Category: Conception – 8 Weeks

Nausea and vomiting in pregnancy and hyperemesis gravidarum

***Key Points***

Nausea and vomiting of pregnancy is a common condition that usually settles by 12-14 weeks of pregnancy.

Hyperemesis gravidarum is a severe form of this condition and can affect up to 1 to 3 in 100 pregnant women.

Nausea and vomiting and hyperemesis gravidarum can affect your mood, your work, your home situation and your ability to care for your family. Extra support from family, friends and healthcare professionals can help you.

While most women can be treated at home or as outpatients in hospitals, some may need admission to hospital for treatment.

A variety of anti-sickness medicines are available that may help your symptoms. While some of these medicines may not be licensed for use in pregnancy, there is no evidence that they are harmful to your baby.

***Key Points***

***Nausea and vomiting***

What is nausea and vomiting during pregnancy?

Nausea and vomiting is a symptom of pregnancy and affects most women to some degree. It begins early in pregnancy, most commonly between the 4th and 7th week. It usually settles by 12–14 weeks, although in some women it may last longer. It is often called ‘morning sickness’ but it can occur at any time of the day or night.

The cause is thought to be pregnancy hormones but it is unclear why some women get it worse than others. However, it is more likely if:

• you have had it before
• you are having more than one baby (twins or triplets)
• you have a molar pregnancy (a rare condition where the placenta overgrows and the baby does not form correctly).

It is important that other causes of vomiting are considered and looked into, particularly if you are unwell, have pain in your tummy or your vomiting only starts after 10 weeks of pregnancy. Possible other causes include gastritis (inflammation of the stomach), a kidney infection, appendicitis or gastroenteritis.

***Nausea and vomiting***

***Hyperemesis gravidarum***

What is Hyperemesis gravidarum?

If the nausea and vomiting becomes so severe that it leads to dehydration and significant weight loss, it is known as hyperemesis gravidarum. It may affect 1 to 3 in 100 pregnant women. Signs of dehydration include feeling ‘dry’ or very thirsty, becoming drowsy or unwell, or your urine changing from a light yellow to a dark yellow or brown colour. Women with this condition may need to be admitted to hospital.

In severe cases, vomiting can last up to 20 weeks. Occasionally, it can last until the end of pregnancy.

***Hyperemesis gravidarum***

***Your experience***

How will it make me feel?

Nausea and vomiting of pregnancy can be a difficult problem to cope with. It can affect your mood, your work, your home situation and your ability to care for your family. Support from family and friends can help. In some women, the symptoms can be so severe that they become depressed and need extra support such as counselling. If you find that you persistently feel down then you should speak to your healthcare professional.

Will it harm my baby?

There is no evidence that nausea and vomiting has a harmful effect on your baby. In fact, you have a slightly lower risk of miscarriage.

Women with severe nausea and vomiting or with hyperemesis gravidarum may, however, have a baby with a lower than expected birthweight. You may be offered scans to monitor the growth of your baby.

***Your experience***

***What can help?***

What can I do to help?

Most women with nausea and vomiting of pregnancy will be able to manage their symptoms themselves. You should:

• eat small amounts often – meals that are high in carbohydrate and low in fat, such as potato, rice and pasta, are easier to tolerate; try plain biscuits or crackers
• avoid any foods or smells that trigger symptoms.

Some women find eating or drinking ginger products helps. However, these may sometimes irritate your stomach. Complementary therapies such as acupressure or acupuncture may also be helpful.

If your symptoms do not settle or if they prevent you doing your day-to-day activities, see your GP, who will prescribe anti-sickness medication. This is safe to take in pregnancy.

 

What if my symptoms do not settle with these measures?

Contact your GP or your midwife. They will arrange for you to be seen in the assessment unit at your hospital. This may be in the maternity department or be part of the gynaecology unit.

***What can help?***

***An assessment unit***

What happens on the assessment unit?

You will have a check-up that may include:

• a discussion about how long you have had your symptoms for and whether:
  • you are keeping fluids and food down
  • you have tried any medication
  • you have lost weight
  • you have any other symptoms
  • you have had this in a previous pregnancy
• a check of your general health including your temperature, pulse, respiratory rate and blood pressure; you will have your weight measured and an assessment of whether you are dehydrated
• urine tests
• blood tests
• an ultrasound scan. This is to check how many weeks pregnant you are. It will also check for twins and rule out a molar pregnancy.

If you are able to tolerate some fluids but are unable to drink enough, you should be offered fluids through a drip in your arm over a short period of time. This is called rapid rehydration. You will also be given anti- sickness medication. Many women feel much better after this and are able to go home.

***An assessment unit***

***In hospital***

Will I need to be admitted to hospital?

Admission to hospital may be advised if you:

• are dehydrated; having ketones in your urine is a sign of dehydration
• have severe vomiting and are unable to tolerate any fluids
• have abnormal blood tests
• have lost weight
• have a medical condition such as a heart or kidney problem or diabetes.

What happens in hospital?

You will be given the fluids you need though a drip in your arm. This will be continued until you are able to drink fluids without vomiting.

Each day your fluid intake and how much urine you are passing will be recorded. Your temperature, blood pressure, pulse, respiratory rate and weight will also be recorded.

You should be offered:

• anti-sickness medication and a B vitamin called thiamine; both of these can be given through the drip in your arm if you are unable to keep tablets down
• special stockings (graduated elastic compression stockings) to help prevent blood clots
• heparin injections (to thin your blood). Pregnant women are at increased risk of developing blood clots in their legs, called deep vein thrombosis (DVT) or in their lungs (called pulmonary embolism). Being dehydrated and not being mobile increases this risk further. Heparin injections reduce this risk. You will be advised to continue these until you leave hospital and sometimes for longer.
• There are a variety of anti-sickness medicines that you may be offered.

If you are taking iron medication, this will be stopped because it can make sickness worse.

When you are feeling better, you can start to drink and eat small amounts and slowly build up to a normal diet.

***In hospital***

***After discharge***

After discharge

You will be given anti-sickness tablets to take home. If you feel better, you can cut down the number of tablets. If your vomiting gets worse, stop eating but try to keep sipping fluids and taking the anti-sickness tablets until you start to feel better. Ask your GP for a repeat prescription before your tablets run out.

Your symptoms may return and you may become dehydrated. If this happens, contact your midwife, GP or maternity unit to be assessed again.

Although this can be a difficult situation for you and may affect you throughout your pregnancy, the symptoms usually resolve or improve after your baby is born. If you have any ongoing concerns, contact your midwife or GP for advice and support.

***After discharge***

Resources

Some foods are not safe to eat in pregnancy. Access our guide here outlining what is safe to eat, not safe and what to limit

***Key Points***

key points

***Key Points***

***Meat and Chicken***

SAFE to EAT

***Meat and Chicken***

***Cold meats***

LIMIT

***Liver***

LIMIT

***Fish and seafood***

***Cheese***

DO NOT EAT

Soft and semi-soft cheese Egg brie, camembert, ricotta, feta,

***Dairy Foods***

***Eggs***

***Eggs***

***Vegetables and Herbs***

***Vegetables and Herbs***

***Fruit***

***Fruit***

***Sushi***

***Soy Products***

***Sesame seeds***

***Leftovers***

Access to quick reference guide here

 

A pregnancy specific multi-vitamin will usually provide adequate doses of all supplements for a healthy pregnancy.

***Key Points***

Eating a healthy and varied diet will provide you with most of you vitamins and minerals during pregnancy, however additional recommended supplements have been shown t be beneficial

• Folic Acid
• Iodine

Some women will benefit from supplements of Vitamin B12, D and K as well as Iron, calcium and Omega 3 fatty Acids.

***Key Points***

***Folic Acid***

Folic Acid or Folate

It is recommended that a supplement of folic acid is taken for one to three months before conception and for the first 12 weeks of pregnancy. This is to reduce the to risk of neural tube defects (NTD).

Don’t panic if your pregnancy was unplanned, just start taking folic acid as soon as you know.

For some women at a higher risk of folate deficiency , it may be advised that you continue folate for the whole pregnancy eg twin pregnancy or hymolytic anaemia

How much Folate should I take?

The recommended dose of folic acidis a minimum of 0.5mg

However some women may require higher dose of 0.5mg, for example if they have previously had a child with a NTD.

RANZCOG recommends that you take a higher dose of folate (5mg/day) if you

• Have diabetes
• Have a family history of a baby born with a neural tube defect
• Are taking anti-convulsive mediations
• Have a BMI >30
• Have an absorption issue, such s inflammatory bowel disease or bariatric surgery

What is a neural Tube defect?

***Folic Acid***

***Iodine***

Iodine

Pregnant women need more iodine than usual as there is increased blood flow through the kidneys leading to more clearance of iodine.

In pregnancy (or considering pregnancy) you should take an iodine supplement of at  least 150 micrograms/day.

Women with pre-existing thyroid conditions should talk to their care provider about personalized advice regarding iodine supplements

***Iodine***

***Vitamin D***

Vitamin D

RANZCOG updated their recommendation for Vitamin D supplementation in 2019.  They recommend that during pregnancy you take 400IU of Vitamin D daily as part of a multivitamin supplement (irrespective of skin pigment and/or sun exposure)

They do not recommend that you are tested for of Vitamin D levels in pregnancy, regardless of individual factors.

***Vitamin D***

***Vitamin B12***

Vitamin B12

If you are a vegetarian or vegan your care provider may rcomemmnd that you take a supplement of B12. The recommended daily intake of Vitamin B12 is 2.6mg/day (2.8mg/day when breastfeeding). This is difficult to get in your diet without eating animal products.

***Vitamin B12***

***Calcium***

Calcium

Getting adequate calcium in your diet is important during pregnancy. We know that calcium is important for your bones but also in reducing the risk of developing pre-eclampsia or your baby being born early.

Should I take a supplement?

Ideally you would get enough calcium in your diet but If you avoid dairy in your diet and do not eat or drink alternative high calcium foods (such as calcium enriched soya milk) then you and your baby may benefit=t from a calcium supplement.

Adequate dietary calcium is important  in decreasing the risk of pre-eclampsia for those at higher  risk. For these women, if this cannot be achieved by dietary  intake, calcium supplements may be useful. As calcium  supplementation has been found to have negative effects on  vascular health in other population groups, it is preferable that  adequate calcium is obtained from whole foods

The Recommended Daily amount of supplementation of calcium during  pregnancy is 1,000 mg/day

***Calcium***

***Omega 3***

Omega 3 fatty acids

Omega 3 fatty acids are known to be critically important building blocks for your baby’s developing brain and eye development. Omega 3 may also help reduce the likelihood of your baby being born early. Oily fish is the richest source of Omega 3 fatty acids

the evidence would support that all women consume fish  very low in mercury 2-3 times per week. The value of dietary supplementation of  fish oil or pregnancy multivitamin supplement containing Omega  3 fatty acids is inconclusive however if you intake of Omega 3 fatty acids is low you may consider taking a supllment  of Omega 3 fatty acids.

***Omega 3***

***Probiotics***

Probiotics

Probiotics are live micro-orgaisms consumed to imprve the gastrointestinal health. Current studies are inconclusive to support routine supplementation of probiotics and further studies are required before advice changes.

***Probiotics***

***Vitamin K***

Vitamin K

Vitamin K may be suggested late in your pregnancy if you have diagnosed with cholestasis in pregnancy

***Vitamin K***

 

Ultrasounds in early pregnancy can be offered to confirm and accurately date a pregnancy.

***Key Points***

Ultrasounds in pregnancy and any antenatal screening tests are offered to all women but the choice is is your.

Your GP, Midwife or doctor will support and your family to make informed, independent decisions about what tests you have in pregnancy.

***Key Points***

***What is an ultrasound scan?***

What is an ultrasound scan?

An ultrasound scan is a procedure that uses sound waves to create an image or picture of your baby. An ultrasound in pregnancy is carried out by an obstetrician or a specialised health professional such as ultrasonographer. During the scan, gel is placed on your abdomen and a probe called a transducer is placed against your skin. Pulses of sound waves create echoes that are turned into images which you can view on a monitor.

Sometimes your doctor may suggest a transvaginal ultrasound to get better view of your baby because during this ultrasound the probe is closer to your uterus. In this case, you will be covered with a sheet while the probe is inserted into your vagina and you will view the images of your baby on a monitor.

Having an ultrasound is usually a pain free procedure for you and your baby and there is no research to suggest an ultrasound increases the likelihood of a miscarriage when carried out in early labour.

***What is an ultrasound scan?***

***What does an ultrasounds check?***

Ultrasounds are a simple and easy way to check how your pregnancy is progressing, and to provide helpful information on how your baby is developing. Generally they used for the following

• To confirm your pregnancy and check the number of babies
• To work out the age of your baby (dating scan)
• To check your baby’s growth and physical development
• To check your baby’s position in your uterus
• To check the position of your placenta and to check your cervix
• To monitor your placenta’s health and blood flow through the placenta
• To check the amniotic fluid around your baby

What routine scans might be offered during pregnancy?

***What does an ultrasounds check?***

Your doctor or midwife will discuss the ultrasounds that are recommended and available in pregnancy. They will discuss the reasons they are recommending any procedure, ultrasound or screening test but the choice is yours.

These are

***Dating scan***

This ultrasound is usually offered in early pregnancy around 7-9 weeks of pregnancy. This scan can date your pregnancy and estimate your baby’s due date. This may be especially important if you are unsure of your last menstrual period date.

An early dating scan can also confirm how many babies you are carrying, and check that your baby is growing in the uterus and not in one of the fallopian tubes, known as an ectopic pregnancy.

***Dating scan***

***Nuchal translucency***

This ultrasound is offered  between 11 weeks, 3 days and 13 weeks, 6 days of pregnancy.

During a nuchal translucency scan a measurement is taken of your  baby’s nuchal translucency — a fluid-filled space behind your baby’s neck.

Your nuchal translucency scan results can be combined with a blood test, (PAPP-A)  usually done in weeks 10 to 12 of pregnancy, to form a ‘combined first-trimester screen’, or CFTS. The combination of this blood test and the ultrasound results can give a more accurate estimate of your risk of having a baby with a chromosomal abnormality such as Downs Syndrome.

This result will not give you a definitive answer but it will provide a report that give a low risk or a high risk of having a baby with Downs Syndrome or risk of other chromosomal abnormality.

The chances of having a baby with a chromosomal abnormality such as Downs Syndrome are greater the older you are when you get pregnant. However, anyone can have a baby with chromosomal abnormalities irrespective of age so screening is offered to everyone, but the decision to have the scan or tests is yours.

An alternative is to consider the Non Invasive Prenatal screening (NIPT) test. This is also known as the cell-free DNA testing (cfDNA) and is another option for antenatal screening test for chromosomal abnormalities. It is more accurate than a nuchal translucency scan or the combined screening test but it can be more expensive as in Australia this is not funded by Medicare.

Some women choose not to have any tests or decide to have a diagnostic test instead such as chorionic villus sampling or amniocentesis which can give them more definite information about their baby’s health. We have a separate content page about these tests.

***Nuchal translucency***

***Morphology scan***

A morphology scan (also known as a ‘fetal anomaly scan’) is an ultrasound offered between 18 and 20 weeks of your pregnancy. This scan check for major physical abnormalities in your baby body organs.

This will check your baby’s heart rate and rhythm, check the location and function of your placenta and can reveal the sex of your baby if you wish to know.

***Morphology scan***

***Other scans***

For some women your midwife or doctor may recommend a third trimester ultrasound scan to assess your baby’s wellbeing and growth and the location and function of your placenta and cervix.

Do I need to have ultrasound scans?

Your doctor is likely to recommend you have one or more ultrasound scans during your pregnancy so they can check how your baby is developing, but you’re still free to choose whether or not you have the scan.

***Other scans***

Talk to your doctor or midwife about tests and scans to understand why they might be offered to you.

Resources

https://ranzcog.edu.au/wp-content/uploads/2022/05/Prenatal-Screening-and-Diagnostic-Testing-for-Fetal-Chromosomal-and-Genetic-Conditions.pdf

Preventing foodborne illnesses and protecting yourself and you baby from other food risks during pregnancy is extremely important.

***Key Points***

Some types of food poisoning organisms can cause problems during pregnancy.

The risk can be minimised by good hygiene and food handling practices and avoiding high risk foods.

***Key Points***

***Listeria***

Listeria bacteria can contaminate food and cause listeriosis which is a flu-like infection.

In pregnancy this infection can be passed on to the baby and can cause miscarriage, stillbirth or premature birth.

Listeria infection is not a common problem and the risk can be reduced by following these tips:

• Eat freshly prepared foods where possible.
• Avoid refrigerated, ready to eat foods that may have been stored for long periods.
• Ensure good hygiene and clean utensils when preparing food.
• Thoroughly wash raw vegetables and fruit.
• Avoid foods such as pate, cold cooked chicken and deli meats such as ham and salami unless reheated to high temperature e.g., on a pizza.
• Avoid coleslaws, salads and fruit salads unless you are sure they have been freshly prepared.
• Avoid soft cheeses (e.g., brie, camembert, ricotta, feta, blue cheese) soft serve ice-cream and unpasteurised dairy products. Soft cheeses in cooked dishes are safe.
• Avoid uncooked or smoked seafood and pre-cooked prawns. Freshly cooked seafood and canned seafood is safe.
• Listeria is killed by thoroughly cooking food. Reheat foods to steaming hot.

***Listeria***

***Toxoplasmosis***

Toxoplasmosis is an infection that can cause brain and eye damage in the baby. It can be carried by raw meat and cats’ faeces.

Thoroughly cook meat, wash vegetables, wear rubber gloves if handling cat litter and wash hands after gardening or handling pets.

Good food handling practices

• Wash hands before preparing foods or eating
• Use separate, clean chopping boards to prevent cross contamination of raw and cooked foods
• Make sure cooked foods are thoroughly cooked
• Don’t leave foods to cool too long on the bench. Put them in the fridge as soon as they stop steaming
• Don’t eat food that is meant to be in the fridge if it has been left out for more than 2 hours
• Eat leftover foods within 24 hours and reheat foods to ‘steaming’ hot
• Keep the fridge clean and below 5 degrees
• Cover stored foods
• Thaw frozen food in fridge or microwave, not at room temperature
• Store raw meat below other foods so that there is no chance that it will drip onto them.
• Store eggs in the fridge.• Follow best before and use by dates and storage instructions. If in doubt throw it out.

***Toxoplasmosis***

***Salmonella***

Salmonella

Pregnant women are not at an increased risk of contracting salmonellosis, but in rare cases it may trigger miscarriage.

Salmonella can cause nausea, vomiting, abdominal cramps, diarrhoea, fever and headache.

It’s advisable to avoid foods that contain raw egg and always cook meat, chicken and eggs thoroughly.

It is recommended that you do not eat any type of sprout including alfalfa sprouts, broccoli sprouts, onion sprouts, sunflower sprouts, clover sprouts, radish sprouts, snowpea sprouts, mung beans and soybean sprouts, whether raw or lightly cooked due to a risk of contamination.

***Salmonella***

Resources

There are many symptoms of early pregnancy that you may experience.

***Key Points***

 You may experience any of the following symptoms in early pregnancy

Most will improve as the pregnancy progresses but seek help from your midwife or doctor if you are concerned.

• Nausea and/or vomiting
• Tiredness
• Dizziness or feeling faint
• Tender Breasts
• Changes to your skin
• Changes to your hair
• Needing to pass urine more often
• Constipation
• Haemorrhoids
• Indigestion or heartburn
• Leg cramps
• Backache

***Key Points***

***Nausea and vomiting***

Most pregnant women experience some degree of nausea between 5 and 14 weeks of pregnancy. Many women report the nausea is at its worst at around 9 weeks. It is often referred to morning sickness, however for it may be present throughout the day or night.

Symptoms can vary from mild to severe – although for most women this will reduce dramatically by 18 weeks for a small number of women the nausea can continue until your baby is born

Although the cause of nausea is not clear, hormone levels and slowed emptying of the stomach can likely to contribute.

The following suggestions may help reduce symptoms and avoid dehydration:

• Avoid being very hungry or having an empty stomach – eat small meals or snacks more often.
• Have a packet of dry biscuits by the bed to snack on when you wake before getting up.
• Eat small meals frequently and have foods that are high in protein such as nuts or cheese.
• Avoid spicy or fatty foods
• Sip cold, clear fluids such as water, mineral water or
• Try drinking sliced ginger in water, ginger or peppermint tea or lemon slices in hot or cold water.
• Avoid strong smells such as greasy, spicy or fatty foods, stuffy rooms or strong odours such as perfume, chemicals, coffee, food or smoke.
• Rest when you can to avoid being over tired
• If pregnancy multivitamins or iron makes the nausea worse, try taking them at night and avoid taking them without food.
• Vitamin B6 supplements (pyridoxine) are proven to be helpful for nausea.. Green leafy vegetables, bananas, tuna and chicken are natural food sources of Vitamin B6.

 

When should I call my midwife or doctor?

If the nausea or vomiting is causing you significant distress, or you are unable to drink small amounts of fluids on an ongoing basis or if you think you are developing hyperemesis gravidarum please call your pregnancy care provider for advice.

Other signs to be aware of:

• Dramatic weight loss
• Extreme fatigue
• Very dark urine
• Vomit that contains blood

There are a range of medications that are safe to use in pregnancy and have been shown to be useful in treating persistent nausea and vomiting of pregnancy. Please talk to your pregnancy care provider about your options.

***Nausea and vomiting***

***Tiredness***

It is common to feel an overwhelming sense of tiredness during pregnancy, often occurring in early pregnancy.

Being tired and exhausted can affect your mood. Look after yourself emotionally as this is a tough period during pregnancy, especially if it is early and you have not shared your pregnancy with friends or family.

If you are feeling experiencing nausea tiredness can make this worse. Be reassured this will not affect your baby but it makes work and life much more difficulty to cope with.

The only option is to rest as much as you can. Take time out to nap in the day if possible and accept help from family and friends. Your body is doing the amazing work of growing and nurturing a baby, you need to care for yourself during this time.

***Tiredness***

***Tender breasts***

Increased hormone production may make your breasts unusually sensitive from early in poregnancy.

Your breasts will feel fuller and heavier, and you will likely increase a  cup size or two.

Wearing a more supportive bra or a sports bra can help with the discomfort.

***Tender breasts***

***Dizziness***

Normal circulatory changes in early pregnancy may result in your feeling dizzy or faint. This is because pregnancy affects your circulation, impacting oxygen levels which makes you feel dizzy or faint.

Try to avoid long periods of standing and when you stand from sitting do so slowly. If you feel dizzy while standing, sit or lie down. Stay hydrated and wear cool loose clothing to avoid over heating as this may  increase the likeliness of feeling faint.

Tips to help with dizziness or feeling faint

• get up slowly after sitting or lying down.

• If you feel faint lie down on your side.
• Drink plenty of water.
• Eat regularly to keep your blood sugar levels stable.

If dizziness persists or is occurring frequently contact your midwife or doctor for advice.

***Dizziness***

***Passing urine more often***

 Needing to go to the toilet more often during your pregnancy is normal and is caused by the hormonal and physical changes occurring in your body during pregnancy.

During early pregnancy,  hormonal changes increase the frequency with which you need to use the toilet and pass urine. This may also be due to weakened pelvic floor muscles during pregnancy. You can help by practicing your pelvic floor exercises to strengthen your pelvic floor muscles.

You should speak to your Midwife or Doctor if you experience burning or stinging when passing urine or if there is an offensive smell when you pass urine.

 

If you are experiencing incontinence pregnancy such as a leakage of urine when they cough, laugh or sneeze, or just get up from a sitting position you should let your midwife or doctor know.

If your pelvic floor muscles are weakened then the internal organs are less well-supported, which can lead to difficulty controlling a leak of urine and at time faeces.

You may benefit from a consultation with a women’s health physiotherapist.

***Passing urine more often***

***Skin changes***

Pregnancy hormones can change the tone and colour of your skin. The extra blood circulating around your body can cause your skin to “glow” or feel flushed.

For some women, the pregnancy hormones may cause acne, pimples or dry reddened patches. Areas of skin that may get darker during pregnancy including the area around your nipples, the genitalia, the inner sides of thighs and armpits.

Chloasma is a specific form of pigmentation also referred to as the “mask of pregnancy” and appears as brown patches on the bridge of the nose, cheeks and neck. Some dark-skinned women develop patches of paler skin on the face and neck. These patches will begin to fade after the baby is born.

Some women develop a dark line running down the centre of their stomach, called a Linea nigra.

Sunlight intensifies areas of skin that are already pigmented and many women find that they tan more easily during pregnancy. Even after birth the deeper pigmented skin will remain darker for sometime, but will gradually fade and disappear.

Stretch marks may also develop in pregnancy, most commonly in the third trimester of pregnancy. These are most commonly found on the stomach or breasts and will fad over time after pregnancy.

***Skin changes***

***Hair changes***

Hormonal changes in pregnancy may result in your hair becoming thicker

Many women report their hair feels thicker around 14-16 weeks of pregnancy. An increase in the hormone oestrogen results in a change of cycle to the hair follicles meaning they stay longer in the growing phase and less hair falls out.

Can I dye my hair during pregnancy?

There is not adequate research into the use of hair dye during pregnancy, however it is not thought to be harmful to your developing baby as your hair only absorbs small amounts of the harmful chemicals used in hair dye.

However we should always be cautious around chemicals, especially in pregnancy so follow these safety tips

• Always colour your hair in a room with adequate ventilation
• Always wear gloves if you are handling the dye yourself
• Do not leave the dye on longer than recommended and follow the instructions carefully
• Rinse thoroughly after application

***Hair changes***

***Constipation***

Hormonal changes during pregnancy mean you are more likely to become constipated, often occurring in early pregnancy. An increase in the hormone progesterone during early pregnancy means your food moves more slowly through your intestine, this is called a reduction in gastric motility.

Constipation means you are not opening your bowels or passing a stool (faeces/poo) as often as you would normally or when you do the stool is hard to pass and you may be straining to open your bowels.

Normal bowel function does differ from person to person but usually if you are passing less than three (3) stool per week we could call this constipation. 25-40%  women will report some degree of constipation during pregnancy hopwever in most cases this will resolve itself as pregnancy progresses.

If you do not have adequate fibre in your diet or are not drinking enough fluids this can increase the likelihood of constipation as well. Some medicines, such as those prescribed for nausea and heart burn and some pregnancy multi-vitamins can also increase constipation.

Tips to assist to relive constipation

• Increase fibre in your diet – eat more wholegrain foods, fruits and vegetable, nuts, dried fruit or legumes are a great source of fibre
• Stay hydrated by drinking 8 glasses of water each day. Reduce intake of coffee, tea or soft drinks
• Stay active and take gentle exercise every day, such as walking, swimming, yoga
• Go to the toilet when you feel the urge, do not put it off.

***Constipation***

***Haemorrhoids***

Haemorrhoids (also known as “piles”) are varicose veins in the rectum and anus. They can be internal, external or a combination of both. Internal haemorrhoids may bleed a little but are usually painless. If the vein becomes enlarged or swollen, it can protrude to become an external haemorrhoid. You may experience itching, burning, slight bleeding and pain when you open your bowels.

The following suggestions may be helpful:

• Avoid constipation and straining on the toilet by including plenty of fibre in the diet by eating fruit and vegetables, wholegrain foods
• Drink plenty of water to reduce constipation
• Avoid standing for long periods.
• Get regular gentle exercise
• Open your bowels when you feel the urge and attempt not to strain to pass a stool. This can make haemorrhoids worse.
• A deep warm bath may relieve the discomfort or an ice pack directly to the anal area may numb the painful sensations temporarily.
• Rectinol ointment, available from pharmacies, can be applied to haemorrhoids that are causing discomfort.

It is important to see a doctor to confirm the diagnosis of haemorrhoids as there are other medical conditions which have similar symptoms.

Your doctor or Midwife can discuss with you the options to relieve symptoms during pregnancy. These may include laxatives, pain relieving medication, suppositories, creams or ointments.

***Haemorrhoids***

***Indigestion or heartburn***

Changing hormones in early pregnancy may result in many women experiencing indigestion or heartburn.

Indigestion is a feeling of pain or discomfort in the stomach or abdomen,  mostly occurs after eating or drinking, although it can occur at anytime. Symptoms may also include nausea, reflux or regurgitation, feeling bloated or burping.

Heartburn is a burning sensation in the throat or chest, caused by stomach acid coming up the oesophagus (the tube that connects your mouth to your stomach) and irritating the lining. Due to the effects of the pregnancy hormones the peristaltic  movements that push swallowed food from your food pipe into your stomach and then along your bowel are slower. Your stomach also takes longer to empty. This slowdown gives nutrients more time to be absorbed into your bloodstream and to reach your baby, however this can also cause heartburn during pregnancy.

• Tips to avoid indigestion and heartburn
• Avoid high fat or spicy foods
• eating smaller meals, more often
• Avoid lying down after eating
• Avoid drinking with meals, drink before or after
• chewing gum, which may cause you to produce more saliva to help neutralise the acid
• raise the head of your bed by 10 to 15cm
• sleep on your left side

***Indigestion or heartburn***

***Muscle cramps***

Muscle cramps in the feet, legs or thighs are common during pregnancy, especially at night. The cause of cramps is unclear. Some suggested reasons include changes in metabolism, vitamin deficiency, being too active or not active enough however research does not adequately tell us the reasons.

The following may help:

• Stretching your calf muscles before bed may reduce overnight cramps
• Gentle exercise such as walking and calf raises can help to promote circulation and reduce cramps
• Magnesium supplements, which can be bought from pharmacies or health-food stores.

Please talk to your Midwife or Doctor if you are considering starting magnesium supplements, they are disturbing your sleep on an ongoing basis

***Muscle cramps***

***Backache***

Most women experience backache at some stage during their pregnancy. The causes include altered posture as the baby grows and hormonal changes, which lead to the loosening of ligaments that support our bones and pelvis. This is helpful as we prepare for labour but can result in backpain in pregnancy.

The following suggestions may be helpful:

• Be aware of your posture – stand with your weight evenly on both legs, your back straight and your pelvis tucked under.
• Do not lift heavy objects
• Use chairs with good back support when sitting.
• Avoid periods of prolonged standing.
• Sleep on your side
• Rest with your legs elevated.
• Wear flat shoes with good arch support

See a women’s health physiotherapist if pain persists or impacts your activity or ability to rest and sleep.

***Backache***

Resources

https://www.seslhd.health.nsw.gov.au/sites/default/files/groups/Royal_Hospital_for_Women/Mothersafe/documents/constipationpb20.pdf

Cullen G, O’Donoghue D. Constipation and pregnancy. Best Practice Research Clinical Gastroenterology 2007; 21 (5):807-818.

Quijano CE, Abalos E. Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium. Cochrane Database of Systematic Reviews. July 2005; Issue3. Art. No. CD004077

Hair treatments in pregnancy. Organization of Teratology Information Specialists. July 2020. Available at https://mothertobaby.org/fact- sheets/hair-treatments-pregnancy/

https://www.continence.org.au/get-help/resources

https://www.gesa.org.au

You may suspect you are pregnant. This can be confirmed via pregnancy test or by a pregnancy blood test.

***Key Points***

A missed period may be the first clue you are pregnant, or maybe you have suspected you were pregnant earlier. You can confirm this by

• Home pregnancy test
• Blood test

***Key Points***

***Home pregnancy test***

A home pregnancy test can be purchased from your local pharmacy or chemist.

These are inexpensive, private and easy to use and if you follow the instructions they are very accurate.

Home pregnancy tests work measuring the pregnancy hormone human chorionic gonadotropin (HcG) in your urine. Your body starts to produce this hormone when the fertilised egg implants in your uterus. The pregnancy hormone can be detected in your urine from about six to fourteen days after fertilisation.

Follow the instructions on the test, some required you to wee on the test stick. With others you may have to dip a testing strip into a urine sample. Most types of tests will give you a result in a few minutes. Results may appear as a line on the test strip while others display a plus or minus symbol.

Most pregnancy tests are sensitive enough to detect levels of HcG and display a positive result on the day you miss your period. However you may retest in a few days of you believe you are pregnant but return a negative result. It would be rare for a pregnancy test to return a positive result that was incorrect or false, but there are other reasons that you may have a high HcG levels such as a tumour.

***Home pregnancy test***

***Pregnancy blood test***

A GP can confirm your pregnancy by a blood test. Even if you have a positive home pregnancy test it is a good idea to visit your GP to confirm the result with a blood test and also discuss with your GP your options for pregnancy care. Pregnancy blood tests are 99% accurate and can detect a pregnancy about one week after conception.

A blood test will also confirm the presence of the hormone HcG but can detect this earlier than the home pregnancy tests. Normally HcG levels rise quickly in the first 12 weeks of pregnancy and this can assist your doctor to tell if the pregnancy is progressing as would be expected.

There are two main types of pregnancy blood tests

• Quantitative blood test – measures the exact amount of hCG in the blood and can give you an estimate of how far along the pregnancy has progressed.
• Qualitative blood test – only checks for the presence of hCG so will give you a positive or negative result but not how far along your pregnancy is.

Talk to your GP about these options.

***Pregnancy blood test***

Resources

For support and advice for an unplanned pregnancy

Reach Out

Family Planning Alliance Australia

Call Pregnancy, Birth and Baby on 1800 882 436 to talk to a maternal child health nurse.

 

What to expect at your first GP visit and confirmation of pregnancy.

***Key Points***

Whether you are planning to have private or public pregnancy care you most women will visit their GP to discuss their Pregnancy care options

The aim of every antenatal visit in pregnancy is to check on your health and wellbeing and the progress of your pregnancy.

Decisions regarding your care will be made in collaboration with you factoring in your preferences for pregnancy care.

Your first appointment with your GP to confirm your pregnancy will ideally be as early as possible in pregnancy.

***Key Points***

***Your GP will discuss***

At this appointment your GP will discuss with you

• Your general health and wellbeing and medical history, social history and any previous babies you have had.
• Options for pregnancy and birth care such as Public hospital care, Shared GP/Obstetric Care, Private Obstetric care, Private Midwifery care or care attended at an Aboriginal health service.
• Potential factors that may contribute to your pregnancy being high risk
• Folic acid supplements and any further supplements recommended
• Any medications you are taking
• Foods to avoid in pregnancy.
• Food hygiene and safety in pregnancy
• Aspects of your life that may affect your health or the health of your baby, eg. smoking, recreational drug use and alcohol consumption.
• What to do if you have concerns about your pregnancy prior to attending your first scheduled appointment at the hospital, midwifery or obstetric practice

***Your GP will discuss***

***Blood tests offered***

GP will provide you with a referral for the following blood tests;

• HCG level (to confirm you are pregnant)
• Blood group and antibody screen

This will include checking if you are Rh negative or positive

• Full blood count
• Iron level and Ferritin
• Thyroid levels
• Vitamin D
• Hepatitis B screen
• Hepatitis C screen
• HIV screen
• Syphilis serology
• Rubella immunity
• Urine screen – to check for signs of any infection

They may suggest any of the following depending on your individual circumstances

• Vitamin B check
• Early diabetes screening

***Blood tests offered***

***Ultrasounds offered***

Your GP will also provide a referral for

• Dating Ultrasound – this ultrasound is usually attended before 12 weeks and confirms an estimated due date by ultrasound
• Nuchal translucency ultrasound – this ultrasound is attended between 11-14 weeks of pregnancy and is part of the first trimester combined screen and also provides information on the development of the baby’s spinal cord and brain.
• 19/20 week morphology ultrasound and placental localisation

***Ultrasounds offered***

***Models of pregnancy care***

All the information that you provide your GP, the results of the initial investigations and blood tests are sent in a referral letter to the place you have chosen for your pregnancy care and birth of baby/babies. IE – Public maternity hospital, Private Obstetrician, Private Midwife.

It is incredibly important to make the most of the time with the Midwife/Obstetrician who meets with you at your first booking visit at the hospital or private practice so as a thorough history is taken and information shared is complete. A checklist in preparation for this visit is available here.

***Models of pregnancy care***

Resources

 

There are many benefits to staying active and fit during pregnancy

KEY POINTS

Before you start an exercise program in pregnancy, speak with your doctor or midwife to make sure that you do not have any health issues to prevent you from exercising.

 Aim to do aerobic exercise such as a brisk walk, stationary cycling or swimming most days of the week and strength training two days each week on non-consecutive days.

There are many benefits to staying active and fit during pregnancy

Regular exercise can help you

• maintain a healthy weight
• be stronger and fitter
• preparing for labour and quicker recovery after birth
• have more energy, improve your sleep
• relax and increase your emotional wellbeing.
• In addition to pregnancy-specific benefits, there are significant life-long benefits of regular exercise for all adults including reduced risk of cardiovascular disease, type 2 diabetes and some cancers.

Before you start an exercise program in pregnancy, speak with your doctor or midwife to make sure that you do not have any health issues to prevent you from exercising.

If there are no health or pregnancy reasons why you should not exercise, then it is a great idea to participate in regular aerobic and strengthening exercises during pregnancy.

When exercising during pregnancy be aware

• Hormones such as relaxin make your ligaments looser. You can prevent injury by avoiding exercise like jumping up and down or repetitive bouncing movements. Take care not to overstretch your hips, knees, or ankles.
• During pregnancy your weight distribution and body shape changes resulting in your center of gravity moving forward. Be aware this may alter your balance and coordination.
• Your blood pressure drops in the second trimester of pregnancy so try to avoid rapid changes of position as this may make you feel dizzy.

How often should I exercise?

During your pregnancy aim to:

• be active on most, if not all, days of the week
• do moderate intensity activities for 2½ to 5 hours each

or vigorous intensity activities for 1¼ to 2½ hours each week

this means do 30 to 60 minutes of moderate intensity activity

or

do 15 to 30 minutes of vigorous intensity activity most days

• Do muscle strengthening activities at least 2 days each week

If you have been physically inactive prior to pregnancy gradually increase to this duration of exercise.

If you have a high level of fitness or regular exercise, there is no evidence to suggest that vigorous exercise during pregnancy is harmful, provided that you listen to your body and adjust your routine over time.

What type of exercise should I do?

There are benefits to both aerobic and strengthening exercises.

Aerobic exercises

Aerobic exercises are activities that increase your heart and breathing rate.

This may include

• brisk walking
• stationary cycling
• swimming
• dancing

If you are already running regularly prior to your pregnancy, there are not studies to show this is harmful. Discuss this with your care provider. It is important to monitor your intensity and listen to how your body feels.

Strengthening exercises
Do muscle strengthening activities at least 2 days each week. Non-consecutive days. Aim to do strengthening activities, such as light resistance training or bodyweight exercises

You should aim to do pelvic floor exercises every day, while pregnant, then for life, to keep your pelvic muscles strong – see the content page on pelvic floor exercises and care

Intensity of Activity

Physical activity during pregnancy doesn’t have to be high intensity to be beneficial.

A simple way to measure intensity is the ‘talk test’. You should be able to carry on a conversation during moderate intensity activities, but in vigorous intensity activities you would find this difficult.

General considerations for exercise during pregnancy:

• includes a gradual warm-up and slow and sustained cool-down with each session

Avoid

• an activity that has a high risk of falling, collision or impact
• Avoid heavy weightlifting and activities that involve straining or holding the breath.
• Any significant changes in pressure, such as scuba diving, or sky diving
• Avoid exercising in high temperatures and humidity,
• Avoid lying flat on your back after the first trimester and
• Avoid walking lunges to prevent injury to the pelvic connective tissue
• Avoid activity at high altitude (above 2000m)
• Avoid spas and hydrotherapy pools

To exercise safely

• Stay adequate hydration and
• wear loose-fitting clothing appropriate footwear
• reduce the time spent sitting
• break up long periods of sitting or standing still

Stop exercising and call your care provider if you experience any of the following

• chest pain
• Vaginal bleeding
• Leakage of amniotic fluid
• unexplained shortness of breath
• dizziness, feeling faint or headache
• muscle weakness
• calf pain, swelling or redness
• sudden swelling of the ankles, hands or face
• vaginal bleeding or amniotic fluid loss
• decreased fetal movement
• uterine contractions or pain in the lower back, pelvic area or abdomen

Why your weight matters during pregnancy and the benefit of being within a healthy weight range during pregnancy.

***Key points***

Weight is a very sensitive subject for some women, we understand. This information is to asisst you if you are underweight or overweight as to why your care providers may bring this topic up with you.

Because of the great benefit to you and your baby, it is recommended that you should try to reach a healthy weight before you become pregnant. By reaching a healthy weight, you are protecting your health and your baby’s wellbeing.

Women who are underweight or overweight have a higher chance of problems in pregnancy. Doctors and midwives often feel uncomfortable bringing up the issue of weight. They are concerned you may feel judged. If you are not a healthy weight, it is important you to talk about this issue with your doctor or midwife so that you can try to reduce the increased chance of complication

***Key points***

***What is BMI?***

What is BMI?

Your body mass index (BMI) is a comparison of your weight to your height.

Your BMI will be calculated at your first antenatal appointment as a simple way for your care provider to discuss if you are in a healthy weight range. It is only one measure but it is helpful as a guide for Midwives and Obstetricians.

A healthy BMI is above 18.5 and below 25.

Many women are unaware of the how much weight they should put on during pregnancy and some gain more than is ideal. There is no need for you to ‘eat for two’, as was previously thought. The table shows the recommended range of weight gain in pregnancy by BMI.

BMI	Classification	Range of pregnancy weight gain
< 18.5	Underweight	12.5–18kg
8.5–24.9	Normal	11.5–16kg
25–29.9	Overweight	6.8–11.3kg
> 30	Obese	5–9.1kg

***What is BMI?***

***Low BMI***

What are the problems associated with a low BMI during pregnancy?

Women who are very underweight have an increased chance of miscarriage and their babies may have an increased chance of prematurity, low birth weight and nutritional problems.

It is essential that you and your baby receive the vitamins and minerals you require. Most of these can be gained through good nutrition and a healthy diet

***Low BMI***

***High BMI***

What are the problems associated with a high BMI during pregnancy?
Most pregnant women who have a high BMI can expect to enjoy a healthy pregnancy. However, having a raised BMI increases the chance of complications for both you and your baby. The higher your BMI, the higher the risks. As your BMI increases, so does the likelihood of one or more of the following problems occurring

• A blood clot in the leg (deep vein thrombosis) or in your lungs (pulmonary embolism)
• Gestational diabetes, a form of diabetes that develops during pregnancy
• High blood pressure and pre-eclampsia
• Difficulties with some procedures – having too much body fat can make it difficult to monitor your baby’s heartbeat, view certain problems with the baby’s anatomy on an ultrasound scan and to give you an epidural.

The problems for your baby associated with a high BMI include:

• Problems with the development of the baby’s brain and spine (neural tube defects)
• Higher rate of miscarriage
• A birth weight greater than 4kg
• Admission to a special care nursery
• Higher rate of stillbirth
• Increased chance of obesity and diabetes later in life

***High BMI***

***Reducing the risks***

How can the chance of having these problems be reduced?

Despite having a high BMI, you can still have a healthy pregnancy.

It takes careful management of your weight, attention to diet and exercise, regular antenatal care to monitor for complications, and special considerations for your labour and birth.

By working together with your healthcare team, the chance of having problems can be reduced for both you and your baby. Healthy diet and an active lifestyle are important. A healthy diet will provide benefits both during your pregnancy and after the birth.

Your doctor or midwife may refer you to a dietician to help you plan a healthy diet or recommend specific supplements. For women with a BMI over 40, your doctor may advise a more limited weight gain than 5–9kg.

***Reducing the risks***

***During labour and birth***

What are the problems associated with a high BMI during labour and birth?

There is an increased risk of complications during labour and birth, particularly if you have a BMI above 40.

If your BMI is above 40 you may need to have your baby at a hospital with the appropriate facilities and experienced clinicians to provide the specialised care that meets your needs.

Some of the problems include:

• • Your baby being born prematurely (before 37 weeks)
• • Difficulty monitoring the baby’s heartbeat
• • Anaesthetic complications
• • Greater likelihood of requiring an emergency caesarean section
• • Shoulder dystocia, which is when the baby’s head is born, but the shoulders do not come out. The doctor or midwife will take steps to help the shoulders to be born, and this can be frightening
• • Heavy bleeding after birth (postpartum haemorrhage)

Because of these possible complications, you should have a discussion with your obstetrician or midwife about the safest way and place to give birth.

***During labour and birth***

***After pregnancy***

After pregnancy

Once you are home with your baby, stick to your healthy eating and exercise habits to help you reach a normal weight.

Highly restrictive diets are not recommended after the birth of your baby, particularly if you are breastfeeding. Breastfeeding is recommended for the first year of a baby’s life. Not only is breastfeeding the best way to feed your baby, it may also help with weight loss.

Overall, women who breastfeed their babies for at least the first few months tend to lose the weight they gained during pregnancy faster than women who do not breastfeed.

Getting to a healthy weight after pregnancy reduces your risks in future pregnancies as well as improving your long-term health

***After pregnancy***

Resources