CHANGES TO EXPECT IN PREGNANCY9 August 2020
During pregnancy, a ‘new normal’ physical, physiological and psychological state emerge. When is this ‘new normal’ state no longer normal and when should you seek healthcare? The aim of this write-up is to educate you on the changes to expect during the course of your pregnancy, to re-assure you when you notice this changes and to know when the changes are no longer normal to enable you seek help early. The changes in pregnancy start very early before conception even though you cannot notice it, as times goes on some changes can easily be obvious to you and others while some can only be noticed by your healthcare provider during clinical examination or after some test. This is why antenatal care is important as it also provides you with the opportunity to discuss this changes with your healthcare provider.
CHANGES TO EXPECT IN PREGNANCY: TIREDNESS
Tiredness is one of the early symptoms of pregnancy and it resolves with time during the first trimester. However, not all tiredness is pregnancy related as it might be as a result of malaria infestation, anemia, complication of diabetes.
You may start feeling like you want to vomit with an increase in saliva production or even start vomiting. This is more common in the morning and often referred to as “morning sickness”. It is caused by a pregnancy hormone called human chorionic gonadotrophin and it usually resolves in the second trimester of pregnancy. Excessive salivation, nausea or vomiting associated with poor intake of fluids and food is called emesis gravidarum which can be caused by malaria infestation, urinary tract infection, vaginal infection, molar pregnancy, vitamin deficiency. You should see your health care provider when it becomes excessive. Dietary modifications could help such as the intake of small meals but frequent, avoid fatty food, eat more of dry food like crackers, toasted bread, date palm fruit. Excessive vomiting might require the use of medication to help or even a hospital admission.
The cyclical changes in the breasts during the menstrual cycle is increased in pregnancy. The areolar which is the pink or dark area around the nipple becomes darker and little elevations appear called the tubercles of Montgomery. The breasts will become tender, increase in size and in the second trimester of pregnancy might start secreting breast milk.
INCREASED VAGINAL DISCAHRGE
This is usually white and does not have an unpleasant smell. However, you should seek healthcare when this vaginal discharge is associated with fever, pain on urinating, itching, unpleasant smell and change in color as these are signs of infection and can cause you problems in the pregnancy.
SPOTTING OF BLOOD VIA THE VAGINA
Some women might spot blood just about the time they are expecting their menses. This happens when fertilized egg developing into a baby gets implanted in the womb. This is of shorter duration and smaller volume compared to your normal menstrual flow. This is a one-time occurrence and whenever you spot blood again and you are not in labour, it might be a sign of a problem. This could be that the pregnancy is threatening to abort or the placenta is abnormally located which might require a hospital admission for management.
MOVEMENT OF THE BABY
You may start feeling the movement of the baby between 18 and 20 weeks and this is called quickening. The movement becomes stronger as the pregnancy advances and gets to maximum at 32 weeks. These movements can be used to assess the well being of the baby and in certain medical conditions in pregnancy the mother is required to keep a chart of these movements. Absent movements, reduced or too much movement might just be a sign that the baby is in distress.
Your stool might become hard or less frequent than it used to be. This might be due to a reduction in the movement of the intestine due to the effect of progesterone the hormone required to maintain the pregnancy, iron supplementation, and inadequate intake of diet with high fibre content. This tends to improve as the pregnancy progresses and with good fluid intake. Diet with high fibre content and rarely medication, can be used to soften the stool.
This is a feeling of peppery or burning sensation felt in the pit of the abdomen in between the breasts. It occurs more as the pregnancy progresses unlike vomiting and constipation which instead resolves. It is as a result of the growing uterus or relaxation of the sphincter between the oesophagus and the stomach resulting in reflux of the acidic content of the stomach into the oesophagus due to the effect of progesterone. It is important to report this so that your health care provider can distinguish it from the symptoms of pre-eclampsia. For heartburn, you should avoid spicy meals, eat small frequent meals, do not lie down immediately after eating and sleep in a propped up position. Antacids can be prescribed by your healthcare provider to relief symptoms but not to treat it as symptoms resolve after pregnancy.
A little percentage of women will have haemorrhoid in pregnancy which will resolve without treatment after delivery. This is due to the increase in the intra-abdominal pressure caused by the growing baby in the womb. Dietary modification with high fibre diet, increased fluid intake to soften stool, and sitz bath can be done to relief discomfort and rarely surgery might be done.
This is normal in pregnancy as the growing uterus presses on the bladder and reduces its capacity to store urine. However, increased urinary frequency associated with lower abdominal pain, discomfort or painful urination is a sign of a urinary tract infection. Care should be sought on time as this can cause miscarriage, premature breaking of baby’s water and premature labour.
This is a very common complaint among pregnant women especially as the pregnancy advances. This might be as a result of an exaggeration of the normal lordosis (forward curvature of the spine) lumbar spine or hormonal relaxation of the ligament of the joints. There are limited interventions for this but message therapy, water exercise and back care classes where available might help. Paracetamol might also be prescribed by your healthcare provider. However, it is also important to note that labour might start as lower back pain or lower abdominal pain radiating to the lower back. When it is not time for delivery, lower back pain with associated spotting of blood per vaginam and lower abdominal pain might be a sign of a miscarriage or premature labour.
Such as striae (stretch mark) might appear in certain areas in late pregnancy like the abdomen, breasts and buttocks. This is due to the separation of collagen or destruction of elastic fibre. It persists after delivery but becomes less evident. Another skin change is the darkening of the forehead, nose and cheek area which is worsened by exposure to sunlight, this is called chloasma. There is also a straight dark line from the navel to the pubic region called the linear nigra. Presence of linear nigra and chloasma are genetically determined so not all pregnant women will have them. There may also be an increase in pimples and greasy skin due to increase activity of the oil glands in the skin.
Weight gain in pregnancy is due to the product of conception (the baby, placenta, amniotic fluid), increased size or volume of maternal tissues (breasts, uterus, blood and plasma) and an increase in fat stores. Weight gain in pregnancy ranges from about 12.5kg to 18kg. There is also the possibility of gaining additional 1 to 2kg after delivery for those with a normal body mass index before pregnancy and even a higher chance of gaining more weight for those whose body mass index is above the normal range before pregnancy. this weight gained can be lost after delivery through enrollment in a proper weight loss exercise regimen and exclusive breastfeeding.
This is also common in pregnancy due to retention of sodium and water as well as venous compression of the gravid uterus. It is advised to elevate the leg on a pillow while sleeping or on a chair while sitting, it helps to reduce the swelling. However, when this swelling suddenly occurs with hypertension and a urine test in the hospital is positive for protein, it is a sign of pre-eclampsia which is an obstetric emergency.
When the uterus grows large it might fall back and press on a large vein that returns blood to the heart, this can subsequently reduce the output from the heart to the brain resulting in light-headedness or even fainting. It is advised to lie on the side preferable the left side to prevent this as the pregnancy advances.
Also known as sympathetic pregnancy is a proposed condition in which an expectant father experiences some of the symptoms and behaviour of his pregnant partner.  This may include; weight gain, nausea, vomiting, and might include labour pain and depression post-delivery.
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