Tips for managing pregnancy symptoms by trimester

Whether this is your first baby or your newest addition, physical changes during pregnancy can feel tiring, worrisome or even scary at times. When it comes to pregnancy symptoms, the line between harmless discomforts and abnormal warning signs can often be difficult to determine.

Of course, every individual — and every pregnancy — is unique. However, being aware of the most common pregnancy symptoms by trimester can help expectant parents know when to self-soothe or when to call their obstetrician or midwife.

First Trimester Pregnancy Symptoms

The first trimester starts at conception and ends at 13 weeks and six days into pregnancy.

Symptom: Nausea and vomiting

Studies find that up to 85% of pregnant women experience nausea and vomiting. Commonly referred to as morning sickness, this unpleasant symptom can strike at any time of day. Most medical professionals associate nausea and vomiting with rising levels of human chorionic gonadotropin hormone (HCG). HCG is produced when a fertilized egg attaches to the uterus. HCG continues to rise through the first trimester, helping to maintain the pregnancy until the placenta can fully take over. The good news: Though these symptoms can be uncomfortable and distressing, studies indicate that nausea and vomiting may be signs that a fetus is developing normally. At the same time, if you are one of the few who doesn’t experience this symptom — don’t be alarmed. Just consider yourself lucky.

  • What to do: Try eating small, frequent bland meals to help manage nausea and vomiting. Other remedies that may work include eating ginger, drinking chamomile tea or wearing an anti-nausea wristband.
  • When to call: If you don’t see improvement, you can ask your doctor or midwife about safe anti-nausea medications. If your symptoms are bad enough that you can’t eat or drink for 24 hours, go to the nearest emergency department immediately.

Symptom: Fatigue

Don’t be too hard on yourself if you’re unable to keep up with activities the way you did before pregnancy. Hormonal changes — specifically, a rise in progesterone — are likely the cause of fatigue in the first trimester.

  • What to do: Take naps if possible and make adequate sleep a top priority. Try to get eight hours of sleep each night. While it may become more challenging later in your pregnancy, most women have little trouble finding comfortable sleep positions in the first trimester. It may help to wind down with relaxing activities before bed. For example, drinking chamomile tea or reading may help calm you for a good night of rest. Energy levels usually perk up by the second semester.
  • When to call: Contact your doctor or midwife if, no matter how much you sleep, you feel like you never have enough energy to get through the day. Your provider may want to check your thyroid levels to determine if there is an underlying cause of your fatigue.

Symptom: Bleeding and spotting

Light bleeding or spotting is normal during the first trimester of pregnancy. It usually doesn’t signal a major problem, such as miscarriage. Bleeding can occur when the fertilized egg implants itself into the uterine lining, around the time of a woman’s missed period. Rising hormone levels make the surface of the cervix more prone to bleeding even with light touch.

  • What to do: Wear a pad and keep track of how much you’re bleeding, noting the blood color and whether it’s smooth or has clots. Also note if you are having other symptoms of cramping or a loss of normal pregnancy symptoms (nausea, vomiting, breast tenderness).
  • When to call: If you have bleeding that soaks a pad, intense cramping or severe abdominal pain, call 911 or go to the emergency room.

Other common first trimester pregnancy symptoms:

  • Tender, swollen breasts
  • Increased urination
  • Food cravings and aversions
  • Mood swings

First trimester tip: Start prenatal care.
Your first fetal ultrasound may be scheduled as early as week 7 or 8. Learn more about the benefits of prenatal care and how to prepare for your first appointment.

Second Trimester Pregnancy Symptoms

The second trimester starts at 14 weeks and ends at 27 weeks and six days into pregnancy.

Symptom: Constipation

During pregnancy, there is no shortage of hormonal changes taking place in your body. Progesterone is a hormone that plays essential roles in pregnancy, as well as conception, menstruation and sex drive. As progesterone levels rise during pregnancy, it’s common for your bowels to move more slowly, which can lead to constipation.

  • What to do: Hydration and fiber are essential to managing constipation:
  • Maximize your hydration by drinking at least 2 liters of water each day. Consider adding herbs or fruit or drinking sparkling water to make it more appealing. Some foods, such as grapes, cucumbers and watermelon, carry high water content, making them good options to help increase hydration as well. This is especially important during the hot summer months. Beside easing constipation, good hydration can help prevent uterine irritability (mild contractions and cramping) and increase energy.
  • Increasing fiber in your diet can also help prevent or manage constipation. Good sources of fiber include bananas, oranges, apples, mangos, kale, spinach, beans, legumes and whole grain bread.
  • Iron in prenatal vitamins or iron supplements can often cause constipation or increase your risk of constipation. Consider increasing hydration and fiber and starting an over-the-counter stool softener to help reduce or avoid constipation. Prunes, prune juice or gentle laxatives are also safe ways to increase regular bowel movements.
  • When to call: If you’re experiencing constipation, discuss it with your doctor or midwife at your next visit.

Symptom: Round ligament pain

As your baby grows, your uterus expands and extends out of your pelvis. Women have two round ligaments — one each on either side of your uterus — that act as suspenders to elevate and support the uterus in the body.

Pregnant belly in belly band or pregnancy support belt
A belly band is a common option to help relieve round ligament pain.

The increasing size and weight of the uterus as the baby grows causes these ligaments to stretch. This stretching can cause sharp, shooting, or jabbing pain that may spread from the sides of your belly down to the labia/vagina. Round ligament pain commonly occurs while walking or exercising, or at night after a day spent standing/walking.

  • What to do: Using a belly band or pregnancy support belt can reduce stress on these ligaments by supporting the back and the uterus. Using a pregnancy pillow or placing a pillow under your belly when sleeping on your side can also provide support while you rest. Yoga, stretching, or working with a chiropractor who specializes in Webster technique can help manage round ligament pain. While these options may work for some, be sure to get clearance from your doctor or midwife before trying any new activity.
  • When to call: If you’re experiencing round ligament pain, discuss it with your doctor or midwife at your next visit.

Other common second trimester symptoms:

  • Enlarged breasts
  • Urinary tract infections
  • Nighttime leg cramps
  • Sensitive or bleeding gums
  • A dark line down your abdomen
  • Feeling lightheaded

Second trimester tip:
Schedule prenatal classes.
From labor prep to breastfeeding, infant care and more, the Family Birth Center offers several in-person and virtual classes. Sign up today!

Third Trimester Pregnancy Symptoms

The third trimester starts at 28 weeks and ends in labor.

Symptom: Heartburn

According to an old wives’ tale, if a pregnant woman has heartburn, it means she’s carrying a baby with a full head of hair. Truthfully, hormones are the culprit once again. Heartburn occurs because increased progesterone relaxes your stomach valve, allowing acid to back up into your esophagus. This, coupled with bowels moving more slowly, means that the acid stays in your stomach for longer and irritates your stomach lining. Lastly, the growing uterus starts to place pressure on the stomach, pushing acid from the stomach up into the esophagus.

  • What to do: Don’t lie down immediately after eating. Allow at least 60 minutes for your food to digest. Avoid acidic foods and eat smaller meals more often throughout the day, especially before bed. For additional relief, calcium carbonate tablets (Tums) are helpful. You also might consider asking your doctor or midwife about trying papaya enzymes or other acid reducing over-the-counter medications.
  • When to call: Contact your doctor or midwife immediately if you have any of the following symptoms in addition to persistent heartburn:
  • Nausea and vomiting
  • A headache that doesn’t go away with Tylenol or caffeine
  • Spots before your eyes
  • Right upper belly pain that feels like heartburn in conjunction with the symptoms listed above could be a sign of preeclampsia.

Symptom: Braxton Hicks contractions

Braxton Hicks are subtle contractions you may experience near the end of your pregnancy. This is a normal way for your uterus to practice and prepare for labor.

  • What to do: Remember to drink 2 liters of water each day. Your uterus is more likely to contract when you are dehydrated.
  • When to call: Braxton Hicks are not worrisome unless you have more than four in an hour and they don’t go away with rest and hydration. If this occurs before you reach 37 weeks, notify your doctor or midwife right away.

Other common third trimester pregnancy symptoms:

  • Backaches
  • Shortness of breath
  • Frequent urination
  • Spider veins, varicose veins and hemorrhoids
Shivika Trivedi

Shivika Trivedi, MD, MSc

Shivika Trivedi, MD, MSc, provides comprehensive general obstetrics and gynecology care. Dr. Trivedi also specializes in contraception and family planning.

Learn more about Dr. Trivedi
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Family Birth Center

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