Common concerns in early pregnancy

It is quite normal to have a few discomforts in early pregnancy. Sometimes they can become quite severe and you may need to talk to your doctor about what to do.

Common concerns include:

• morning sickness – nausea and vomiting which may last on and off all day
• constipation
• food cravings and aversions
• heartburn
• frequent need to pass urine
• back pain and tiredness
• vaginal thrush
• skin changes and itching
• haemorrhoids (piles)
• leg cramps
• swollen ankles, feet and fingers
• backache
• fainting
• larger breasts which may become tender. You may need to get some new bras. It is important to have them properly fitted, so that they are comfortable and not too tight. It is also good to avoid hard under-wire bras.

Morning sickness

'Morning sickness' can occur at any time of the day. The cause is unknown although it has been linked to changes in the levels of various hormones during pregnancy. It usually starts at about the sixth week of pregnancy and settles by about the fourteenth week. Some women will not be affected by morning sickness, but in others it can be so bad they have to be hospitalised.

Generally the baby is unaffected by morning sickness unless your symptoms are severe and prolonged.  However, it is probably a good idea to see a health professional if you were not eating well before pregnancy, you have lost a lot of weight quickly, you are dehydrated or you are worried about your health and how you are feeling.

Things you can do

Drink plenty of fluids

It is important to drink plenty of fluids as dehydration makes nausea and vomiting worse.

• Drink small amounts often.
• Sometimes other fluids are managed better than water. Try flat lemonade, Lucozade, sports drinks such as Gatorade, diluted fruit juice, cordial, weak tea, clear soup or Bonox/Bovril.
• Suck on ice or icy poles if other fluids cannot be managed.
• Some people find ginger helps relieve nausea. Try dry ginger ale or ginger tea. To make ginger tea, soak three or four slices of ginger in boiling water for five minutes. Sip slowly. Ginger tablets are also available from your local pharmacy.

Reduce the severity of your symptoms

• Eat small amounts of food more often, rather than large meals.
• Avoid having an empty stomach. Snack in between mealtimes, e.g. biscuits, fruit, toast.
• Early morning nausea may be helped by eating a dry or plain sweet biscuit before getting out of bed or by snacking during the night if you wake up.
• Salty foods may help. Try potato crisps or salty biscuits.
• Try sucking on barley sugar or boiled sweets.
• Avoid fatty, rich or spicy foods like takeaways, curries, hot chips, chocolate.
• Make the most of your best time of the day – eat well when you feel best or whenever you feel hungry during the day.
• If the smell of hot food makes you feel ill – try eating cold food instead. If possible, avoid cooking and ask for help from friends and relatives.
• Choose simple dishes that are quick and easy to prepare. If you spend too much time preparing food you may not feel like eating.
• Get plenty of rest.

Foods you can try

• Dry or plain sweet biscuits
• Toast with honey or jam
• Sandwiches with low fat fillings such as tomato, salad, vegemite
• Low fat soups
• Fresh or stewed fruit
• Ice cream, custard or yoghurt
• Grilled, lean meat
• Steamed chicken
• Baked or grilled fish
• Boiled or scrambled eggs
• Boiled rice
• Mashed potato

Severe morning sickness

A small percentage of women suffer from excessive and prolonged vomiting, called 'hyperemesis'. If left untreated, hyperemesis can lead to dehydration. It is important to see your doctor if symptoms are severe.

How is hyperemesis treated?

There is a range of medications of varying strengths which help to relieve severe symptoms. Make sure you take your medication regularly, as prescribed, or it will not be effective.

If you are unable to drink enough fluid, you may need to attend your hospital for regular intravenous fluids. This may be recommended two to three times per week.

Drink as much as you can to keep hydrated and eat whatever you can tolerate.

As symptoms settle, gradually get back to healthy eating. This is important to replace the nutrients you have been missing out on. Your dietitian may also recommend a multivitamin supplement.

Weight loss

It is not uncommon to lose weight whilst you are unwell. A small amount of weight loss is unlikely to harm your baby. For prolonged vomiting with continued weight loss, seek further advice from your doctor. Also, your dietitian may recommend some supplements to help prevent weight loss. Weight can be regained quickly once you begin to eat normally again.

Gradually increase your intake until you are able to eat a well-balanced diet.

As your appetite improves, you will be able to manage greater amounts and a wider variety of foods. Aim to eventually choose foods according to the healthy food guide and drink at least 8 to 10 glasses of fluid each day [see Food and nutrition in pregnancy].

Alternative and complementary options and approaches

There are alternative and or complementary treatments that some women find useful such as acupuncture, massage or hypnotherapy. There is very good evidence to support the effectiveness of some of these treatments. There are also some alternative treatments for which the evidence will vary. Generally, at the very worst, a therapy that hasn’t been shown to work is likely just to be ineffectual and expensive but some can actually be harmful to your pregnancy or may impact on other medicines you are taking.

Finally

If symptoms persist or if you are vomiting and losing weight, see your GP or speak to your midwife.

See also our fact sheet Nausea and vomiting in pregnancy.

Constipation

Pregnancy hormones can slow down the muscles in the bowel and in some women this can cause constipation.

Things to try:

• Include plenty of fibre in your diet. Fibre is contained in fresh fruit and vegetables, wholemeal breads and breakfast cereals, dried fruit, nuts and legumes.
• Take a fibre supplement such as psyllium.
• Drink plenty of water and other fluids.
• Exercise regularly.

Important information

• Don’t take laxatives without advice from your doctor or midwife.
• Iron tablets can cause constipation; you may need to speak to your doctor about taking a different brand of iron tablet.

Food cravings

Some women have food cravings during pregnancy. The reason for this is not really understood. The cravings are often for foods that we seem to need, such as milk (we need more calcium during pregnancy), or tomatoes and oranges (vitamin C requirements double during pregnancy).

Some women may also crave things that aren’t actually food, such as chalk or clay. Again, it’s not clear why this happens.

Taste changes and food aversions

Women sometimes find that foods taste different or they 'go off' certain foods such as tea, coffee or meat. This usually settles down as the pregnancy progresses. If you have found it difficult to eat particular foods that are important for your diet, you may like to try them again later in the pregnancy.

Heartburn

Heartburn is quite common during pregnancy and can be triggered by hormonal changes as well as the growing baby pressing on your stomach. Heartburn is a burning feeling in your chest, accompanied by a bitter taste of fluid in the mouth.

Things to try:

• Eat small meals frequently and slowly.
• Avoid fatty, fried or spicy food.
• Sleep semi-upright, well supported by plenty of pillows.
• Drink a glass of milk before you eat
• Avoid drinking with meals.

If these measures don't help, your doctor may prescribe an antacid.

Tiredness and difficulty sleeping

During pregnancy your sleep can be disturbed by visits to the toilet, heartburn, a kick from the baby or just a general feeling of discomfort when you lie down. Some women may experience disturbing dreams or nightmares in the last couple of months, which can be due to anxiety about approaching childbirth and parenthood.

Things to try:

• Lie on your side with a pillow under your tummy and another between your knees.
• Rest during the day.
• Avoid stimulants such as tea and coffee before bedtime.
• Wait until you are very tired before you go to bed at night.
• Go for a walk, or do some other exercise, in the late afternoon or early evening.
• Try a relaxing activity before bed such as soaking in a bath, listening to music, massage or meditation.

Haemorrhoids (Piles)

Haemorrhoids are swollen veins around the rectum and anus (back passage) that may itch, ache or feel sore. Piles may bleed a little and can make it very uncomfortable to go to the toilet. They can be triggered by constipation or pressure from the baby's head, or both.

Things to try:

• Include plenty of fibre in your diet such as fruit and vegetables, wholemeal breads and breakfast cereals.
• Avoid standing for long periods.
• Avoid straining when sitting on the toilet.
• Talk to your midwife or doctor about a suitable ointment or suppository if bleeding and pain persist.

Vaginal thrush

Vaginal discharge affects nearly all women during pregnancy. If the discharge smells unpleasant, causes soreness, itching or is discoloured, you may have a vaginal infection. The most common infection is thrush. It is important to see your doctor for treatment.

Another visit to the toilet

It may feel like you are always running to the toilet. In early pregnancy this is due to hormonal changes, but in later pregnancy it is because your growing baby is pressing on your bladder. In late pregnancy, you may also find it difficult to completely empty your bladder.

In the last few weeks of pregnancy you may 'leak' urine when you cough, sneeze or lift something. This is usually due to the pressure on or the weakening of your pelvic floor. Pelvic floor exercises are crucial during pregnancy and throughout your adult life to avoid continence problems as you get older. See our fact sheet on Pelvic floor exercises.

Important information

If you feel pain or burning when you pass urine it may mean you have an infection. It is important to talk to a doctor if this is the case.

Cramps

Muscle cramps in the foot, leg or thigh are very common during pregnancy, especially at night. It is not clear what causes cramps. It was once thought that it was due to a lack of calcium; however, studies have not proven this to be the case.

Things to try:

• Massage and stretching the affected limb or muscle during the cramp often gives relief.

Swollen ankles, feet and fingers

Eighty per cent of pregnant women will experience swelling in their ankles, feet and fingers. There is extra fluid in the tissues of your body during pregnancy and some of it collects in your legs, particularly at the end of the pregnancy. If you stand for long periods of time, especially in hot weather, this fluid can cause swelling in the ankles and feet. It is more noticeable towards the end of the day and usually goes down at night while you sleep.

Things to try:

• Avoid prolonged standing.
• Rest frequently with your feet elevated.
• Wear comfortable/loose shoes.

Important information

Swelling may be a symptom of high blood pressure or pre-eclampsia.

Tell your doctor or midwife if:

• your ankles, feet or fingers are very swollen
• the swelling is not relieved by rest
• you notice swelling in other parts of your body.

Backache

Most women experience backache at some stage during their pregnancy. Your posture can be affected by the growing baby, the loosening of ligaments due to hormonal changes and greater water retention in the tissues. Backache is often worse at night contributing to sleeping difficulties, especially during the later stages of pregnancy.

Things to try:

• Avoid heavy lifting and housework.
• Avoid prolonged standing.
• Rest frequently with legs elevated.
• Try to maintain good posture.
• Sit in chairs with good back support.

See also the section on back care and posture.

Fainting

You are most likely to feel faint if you get up quickly from a chair or hot bath or if you stand for too long. Lie or sit down at the first sign of faintness. In late pregnancy, lying on your back can make you feel faint; you will feel better if you turn onto your side. Contact your doctor or midwife if you have frequent dizziness or fainting.

Itching

As your baby grows, the skin of your abdomen gets tighter and may cause mild itching. This is common in pregnancy. However, contact your doctor or midwife for persistent itching as this can be a sign of a more serious problem. Medication and further tests may be ordered.

Skin

Pregnancy can change the tone and colour of your skin, this is due to pregnancy hormones. The extra blood circulating around your body can cause your skin to 'glow' but for some women it may cause red patches, acne may get worse and areas of your skin may become dry and scaly and you may notice deeper pigmentation across your face.

Changes in pigmented skin affects nearly every woman, this includes moles, freckles and the areola (nipples) of the breasts. Genitalia, the inner sides of thighs, underneath your eyes and in your armpits may also become darker. Some women develop a dark line running down the centre of your stomach. This is called the linea nigra. Sunlight intensifies areas of skin that are already pigmented and many women find that they tan more easily during pregnancy. Even after birth, the deeper pigmented skin will remain darker for some time but will gradually fade and disappear.

Chloasma

Chloasma is a special form of pigmentation also called the mask of pregnancy, which appears as brown patches on the bridge of the nose, cheeks and neck. Some dark skinned women develop patches of paler skin on their face and necks. These patches will begin to fade after the baby is born.

Stretch marks

About 90 per cent of women get stretch marks. These usually appear across the abdomen, although they can affect the thighs, hips, breasts and upper arms. While the red streaks look prominent during pregnancy, after the birth they fade and become pale silvery streaks. 

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