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Early Pregnancy Problems

It is widely known that the first trimester holds the highest risk for miscarriage, so it is not surprising that women worry more about their symptoms during this time.  Nausea is so common that it is considered to be a normal physiologic sign of pregnancy.  Nausea with or without vomiting is present in 50-90% of the pregnant population, usually starting around five or six weeks, peaking at nine weeks, and declining by 16-18 weeks.  It may continue into the third trimester and even up to delivery in 15-20%.

Hyperemesis gravidarum is the name given to vomiting that is severe and persistent with weight loss exceeding 5% of the pre-pregnancy body weight.  The incidence of this is much lower at 0.3-2%.  The cause is not certain, but it seems to be associated with higher HCG levels.

The treatment for nausea and vomiting of pregnancy is usually conservative and involves:

  • Avoidance of triggers: odors, motion, heat, humidity, and certain foods.  Iron can also cause gastric irritation
  • Dietary changes: eat before feeling hungry to avoid an empty stomach and associated nausea.  Generally small frequent high carbohydrate, low fat meals are recommended.
  • Accupressor wrist bands: have not shown benefit compared to placebo in randomized controlled trials; however, they are harmless and possibly worth a try.
  • Vitamin B6: has been shown to decrease nausea but does not have a significant impact on vomiting
  • Ginger: trials show that it is more effective than placebo and equivalent to B6 in improving nausea.  No adverse events were noted. 
  • Anti-emetics: medications are available to control nausea and vomiting; however, they have not been thoroughly studied in pregnant women, so they should be reserved for severe nausea and vomiting.  Consult your doctor if you think you fall into this category.
  • Fluids: proper hydration is important throughout pregnancy but especially when vomiting is present because of the need to compensate for fluid losses.  Most women tolerate small amounts of clear fluids taken often.  However, women with severe vomiting may require IV fluid replacement in a hospital.

Bleeding or spotting during early pregnancy can be quite alarming, but it is actually quite common.  It is usually light, requiring less than 2 pads or tampons in 24 hours and is not associated with pain or cramping.  If you have heavy bleeding with or without clots and/or pain, you should contact your doctor.  He/she will want to evaluate you to rule out ectopic pregnancy and miscarriage.  In a recent study of 151 women, 9% experienced vaginal bleeding on at least one day during the first trimester, the majority of whom went on to have normal healthy pregnancies.  

Breast tenderness is common due to HCG stimulation of the secretory glands as well as increases in both estrogen and progesterone hormones.

Urinary frequency is thought to be caused by the blood plasma volume expansion and increased filtration of the kidneys that occurs during pregnancy.

Fatigue: the exact cause is unclear, but it may be due to the rapid and large increase in the concentration of progesterone.

Other symptoms that have been reported include:

  • Food cravings and aversions
  • Mood changes
  • Lightheadedness
  • Bloating
  • Constipation
  • Heartburn
  • Low back pain
  • Nasal congestion
  • Mild uterine cramps

Gestational diabetes and preeclampsia are common medical conditions that typically occur later in pregnancy.  They are much more serious than those listed above and have more lasting impacts on the baby if not treated in a timely and appropriate manner. 

Gestational diabetes can be diagnosed if fasting plasma glucose is greater than 92 but less than 126 at any point in pregnancy.  If it is greater than 126, the diagnosis is likely just diabetes.  Your doctor may also perform a two-hour glucose challenge somewhere between 24 and 28 weeks to see how your body is able to handle a high sugar load.  Gestational diabetes has been associated with large fetal head size, fetal organomegally (enlarged heart or liver), operative delivery, perinatal mortality, neonatal respiratory problems, and metabolic complications such as elevated billirubin, low calcium, or low blood sugar.  It is often treated with glucose monitoring and a diet and exercise program.  However, oral diabetic medications or insulin is sometimes required to keep glucose numbers under control and improve the health of both Mom and Baby.

Pre-eclampsia usually manifests as the gradual onset of hypertension and proteinuria after 20 weeks gestation in a previously normotensive woman.  It can be mild or severe and symptoms can include headache, visual disturbance, epigastric pain, nausea, vomiting, and a decrease in fetal movement.  The treatment and prognosis varry depending on gestational age when it develops as well as the severity.  Your doctor will likely check your blood pressure at every visit to screen for this condition and manage it as effectively as possible if it does occur.

While most women do experience some uncomfortable symptoms during pregnancy, most of them are not dangerous.  However, if you are worried about any particular symptom, you should contact your doctor.

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