Pregnancy is a special journey in a woman’s life. Pregnancy causes dramatic changes to a woman’s physical appearances, emotions and well being. Some women embraces these changes but some women find these changes uncomfortable. It is important to understand these changes to appreciate the normal changes in pregnancy and to identify abnormal changes which may need early attention and intervention.
(1) The Skin
In most pregnant women, the skin areas which were already pigmented (nipples, skin around genitals and back passage region) become even more so. Some fresh pigmentation may also appear. Chloasma, which is a brownish pigment may appear on the forehead and cheeks. This usually fades after pregnancy. On the abdomen, there may be a dark line appearing in the middle (linea nigra). These changes are thought to be due to deposition of melanin.
Striae gravidarum, which are pinkish stretch marks can appear on the abdomen, breasts and thighs in most women. After delivery, these stretch marks regress and become less pronounced and the pinkish colour become whitish in colour (striae albicantes). These stretch marks are due to stretching and may also be associated with increased secretion of hormone from adrenals due to pregnancy. The skin around these areas can become itchy. Using moisturizing cream, lotion or olive oil can improve the symptoms.
(2) The Eyes
Due to fluid retention which occurs during pregnancy, the shape of the lens change. Some women experienced changes in their sights. It is important to get your eyes check by an optometrist if you find changes in your eyes. Some women experience dry eyes and this can be eased with eye drops such as artificial tears.
(3) The Teeth
Due to the hormonal changes in pregnancy, gum bleeding becomes more easily during pregnancy. Inflammation of the gum or gingivitis is common in pregnancy and can be uncomfortable and cause swelling, bleeding, redness or tenderness in the gum tissue. Some women crave for sweet food during pregnancy and this can lead to increase risk of tooth cavities. Therefore, it is important to brush and floss your teeth regularly in pregnancy. Visit your dentist regularly before and during pregnancy is important to ensure good dental care and to prevent complications associated with dental diseases.
(4) The Breasts
Under the influence of female hormones (oestrogen and progesterone), the breasts increase in size due to increase number and size of the milk glands. The skin around the nipples also darkens during pregnancy. Montgomery’s tubercles, which are raised pink-red nodules around the nipples may become prominent and should not raised any concerns. In some women, some discharge from the nipple (colostrums) can be present even from the first trimester and continues to term. Wearing a good and comfortable supportive bra can help to prevent sagging and reduce the tenderness cause by the changes in the breasts.
(5) The Heart and Cardiovascular System
During pregnancy, as a result of the growth of the fetus and an increase in metabolism, the heart has to work harder to meet the demand. With the increase in demand for oxygen, increased blood volume and increased size of the blood vessels, the heart works harder to increase the output. This is achieved by increasing the heart rate and the volume of the blood pumped every cycle. The heart also increases in size. The volume of blood pumped out by the heart increases by 40-60% when the pregnancy reached the second trimester. The heart rate also goes up by 30 per cent.
Despite the increase in cardiac output, the blood pressure drops during the second trimester and gradually returns to normal in the third trimester. This is mainly due to the dilatation of the blood vessels in the body during pregnancy.
The demand for an increased blood supply to many parts of the body is met by increase in blood volume. The blood volume increases by 50% and sometimes this may cause the Haemoglobin level to drop slightly due to dilutional effect. Therefore, a pregnant woman is more prone to developing anaemia in pregnancy. It is important to discuss with your doctor whether you need iron supplementation to avoid developing anaemia in pregnancy.
As the baby grows and the womb enlarges, sometimes it could compress the major blood vessel (Inferior vena cava) which drains the blood from other part of the body into the right side of the heart. This may cause light headedness or fainting spells especially when the pregnant woman lies flat on their back. Therefore, it is important to lie on your sides or slightly tilted to avoid these symptoms.
Some women experience feelings of the heart beating faster (palpitations) during pregnancy. This symptom is quite common and is normal. Certain irregular heartbeats can occur during pregnancy and resolves completely after delivery. However, if these symptoms are accompanied by breathlessness, chest pain and coughing out blood, you should consult your doctor immediately as these symptoms are NOT normal for pregnancy.
The growing womb exerts pressure onto the pelvis and interferes with drainage of blood from the pelvis and the legs back to the heart. This causes swelling of the legs and enlarges the vein and causes varicose veins. These changes are more marked during the daytime due to the upright posture. They tend to reduce at night when the pregnant woman retires to bed. These changes will soon disappear after delivery.
(6) The Lungs
During pregnancy, progesterone hormone is high in the blood stream and it stimulates the breathing centre in the brain. Therefore, the expecting mother may find that she is breathing faster and deeper than normal. These symptoms become more apparent towards the final stage of pregnancy. The growing womb pushes the diaphragm towards the chest and that makes breathing more difficult. The accumulation of water during pregnancy causes the airway lining to be more swollen than usual and therefore some women experiences stuffiness of the nose.
(7) The Bladder and Kidneys
Due to the increase in total blood volume, the kidneys need to work harder throughout the pregnancy. The kidneys filter the waste products in the blood stream and pass out as urine. The enlarging womb can sometimes compresses onto the blood vessels supplying the kidneys and causing decreased urine output. When a pregnant woman lies down, the kidneys activities improve and that explains why a pregnant woman needs to urinate more frequently especially at night. As the womb enlarges, it compresses against the bladder causing it to decrease in size and hence the pregnant woman has urge to urinate more frequently.
It is important to note that if a pregnant woman experiences urgency, pain or burning sensation during urination, this could be associated with urinary tract infection. Talk to your doctor if you have these symptoms.
(8) The Guts
The increased level of progesterone hormone in the body will cause decreased activity of the gut and hence causing some changes in a pregnant woman’s body. Progesterone causes relaxation of a ring like muscle (sphincter) at the opening of the stomach and causes the stomach content to flow backwards. This leads to heartburn. This symptom can be relieved by taking smaller but frequent meals and avoiding bending over after a meal. It is important to avoid spicy and oily food if you are experiencing heartburn. Elevating your head to sleep at night can help to reduce this symptom. In severe cases, certain medications which reduce the acidity of the stomach content can help. You can speak to your doctor if you feel that you need some medications to help with this symptom.
Progesterone also causes reduction in stomach secretion and diminished gut activity resulting in slower emptying in stomach content. This can cause nausea in some woman. Reduce activity in the small intestine causes increase time for absorption of food. Reduce activity in the large intestine tends to cause more water to be absorbed and aggravates constipation. As the womb enlarges, it compresses onto the large intestine and worsen the constipation. Therefore, eating a high fibre diet such as bran, fruits and vegetables, drinking plenty of fluid and exercise will help to prevent constipation. In some women, a mild laxative which can be taken orally can help with this symptom. Speak to your doctor about it.
Haemorrhoids or piles are common during pregnancy. The increase in progesterone level causes dilatation of blood vessels. The growing womb exerts pressure onto the pelvis and interferes with drainage of blood from the pelvis. This increases the incidence of piles formation. Straining from being constipated will further aggravate piles formation. Piles can become painful, itchy and can bleed. Stool softer and anaesthetic gels can be used to relieve the symptoms. In some women, a small surgical procedure to inject or cut away the piles may be necessary. A medication, which can be taken orally and is safe for pregnancy can be used to treat piles. Speak to your doctor about it.
(9) The Womb and Female Reproductive Tract
The womb continues to grow throughout the pregnancy and is first felt in the abdomen by 12 weeks of pregnancy. The increase in abdominal size is apparent by 15 weeks. The womb reaches the umbilicus by 22 weeks and lower edge of the rib cage by 36 weeks of pregnancy.Vaginal discharge increases in pregnancy and is usually clear or whitish or slightly yellowish in colour. However, if it is associated with itching, unusual or fish-like smell, greenish in colour, you should speak to your doctor immediately.
(10) The Muscles and Joints
Due to the progesterone and relaxin hormone, the joints and the ligament especially comes in the pelvis become loose. This is for the preparation of delivery. The enlarging womb causes significant strain to the spine and therefore backache is a common complaint in pregnancy. It is important that you look after your back during pregnancy. Avoid bending over to pick up things. Instead, bend your knees and keep you back straight to get down.
(11) The Nervous System
As the pregnancy progresses and water retention becomes more prominent. This can cause compression of the nerves in a pregnant woman’s hands. Therefore, the woman feels numbness and tingling sensations in the palms and the fingers. Occasionally, it may be painful and causes difficulty in grasping. This usually goes away after the delivery. Simple pain relief and physiotherapy can be helpful in some women.
(1) Miller A, Callander R. Obstetric Illustrated. Fourth Edition. 1989. Churchill Livingstone. Edinburgh, UK.
(2) Chia P, Raman S. Is My Pregnancy Normal? 2006. Discern Publishing House Sdn Bhd. Kuala Lumpur, Malaysia.