Digestive System discomforts during Pregnancy
Nausea and Vomiting (Morning Sickness)
This is a very common discomfort. Around 70% of the pregnant women suffer from this complication, which lasts from 6-8 weeks until 13-16 weeks. This complication is accompanied by changes in smell and taste. Morning sickness is more common in primigravidas, young mothers, obesse mothers, smokers and women with high hcg levels (multiple pregnancies and hydatiform mole.
- Smaller more frequent meals
- Avoid greasy & spicy foods, eat protein snack at HS
- 250 mg of ginger 4X per day, 25mg B6 3X per day
- Contact provider if symptoms not relieved for pharmacological interventions
Heart burn is caused due to reduced smooth muscle motility alongwith related relaxation of the lower oesophagal sphincter and cardiac sphincter. The expanding uterus displaces the stomach upward decreasing stomach size and increasing pressures inside the organ. Heart Burn is experienced by 85% of pregnant women.
- Avoid, overeating, spicy foods, gas producing foods, fried foods
- Avoid lying recumbent soon after eating
- Eat small frequent meals
- Sleep on stacked pillows or raise head of bed with blocks
- Antacids containing magnesium hydroxide or magnesium trisalicylate
Constipation is mainly caused in the 1st trimester due to decreased bowel transit time an in the 3rd trimester due to displacement and compression of intestine by growing uterus. As Iron is an essential nutrient during pregnancy, but excessive iron supplementation also causes constipation.
- Consuming at least 2 quarts of fluid daily
- Include bulk fiber in diet (fresh fruits, vegetables & grains)
- Regular exercise
- Mild laxatives (MoM, and stool softeners)
- Cathartic laxatives and enemas are needed rarely use only provider consultation
- Firm abdominal massage in a clockwise direction to stimulate peristalsis
- Acupressure for 10 seconds midway between the pubic and umbilicus over 10 minutes may stimulate bowel activity
Hemorrhoids are caused due to relaxation of smooth muscle which contributes to vessel wall weakening. It increases in venous pressure. Usually hemorrhoids are mildly irritating that can be compounded by untreated constipation. It has been seen that it often regresses after delivery. They can only worsen after delivery especially after prolonged second stage and/or excessive pushing during delivery.
- Alert provider if they become hard and tender (possible thrombosis) or cause bleeding
- Avoid constipation & prolonged sitting
- Kegel exercise to improve rectal tone
- Proctofoam, Anusol, and preparation H are safe and effective
- Thrombosed external hemorrhoids may require incision and evacuation under local anesthesia
Flatulence is due to relaxation of smooth muscles leading to decreased motility resulting in gas pockets. It causes bloating and gas pain.
Avoid foods like:
- Collard greens
- Brussels sprouts
Eat foods like:
- Drinking buttermilk
Respiratory System discomforts during Pregnancy
Shortness of Breath
Shortness of breath is actually pregnancy induced hyperventilation. It causes reduced residual volume and functional residual capacity due to the mechanical limitation of a growing uterus. I can also cause dyspnea.
- Measures to alleviate dyspnea:
- Sit erect
- While lying use one or more pillows to prop up head and shoulders
- Breathe slowly and deeply
- Pace herself to accomi8date the added demand that pregnancy places on pulmonary function
Nasal congestion causes increased prevascular oedema and enlargement of nasal turbinates. I exacerbate preexisting allergy or sinus problem which sometimes start nosebleeding.
- Petroleum jelly to nasal mucosa
- Room humidifier
- Saline nose drops
- Topical nasal decongestants limited to 2 to 3 days to prevent rebound rhinitis medicamentosus
- Nasal steroids use with patients with chronic symptoms
Urinary System Discomforts in Pregnancy
Frequency of urination
Frequency of urination increases in the 1st trimester due to increased pressure on the bladder from the uterus until it rises out of the pelvis in 2nd trimester. In 3rd trimester the frequency increases more due to foetal engagement of presenting part. This in turn increases blood circulation volume and glomerular filtration rate.
- Burning or pain needs to be ruled out for UTI and vaginal infections which can lead to preterm labor or acute and chronic pyelonephritis
- Decrease fluids close to bed time BUT do not decrease fluid intake overall
Urinary incontinence is usually caused by physical stress factors like coughing, sneezing and laughing. Sometimes severe cases are confused with premature rupture of membranes. Multigravidas experience more due to poor muscle tone in the perineal muscles.
- Encourage Kegel exercises
- May not resolve until after deliver
Cardiovascular Discomforts in Pregnancy
Dizziness and Syncope
Growing uterus causes compression of lower extremities and pelvic veins causing venous pooling which in turn causes dizziness and syncope. It is potentiated in warmer weather when body heat is dissipated by peripheral vasodilatation. These symptoms occur later in pregnancy while lying recumbent secondary to uterine pressure on the vena cava causing hypotension. Hypoglycemia secondary to nausea and vomiting; later in pregnancy, fetal demand may lower maternal glucose levels which again causes dizziness and syncope.
- Calf exercises and long support stockings to combat venous pooling
- Use of left lateral tilt position for correcting hypotension
Slowed venous return caused by uterine pressure on vena cava in the third trimester causes oedema. Oedema increases circulating volume.
- Avoid sitting and standing for long periods of time
- Daily leg exercises
- Support stockings
- Loose fitting waistbands
- Leg elevation and rest
- Be alert for edema rapidly progressing or not lessening overnight particularly in the third trimester (may be a sign of preeclampsia)
Relaxation of vessel smooth muscle and increased venous pressure in pelvis and lower extremities causes varicose veins. It is normally found in legs and vulva. It leads to leg fatigue and painful night time leg cramps.
- Rest and elevation
- Elastic stockings
- Vulvar varicosities respond to added pressure by wearing several perineal pads
- If varicosities become warm, hard or painful see provider as phlebitis may be present
Heamatological Issues in Pregnancy
Because plasma volume increases more than the RBC mass, maternal hematocrit falls causing anaemia. Anemia reaches a nadir at 30 to 34 weeks. Hematocrit may rise at 30 weeks when volume expansion has plateaued.
- Need to absorb 3.5 mg/day during first two trimesters
- 6 to 7 mg per day in third trimester
- Increasing iron rich foods is usually not enough
- 30mg elemental iron /day
- 325 ferrous gluconate
- Taking iron prior to 20 weeks and increase nausea and vomiting
- Take with stool softener to decrease constipative effects
Breast Discomforts in Pregnancy
The major problem here is breast tenderness ranging mild to severe and transient in nature abating by end of first trimester. Breasts increase in size and becomes nodular. Nipples become darker and more erectile. Production of colostrum sometimes starts in late 3rd trimester.
- Wear good support bra one size larger than pregnancy size no underwires or seams with wide enough shoulder straps and back to prevent tension over shoulders and under arms
- Acetaminophen or cold compresses with severe pain
- *Human placental lactogen
Skin Discomforts in Pregnancy
Skin changes are a result of stimulation of melanocytes. The common changes are :-
- Areola of breast become darker
- Linea nigra develops from xiphoid to pubic symphysis
- Mask of pregnancy (reddish brown color over bridge of nose and under eyes)
- Striae (stretch marks) on abdomen, breasts and hips which occurs in 65% of all pregnancies and usually fade to a pink or silver after delivery
- No proven prevention for stretch marks
- Cocoa butter, vitamin E and lotions may help with itching that can accompany striae formation
Rashes of Pregnancy
Rashes during pregnancy are mainly papular dermatis, prurigo gestationis and pruritis gravidarium.
Papular dermatitis are 3-5 mm erythematous papules anywhere on the body.
Prurigo gestationis are small excoriated puritic papules on abdomen trunk or extensor surface of extremities. this may also lead to pruritic urticarial papules and plaques of pregnancy syndrome (PUPPPS). PUPPPS are discrete erythematous papules and urticarial plaques over the abdomen, thighs, buttocks, legs and arms.
Pruritis gravidarium is abdomical pruritis without distinct lessions.
- Oatmeal baths
- Loose-fitting clothing
- Calamine lotion
- Severe cases:
- Topical corticosteroids
Perspiration increases due to increase in eccrine sweat glands all over the skin surface. This is possibly due to increased thyroid activity. Increased dilation of the blood vessels in the skin enhances the body’s ability to eliminate waste and dissipate excess heat.
- Reassure that this is a normal occurrence
- Loose fitting clothing of absorbent material
- Control room temperature
Uncomfortable warth is due to vasodilatation that increases skin temperature and maternal fatty stores. In latter stages, placenta may contribute to increased body temperature which in turn increases this problem.
- Reassurance normalcy in absence of infection
- Wear light layered clothing
- Keep thermostat at a lower setting
Musculoskeltal Discomforts in Pregnancy
Altered centre of gravity due to increased abdominal weight and breast weight leads to streched abdominal muscles. Alongwith this compensatory lumbar lordosis causes predisposition to low back pain. In later half of preganancy, joints and ligaments in the body becomes more lax. Women with poor abdominal muscle tone are more susceptible tolower backache.
- Avoid excessive weight gain
- Improve posture
- Proper bending with back straight
- Proper lifting techniques
- Sleeping on a firm mattress
- Local heat application
- Report unilateral leg pain or weakness to provider (possible lumbar disk disease)
Sharp pain caused by spasm of the round ligaments are the most common leading to abdominal pain. Enlarged uterus makes these ligaments more susceptible to strain. Pain is associated with abrupt movements and felt mostly on the right side. Contractions, gastroenteritis, appendicitis and renal or biliary colic should be considered as well.
- Increase physical exercise and abdominal muscle tone
- Rise and sit gradually
- Avoid sudden movements
- Rest with local heat application
- Analgesia is necessary occasionally with acetaminophen
Miscellaneous Discomforts during Pregnancy
Leukorrhea is whitish variable flow with variable consistency which increases during pregnancy. It is non-problematic unless accompanied with itching, burning, foul odor or labial swelling. Change in quantity or quality should be differentiated form leaking or ruptured membranes.
- Bathe daily
- Wear cotton underwear
- Dushing is not indicated unless advised by provider
Headaches can be due to :-
- Sinus congestion
- Increased vascular blood flow
- Nasal edema
- Tension eyestrain
- Relaxation and warm compresses
- Acetaminophen may be necessary
- Be alert for HAs that are accompanied by dizziness, blurred vision, scotomata, and or unrelieved by acetaminophen (possible sign of preeclampsia
Fatigues can be due to :-
- Increased basal metabolism rate
- Increased demand on cardiovascular and renal systems
- Loss of sleep due to urinary frequency
- Emotional factors
- Lessens in second trimester then increases in late pregnancy due to:
- Increased wt
- Difficulty finding a comfortable position
- Fetal factors
- Urinary frequency
- Proper nutrition and exercise
- Treat possible anemia with diet and exercise
In early pregnancy it is due to psychological stressors and increased frequency of urination. In later pregnancy the causes are difficulty finding position of comfort, fetal movements and feeling short of breath.
- Plan quiet time before going to bed
- Limit fluid intake prior to sleeping
- Pillows to support back, abdomen and legs
- Warm bath or shower and massage
- Meditation and visualization
- Warm milk
- Raspberry leaf tea
- Skullcap tincture (30 drops of commercial tincture ½ hour before bedtime)
Dental problems are due to gum hypertrophy, gum bleeding and for ones with tooth decay because tooth decay progresses more rapidly.
- Soft toothbrush
- Mild toothpaste
- Daily flossing
- Dental work can be done during pregnancy with local anesthesia (General anesthesia should be avoided)
Leave a comment in case of any doubt.
You can consult with us. Book an Appointment with our expert dietitians.
Read more related Articles.