligament stretching; these are not serious. Some women experience quite severe discomfort just in front of the bladder where the pubic bones meet in the mid-line. Usually these bones are held tight together by a strong ligament but in pregnancy this softens and stretches to make more space in the pelvis. This can cause unpleasant discomfort and is usually worse on walking and exercise as the pubic bones move relative to one another. Again, no treatment is necessary and this will settle after pregnancy.

If abdominal pain is severe or accompanied by bleeding then do seek medical advice. Although rare problems like appendicitis, gall stone disease and bleeding into the womb can cause severe symptoms. Please ask your doctor for advice if you are concerned.

Breathlessness

Breathlessness is a common symptom in pregnancy. The depth of breathing increases by about 40% during pregnancy and this causes a sensation of breathlessness. Partly this is due to your body having to breathe harder to blow off waste carbon dioxide that your baby produces and passes into your bloodstream via the placenta. Your body resets its basal breathing rate and this can give symptoms of breathlessness. Other factors later in pregnancy include the bulk of the pregnant uterus pressing up onto the diaphragm that give you less room.

If breathlessness is accompanied by cough or chest pains, or you have associated episodes of faintness and collapse then you should see your doctor to check for possible clots on the lung. This is rare but requires treatment.

Asthma sufferers should ensure that their asthma is well controlled at the beginning of pregnancy. Do continue to use your inhalers throughout pregnancy. They are safe and will not damage the baby but a bad asthma attack might reduce the baby's oxygen supply and can be dangerous. If you smoke, give up now.

Constipation and piles

Your bowels become lazy when you are pregnant. In addition you may be taking iron supplement that cause constipation as well. Avoid taking stimulant laxatives like senna because they can stimulate the womb as well. Make sure that your diet includes plenty of fibre found in fruit, vegetables, brown bread and high fibre breakfast cereals. To make all the fibre soft in your bowel you need to drink plenty of fluids. A simple laxative like lactulose may occasionally be useful.

Because of the bulk of the womb in the pelvis, its rich blood supply and the tendency to constipation some women develop piles (haemorrhoids). These occur when you open your bowels and some of the lining of the bowel is pushed out. It may bleed or be painful but is rarely dangerous. If possible push the piles back up your bottom. Some simple ointment from the chemist may be necessary if they are inflamed. The piles will usually settle after pregnancy. Try and avoid straining on the toilet, eat plenty of fibre and drink plenty of fluids.

Varicose veins

These are swellings of the veins in the leg due to the pregnant womb obstructing blood flow back up through the pelvis. They will usually settle after pregnancy and although uncomfortable usually do not cause problems like bleeding or thrombosis. If you need some elastic compression stockings to reduce discomfort do speak to your doctor.

Backache

Backache is common. In pregnancy your ligaments soften and muscles relax and this contributes to the discomfort. Often the pain is worse at night. Attention to posture, regular exercise, simple pain relief like paracetamol may all help. If particular severe gentle physiotherapy or advice about exercise and posture may be necessary. Because of the softening of ligaments and the ability of your joints to move abnormally it is not advisable to seek manipulation from osteopaths or chiropractors during pregnancy. They may be of help with more gentle treatment and advice, however.

If you have a fever check with your doctor that the back pain is not due to a urinary infection. Towards the end of pregnancy lower back pain may become worse as the baby's head moves into the pelvis and many women experience low back discomfort at the beginning of labour.

Pins and needles

Swelling of the soft tissue at the wrist can put pressure on one of the nerves going into the hand. This is called carpal tunnel syndrome. This may result in unpleasant sensations of pins and needles or numbness in the hand, often at night. It may help to keep your hands high when you sleep rather than letting them slip underneath you or dangle out of bed. If the discomfort is unbearable it is worth seeing your doctor to discuss treatment options. Wrist splints may help and exceptionally an injection or operation to relieve the pressure on the nerve is required. If symptoms are mild we would encourage you to wait until the preganncy is over as the condition usually settles.

Some women develop similar symptoms at other places such as the outer thigh (meralgia paraesthetica) where a nerve is trapped at the top of the leg. Again, finding a comfortable position helps. This nerve is pinched when you stand or walk so lying down with your hip flexed may help. The problem goes away after delivery.

Ankle swelling and leg cramps

This is very common later in pregnancy and usually of no significance. If your hands are getting puffy do take your rings off before they become stuck. Your doctor or midwife will want to check your blood pressure and urine at the ante-natal clinic to make sure the ankle swelling is not associated with other problems.

Leg cramps affect one third of women in the later half of pregnancy. For some women they can be quite severe, particularly at night. There is little one can do to help but try raising the foot of the bed by 20cm to elevate your legs at night.

Just occasionally women develop a clot in the deep veins of the leg. If your ankle swelling is in one leg only and your calf muscles are hot and tender see your doctor for advice.

Nausea and vomiting

A feeling of sickness affects 80% of women at some stage of their pregnancy. Approximately half experience some vomiting symptoms. Nausea and vomiting may start by 4 weeks and tends to decline over the following 2 months. However, by 20 weeks of pregnancy (half way!), one in five women are still experiencing some vomiting. Try eating small meals; most women respond to this. Stick to cold food because this has less aroma and smell than hot foods at your sense of smell can become very acute during pregnancy. If the vomiting is occurring very early in the morning try having something to eat before you get out of bed. Console yourself that women who feel nauseated and vomit are more likely to have a successful pregnancy!

Severe vomiting is rare. If your vomiting is so severe that you are unable to keep food or fluids down and you are losing weight you run the risk of dehydration and vitamin deficiency. Contact your doctor so that we can exclude a urinary tract infection and if necessary can arrange for a short stay in hospital to correct and fluid imbalance. Very occasionally we may prescribe medication for severe vomiting but as a rule, most women settle without treatment. It is unlikely that the baby will come to any harm; it is tiny early in pregnancy with modest nutritional requirements and it will use your body reserves.

Some women develop nausea towards the end of pregnancy. This can be normal but you should see your doctor or midwife to check your blood pressure and urine.