“Although the academic books refer to physiological changes of pregnancy, with symptoms, as minor, a female colleague of mine correctly called it ‘Unpleasant complaints of Pregnancy’”, explains Dr Lodé Fourie, Gynaecologist & Obstetrician at Mediclinic Paarl. As mentioned, most of these symptoms are normal and expected changes in the pregnant lady, and pose no threat to the mother, pregnancy, or foetus.
“Medication should mostly be avoided to treat these symptoms, especially in the first trimester. Reassurance and explanation are the backbone of management. If properly understood, the pregnant couple knows better how to cope,” continues Dr Fourie.
The different systems and main symptoms are explained below along with possible treatment options.
Gastro-Intestinal System
Common gastro-intestinal complaints include nausea and vomiting, heartburn, constipation, diarrhoea, Gingivitis (swelling and bleeding of gums), and excessive salivation (sputum production).
Dr Fourie believes that general measures to alleviate these symptoms include eating smaller meals more frequently, avoid eating less than 2 hours before bedtime, elevate the head and avoid tight fitting clothes.
Avoid beverages containing gas, caffeine, and alcohol, and spicy food.
Cardiovascular system
Palpitations, dizziness, varicose veins, haemorrhoids, nose bleeding, and swelling of the legs are mostly associated with normal findings of a healthy pregnancy. Dr Fourie emphases that these symptoms should always be mentioned to your healthcare provider, for some of these symptoms and signs might also be associated with dangerous conditions, for example pre-eclampsia or heart failure.
General pregnancy vitamin supplementation, iron, calcium, and magnesium supplementation may relieve some of the cardiac symptoms. Dr Fourie also suggests elastic stockings for swelling and varicose veins, and avoiding constipation to decrease the risk of haemorrhoids.
Muscle, joints, and ligaments
Muscle-cramps, backache, spontaneous widening of the symphysis, especially in the third trimester, can be moderate to severe, and is mostly due to calcium deficiency, an enlarging uterus and stress on the back muscles, and a natural softening of the ligaments caused by relaxin. Relaxin is a substance that is naturally released at a stage of the pregnancy. It softens the ligaments in the body, and can cause pain and a sensation of instability of the pelvis.
Management of these conditions mainly includes calcium supplementation for cramps, comfortable shoes, better sleeping position, local heat application, and supporting belts for backache and joint pains.
Central nervous system
Headache, sleeplessness, tiredness, and drowsiness are common complaints, and are mainly due to hormonal changes (high progesterone levels in the first trimester), and discomfort of the enlarging uterus towards the end of the pregnancy.
General management may include use of mild analgesia like paracetamol, enough rest in a comfortable environment, and pregnancy supplements might improve the symptoms.
Bladder and genital tract
Frequency of urination is caused by an increased kidney function in early pregnancy, and pressure from the baby’s head deep in the pelvis in late pregnancy.
Leaking of urine is common in 50% of pregnancies and can recover completely.
Some women experience a white vaginal discharge, which is caused by increased levels of oestrogen.
These symptoms are often mistaken for infections, and wrongfully treated with medication.
Respiratory tract
Increased respiratory rate is common in pregnancy and is caused by increased levels of progesterone. Although usually harmless, it must be mentioned to your healthcare provider.
Other complaints
Skin changes like hyperpigmentation (darkening) of the skin in localised areas like the areola, linea nigra, and face are common. Although it gets lighter after regnancy, it might not disappear completely.
Reddening of the palms of the hands and spider haemangiomas are common signs during pregnancy.
Hair growth increase during pregnancy. It is more of a concern after pregnancy when hair loss occurs. This is not true hair loss, but mainly a correction which refers to the return of hair volume to the normal pre-pregnancy state.
Pica is the intake of substances with no nutritional properties. Soil is the most common, and it is mostly due to deficiency of mainly iron.
Discomfort of the hands are mainly caused by stretching or pressure on nerves, and correction of posture or supporting splints of the hands in a neutral position may ease the symptoms.
Conclusion
Although many of the above-mentioned symptoms and signs are referred to as minor complaints, the person who is affected by it, may experience it as something that has a major impact on her quality of life.
Details of your complaints It is important to tell the healthcare provider all your concerns and how you are feeling, so they can explain and reassure you, but more important than this, can identify serious conditions that necessitate more complicated treatment
References
HS Cronje, CJF Grobler and AA Visser, Obstetrics in South Africa (1st edn, JL V Schaik 1996)310-318