Common health problem during pregnancy

Pregnancy is not an illness; it is a normal human condition. However, it also presents the body with a number of challenges, many of which can produce symptoms and cause problems. Most of these conditions are not serious for mother or baby, although they can be very unpleasant.

Morning sickness

Morning sickness is very common in early pregnancy, with about half of all pregnant women experiencing being sick (vomiting) and more than 8 out of 10 women feeling sick (nauseous) at some point.

The symptoms of morning sickness include feeling and being sick, tiredness, and producing lots of saliva. Tastes and smells can seem stronger and usual favourite foods can be disliked intensely. Sometimes one particular food is craved and temporarily eases the sickness. Despite its name, morning sickness is by no means limited to any one time of day and indeed can occur throughout the day and night.

Morning sickness tends to be at its worst at 9-10 weeks of pregnancy. It typically begins at around 6-7 weeks of pregnancy, and then tails off by weeks 13-14.  The earlier it begins, the later it is likely to stop - severe cases may last much further into the pregnancy - but the worst time is still usually around 9-10 weeks.

The condition is worse in those expecting twins (or more), and if you have had morning sickness in your previous pregnancies then you are likely to experience the same thing again. Those who are prone to be travel sick (have motion sickness) tend to be among the worst affected.

Morning sickness will come to an end by itself. The trouble is, you don't quite know when that will be, and it can seem like an endless future of feeling sick with nothing much available to help. Doctors try to avoid giving sickness medication in early pregnancy unless symptoms are very bad, but there are a few other things that can help.

How do I deal with morning sickness of pregnancy?

You can try the following simple methods:

• Eat small frequent meals rather than fewer large ones, and aim for carbohydraterich foods like bread, rice and pasta.

• Try eating dry crackers and ginger biscuits, particularly on waking and when symptoms are at their  worst.

• Try cold drinks rather than warm ones, and cold food rather than hot (it tastes and smells less strong).

• Try to avoid having to do cooking and food shopping.

• Get plenty of rest.

• Try Sea-Bands® - these are acupressure wrist bands that you can buy from the chemist.

• Avoid travel as much as you can.

• Avoid tea and coffee, garlic, alcohol and spicy food.

• Try to keep your mind off it - listen to music, watch TV, carry on working - the more you think about how you are feeling, the worse you will feel.

Hyperemesis gravidarum

This is the term for severe cases of morning sickness where the being sick (vomiting) of pregnancy means repeated hospital admission for replacement of lost water (rehydration) and sickness medication possibly being needed.

Hyperemesis gravidarum is also discussed in the separate leaflet called Sickness and Vomiting in Pregnancy.

Indigestion

Indigestion is sometimes referred to as heartburn, dyspepsia or reflux. It occurs in around half of all pregnancies and is the sensation produced by acid from the stomach washing up the gullet (oesophagus). The tissues of the gullet are quite good at resisting stomach acid, but if the acid wash happens repeatedly, sore areas can develop, and are painful.

Once there is a sore area on the gullet then every time acid washes up it is likely to hurt.

Indigestion doesn't only occur after meals, and indeed it can be worse when you are hungry and the stomach starts to produce extra acid in expectation of food. It can also be worse at night, when you are lying down and gravity is no longer acting in your favour to keep the acid down in the stomach where it belongs.

What are the typical symptoms of indigestion?

These include:

• Heartburn - a burning feeling coming from the tummy towards the neck.

• Upper tummy (abdominal) pain or discomfort.

• Pain in the centre of the chest behind the breastbone.

• A bitter taste in the mouth (the taste of acid).

• Feeling and being sick (nausea and vomiting).

• Bloating.

• Quickly feeling full after eating.

Symptoms are caused in part by the growing womb (uterus) pushing on the stomach and slowing the rate at which it empties. An added cause is the relaxation of the muscle ring at the top of the stomach during pregnancy. This ring normally tightens to keep the stomach acid from flowing (refluxing) back. Indigestion tends to be at its worst in late pregnancy when the baby is large and the pressure is greatest.

How do I deal with indigestion during pregnancy?

There are several things you can do to help:

• Stay upright after meals so that gravity is on your side.

• Sleep in a propped-up position, perhaps on a couple of pillows, if you can.

• Eat small frequent meals (high volumes in the stomach will make things worse).

• Reduce your intake of high-fat foods (these take longer to digest).

• Reduce your intake of coffee and alcohol (these tend to increase stomach acid).

• Ask your doctor or midwife for an antacid preparation that's safe in pregnancy.

These liquids are taken in small doses after meals, to attempt to reduce the acidity of the stomach. They coat the gullet in protective liquid.

• If all this is not enough your doctor can offer you medication to reduce your production of stomach acid. These medicines are safe in pregnancy and are highly effective in reducing symptoms.

Constipation

Constipation is very common in pregnancy. It means passing hard poo (faeces, stools, or motions), sometimes painfully.  It can also involve going to the toilet to open the bowels less often than usual. Constipation can cause a great deal of tummy (abdominal) discomfort, cramping and wind (flatulence) in addition to pain when passing stools.

Stools are hard because they are drier, and constipation can be caused by not drinking enough - but it's not that simple. By the time you pass a stool it has come all the way through the bowel. The speed at which it does this (called the 'transit time') varies, but whilst the stools are in the bowel, they tend to start to dry out because your body takes water from them. The longer the stools spend in your bowel, the more water your body will take back, and the harder and drier they become.

The stools moves through the bowel more slowly if there is a lack of fibre in the diet to bulk it up. In pregnancy, the bowels tend to be more relaxed and to work more slowly anyway. This is partly due to pregnancy hormones and partly due to the growing womb (uterus) putting pressure on the bowels. Some medicines, including painkillers, can also cause constipation. However, it's unlikely you will be taking these in pregnancy.

Bowels work more quickly and effectively when you are well exercised, as the tummy muscles help stimulate the bowel. In pregnancy the tummy muscles are rather stretched and do this job less well.

What are the typical symptoms of constipation?

These include:

• Opening the bowels less than usual ('usual' frequency varies between people, but typically people would normally go once or twice a day).

• Passing hard, pellet-like stools.

• Tummy cramps.

• Wind.

How do I deal with constipation during pregnancy?

You can improve symptoms of constipation by doing things that speed the passage of stools through the bowel, and by making sure there is plenty of water in your system. Water can make the stools soft. So if you are constipated you should:

• Drink plenty of water.

• Make sure your diet is rich in fibre-containing foods.

• Take regular exercise.

If none of this proves to be enough, see your doctor or midwife about the possibility of taking laxatives.

'Softening' laxatives

These simply soften the stools. They tend to cause more wind and are not always helpful in pregnancy.  This is because they don't tend to speed the passage of the stool very well through the bowel.

'Stimulant' laxatives

These tend to make the bowel work faster. They are more effective than softening laxatives in pregnancy. However, they can cause cramping pains and wind as they start to work.

Breathing difficulties

As the womb (uterus) grows, many women start to feel that they can't get their breath; or, they feel that they can't get enough breath. It's an unpleasant feeling and you may feel rather panicky. This can lead to over-breathing (hyperventilation), which will also make you feel odd.

The feeling of breathlessness is usually caused by the growing womb occupying space in the tummy (abdomen). This means that the diaphragm (the big muscle underneath your lungs that pulls them open when you breathe) has less room to expand the lungs. This becomes more marked as the pregnancy advances.

The important thing is that it's a FEELING of breathlessness. It doesn't mean you are not getting enough air. If you were to breathe with only half of your lungs, you would still get enough air. However, the sensation that the lungs can't quite expand enough FEELS like a real shortage of breath.

Unfortunately, if you try to breath deeper and faster to make up for this, you can feel even more breathless. This is called hyperventilation. When you do it, you increase your oxygen levels to well above those that you need; you also reduce your carbon dioxide levels to much lower than normal. The end result is that you can feel panicky, tingly, dizzy and faint. Hyperventilation is quite common in pregnancy.

There are some other causes of breathlessness in pregnancy which need your doctor's help, and some of them are serious. Therefore, if you are severely breathless, you should see your doctor urgently.

What other causes of breathlessness are there in pregnancy?

The most common of these are:

Asthma (which you would normally already know you have, but which can get worse in pregnancy).

Anaemia - when the iron levels in the blood have fallen and the blood can therefore carry less oxygen. If anaemia is severe then this can significantly reduce the amount of oxygen carried to the brain. You then have to take more breaths to make up for it. This can be enough to make you feel breathless.

Other causes of breathlessness in pregnancy, such as a clot in the lung (pulmonary embolus) and fluid in the lung, are thankfully very rare.