a-z of pregnancy health

 

 

Having a baby means some major adjustments for your body. Our handy guide will help you recognise minor ailments and some conditions that could be more serious. Compiled by Sue Ramsey.

 

When you’re carrying a baby you have around 40 per cent more blood flowing through your body. However, the number of red blood cells produced isn’t proportionate, which means your blood is, in effect, ‘diluted’ at a time when demand for iron and other nutrients is increased. Your baby and the placenta need iron, so there’s an even greater demand on your iron stores, which increases the likelihood of anaemia.

Your blood will usually be tested at the beginning, middle and end of your pregnancy to check your haemoglobin levels, which can indicate anaemia. Eating a balanced diet can help prevent the condition – iron-rich foods include lean red meat, iron-fortified cereals, dark leafy green vegetables, pulses, apricots, raisins, wholemeal bread and eggs.

 

Backache is quite common in pregnancy and extra care should be taken with movements that involve lifting and twisting, for example when taking a child out of a car seat. Sciatica can be much more severe, with symptoms ranging from pins and needles, and numbness that comes and goes, to excruciating pain in the lower back, which may shoot down one leg. Your GP may refer you to a physiotherapist who can advise on posture and may fit you with a support belt.

PP’s consultant midwife, Shea Caplice, recommends non-weight-bearing exercise, such as yoga or swimming (but not breaststroke), as well as protecting the back by keeping it straight as much as possible, bending from the knees and avoiding high heels.

 

Your breasts may be noticeably bigger as early as six weeks after conception, although those with an already ample bosom are less likely to notice. In the first trimester your bust will typically expand by one cup size, followed by another cup size in the second trimester. You’ll need several bras to take you through the nine months – it’s important to get properly measured in your first trimester, and again near your due date for a nursing bra. It’s best to avoid underwire bras, as they can put pressure on the breast, which may lead to blocked milk ducts and mastitis.

The areola (the darker area surrounding the nipple) usually gets slightly darker and little bumps called Montgomery’s tubercles start secreting tiny amounts of oil to keep your nipples soft in preparation for your baby sucking on them. Your nipples may stick out more too, but none of these changes are permanent. Nipples produce a natural moisturiser that keeps them hydrated. Don’t use soap, or anything drying on your nipples, and after bathing, gently pat your breasts dry.

 

Constipation

This can be a real problem during pregnancy because hormonal changes cause food to move more slowly through your digestive system. Iron tablets can also cause constipation (and diarrhoea). A high-fibre diet, drinking plenty of water and getting regular exercise can all help to promote healthy bowel function. Gentle bulk-forming laxatives can be used, but stronger laxatives containing senna, cascara or bisacodyl should be avoided as they can disturb normal bowel function, deprive your baby of nutrients and may cross the placenta.

 

If you catch a cold while you’re pregnant the best treatment can be to rest. But if you’re coughing up green phlegm, see a GP in case of a chest infection. Make sure you keep up your fluids as a runny nose can be very dehydrating. Hot lemon and honey will help to soothe your symptoms. Studies have shown that a high temperature in early pregnancy may result in mis-carriage, so it is safer to treat a fever with paracetamol than do nothing. Cough and flu remedies contain some ingredients that may not be safe in pregnancy, such as caffeine, alcohol, ephedrine and dextromethorphan.

 

Cramps

Usually in the thigh, calf or foot, cramps are common in pregnancy, especially in the last trimester. Low calcium or magnesium levels are among the possible causes, as well as fatigue and fluid retention in the legs. Massaging the area can help reduce the pain, but if cramps become a problem it’s wise to talk to your doctor or midwife.

 

Around 20 per cent of women are affected by cystitis in pregnancy. It’s thought pregnancy hormones relax muscles that control the flow of urine, predisposing you to infection. Always see your GP or midwife because, left untreated, it can spread to the kidneys and cause premature labour. It’s important to drink plenty of water. Cranberry juice can also be helpful as it reduces the incidence of the bacteria that cause cystitis and can relieve the discomfort.

 

Pregnant women are constantly visited by strange and vivid dreams, some more pleasurable than others. The body’s extra blood supply goes to work downstairs with an increased flow of blood to the clitoris and labia. Just as men will follow a night erection with an erotic dream, women also are known to respond to engorgement of the genitals with colourful and sexy romps around the subconscious that don’t necessarily feature the father of the baby!

 

Three out of four women will develop oedema (fluid retention) due to fluid retention in pregnancy. This usually occurs in the ankles, feet, fingers and hands, and may be more pronounced in warm weather or after you’ve been standing or sitting for a long time.

Always mention swelling in these areas, as well as in the face, to your doctor as it can be a sign of pre-eclampsia (see High blood pressure).

 

Folic acid, or folate, is one of the B-group vitamins and is important before conception and in pregnancy as it is known to help prevent neural tube defects such as spina bifida. As folate is not stored in the body, PP’s consultant nutritionist, Kathy Usic, advises it is important to eat foods that are rich in the nutrient on a daily basis.

Health authorities recommend women consume twice the normal daily requirement (400 micrograms) three months before conception and three months into pregnancy. Good sources include green leafy vegetables, broccoli, cauliflower and oranges, as well as breads and breakfast cereals with added folate.

 

A temporary form of diabetes only experienced in pregnancy, it occurs in around 9 per cent of women around the 24th to 28th week.

Certain ethnic groups are at greater risk, among them Chinese, Vietnamese, Pacific Islanders and indigenous Australians. Being overweight, aged over 30, and a family history of type 2 diabetes are also risk factors. Because there are often no symptoms, most doctors will screen for gestational diabetes around 28 weeks. Treatment focuses on bringing glucose levels within the normal range. Many women can achieve this through diet and exercise.

 

Many women suffer headaches during pregnancy – some even have migraines for the first time. Hormonal changes, stress and tension may all play a part. To prevent headaches, avoid long periods at the computer, get some fresh air and make sure you are drinking plenty of water. If you do develop a headache, try taking a nap in a darkened room or ask your partner to massage your shoulders, head and neck. If you need to take a painkiller, paracetamol is considered the safest option. See your doctor if headaches persist.

 

Heartburn can cause a burning sensation just behind your breastbone and you may get some stomach acid in your mouth. This is caused by the valve at the entrance to your stomach relaxing due to pregnancy hormones – or later in pregnancy your baby may press on your stomach, pushing the contents back up into the oesophagus.

Eat small, frequent meals and steer clear of spicy, fatty foods; also, avoid eating just before you go to bed as heartburn can occur when you lie down. Try sleeping propped up by a couple of pillows. Your doctor may prescribe antacids.

 

High blood pressure can occur at any time during pregnancy, but is more likely in the last trimester. According to Dr Miriam Stoppard, author of Conception, Pregnancy & Birth, it is more common in women having their first baby, especially if they are over 35.

If high blood pressure, or hypertension as it’s also known, is diagnosed, your doctor will keep a close eye on you, as a rise can be a warning sign of pre-eclampsia, which can be dangerous for you and your baby.

 

Many women have occasional urine leaks when they’re pregnant, typically when coughing, laughing or sneezing. Exercising your pelvic floor muscles during and after pregnancy is really important for preventing this stress incontinence. Ask your midwife or GP for more information, particularly regarding pelvic floor exercises.

 

Insomnia can crop up at any time during pregnancy, but especially during your third trimester when you’ll probably need to pee during the night due to pressure on your bladder.

You’ll also have a lot on your mind as the baby’s arrival comes closer, so relaxing activities like a warm bath or a massage before bed time will help you to wind down. As your belly gets larger it will also be difficult to get comfortable, so try using several pillows, or even a specially designed pregnancy pillow, under your bump to support you as you sleep.

 

Itching is extremely common, due to the skin being stretched, as well as hormonal changes. Your skin may also be more sensitive than normal, so avoid highly perfumed skin-care products and use a gentle washing powder for your clothes. Wearing loose, cotton clothing can help, and a cream containing calendula or chamomile, or even plain old calamine lotion may reduce irritation. As always, drink plenty of water. If the itching is annoying and doesn’t settle down, see your GP as it could be caused by a number of things, including obstetric cholestasis, which requires specific treatment.

 

Up to 80 per cent of pregnant women suffer from morning sickness, with symptoms ranging from slight queasiness through to severe vomiting and dehydration. Keeping blood sugar levels steady can play a big part in helping to control morning sickness. Eating little and often helps stabilise blood sugar and prevents bloating, while some women swear by ginger tea. Chamomile is another gentle calming brew. As always, drinking plenty of water is essential. See your GP or midwife if your morning sickness is severe or persistent as this can result in weight loss and dehydration.

 

Intense itching on the legs and body, but especially on the palms of the hands and soles of the feet, can be a sign of a serious liver condition called obstetric cholestasis, or cholestasis of pregnancy. Affecting around 1 per cent of pregnant women, it usually develops in the last trimester and if undiagnosed, can lead to increased risk of premature labour, maternal haemorrhage or stillbirth. It can be diagnosed with a blood test and treatment includes close monitoring of your pregnancy and the possibility of an induced birth at 37 weeks.

 

The hormone relaxin softens the ligaments around your pelvis to allow it to open slightly in preparation for birth. In some women they can stretch too much, leading to instability in the pelvic joints, known as symphysis pubis dysfunction (SPD). It can occur as early as the end of the first trimester and pain in the pubic area, groin, hips or inner thigh may be the first indication.

The pelvic area may also be tender to the touch and the woman finds she’s unable to stand on one leg. An ultrasound may be used to confirm the diagnosis, and you may be referred to a physiotherapist.

 

Changes in skin pigmentation are common and some women develop discolouration on the face, known as chloasma or the ‘mask of pregnancy’. Skin darkening can also occur around the nipples, the perineum and the navel and, in some cases, the armpits and inner thighs. A darker line between the navel and pubic bone may develop, known as the ‘linea negra’ or black line.

Pigmentation changes can be aggravated by UV light, so it’s best to avoid the sun or wear a hat. Links have also been made with folic acid deficiency, so keep up your intake of leafy green vegetables, whole grains and chicken, which are good sources. The good news is that the pigmentation usually fades a few months after you’ve given birth.

 

A number of rashes occur only during pregnancy. The most common is PUPPP (pruritic urticarial papules and plaques of pregnancy). Other conditions include papular dermatitis of pregnancy, prurigo gestationis, herpes gestationis and impetigo herpetiformis. Some of these can indicate a serious underlying condition that can endanger you or your baby, so get it checked out by a doctor.

 

Skin changes are normal in pregnancy – and if you’ve suffered from acne in the past you could get a flare-up. To keep spots at bay, thoroughly cleanse skin, drink plenty of water and exercise. Calamine lotion can help to dry up spots.

 

Very common in pregnancy, stretch marks usually occur on the breasts, belly, hips and thighs, often during the second trimester. Many women like to use creams, oils, or lotions to moisturise the skin and to try to prevent them.

Although there is no proven way to prevent them, stretch marks do become less noticeable over time and fade to a pale silvery white.

 

A yeast infection characterised by itchiness and a white, curdy discharge from the vagina, thrush is 10 times more common during pregnancy. Your GP may suggest anti-fungal creams and pessaries, such as Canesten, or a single oral dose of Diflucan. Natural alternatives include eating natural live yogurt containing acidophilus to increase good bacteria, and chamomile cream (from homeopathic pharmacies), which can be applied to the vulva.

 

Pregnant women may be prone to developing swollen veins just under the skin, commonly in the legs or anus (haemorrhoids) or, more rarely, in the vulva. As your baby grows, the uterus can put pressure on the veins in your pelvis, which causes back flow. Blood then tends to pool and makes the veins distend.

The good news is that varicose veins will usually resolve once you have given birth, although sometimes not completely. To minimise the risk, it’s good to avoid standing for long periods and to put your feet up periodically through the day. If you have a desk job, make sure to get up and walk around at regular intervals, or move your legs and flex feet to help circulation. Support stockings may also be helpful.

 

A normal pregnancy can result in a weight gain of anything between 9kg and 13.5kg, mainly around the breast and belly. Women gain weight at different rates. On average you won’t gain much, if any, weight in the first 12 weeks but by week 20 you’ll probably have put on 25 per cent of your total weight gain, with another 25 per cent by week 30 and the remainder in the last 10 weeks.

At each antenatal appointment your care giver will feel your abdomen and measure the distance from your pubic bone to the top of the uterus (called the fundus). If your care giver feels your baby isn’t growing as well as expected, they may send you for a scan or a consultant opinion.

 

Known as a ‘wonder’ nutrient, zinc has

a powerful effect on fertility and is also important during pregnancy as it’s involved in cell division and growth. A low intake has been linked to low birth weight. Iron supplements can inhibit the absorption of zinc, so be extra careful if you are taking one.

According to PP’s Kathy Usic, zinc levels can easily be improved by diet. Good sources include red meat; pulses, such as lentils, beans and chickpeas; wholegrain foods and wheatgerm; green vegetables; sardines and oysters; and dried fruits such as apricots and figs.

 

The main dental problem you may encounter during pregnancy is soft, spongy gums that become prone to bleeding. This is a result of the combined effect of increased blood supply and pregnancy hormones. Try brushing your teeth with a soft brush and opting for softer, even pureed, fruits and vegetables if you are particularly vulnerable.

Gum infections can also worsen during pregnancy and can be hazardous for pregnant women and their babies as the bacteria produced travel all around the body. There is also a link between gum disease and premature births. It’s a good idea to gently floss at least twice a day during pregnancy and see your dentist (in conjunction with your GP or obstetrician) if you are concerned about gum disease.