Finding out you’re pregnant can be both exciting and terrifying. Tons of questions start going through your head. What if something is wrong with the baby?  What is labor really like? What is going to happen to my body?

In Nine Healthy Months, Charles Hux addresses the concerns of many expectant mothers. From your first trimester to your third, Dr. Hux explains what symptoms you can expect during your pregnancy, and how to stay healthy throughout it. We’ve excerpted a portion of the book for you below. Enjoy!

Common Symptoms During the First, Second, and Third Trimesters

The First Trimester (Week 1-Week 12)

o You may experience nausea and vomiting.
o You may feel more tired.
o You may experience heartburn and acid indigestion.
o You may have to urinate more often.
o You may become more sensitive to smell.
o You may have a darkening of the area around the nipple (areola).
o You may experience sensitivity in your gums and possibly bleeding gums.
o You may experience increased saliva, with a metallic taste.
o Your breasts may be swollen and tender.
o You may crave certain foods.
o You may have headaches.
o You may experience mood swings.
o You may become constipated.
o You may experience some light spotting.
o You may have an increase in vaginal discharge.
o You may experience increased perspiration.
o You may experience dizziness.
o You may break out with acne.
o You may notice that your nails and hair are healthier and growing faster.

The Second Trimester (Week 13-Week 26)

o You may still be experiencing heartburn and acid indigestion.
o Your extremities may start to swell from extra fluid.
o You may experience increased hunger now that your hormones have leveled out.
o Your breasts may start to increase in size.
o You may have nasal congestion and nosebleeds.
o You may feel achy in your lower abdomen from stretching ligaments.
o Your abdomen may feel itchy from your expanding belly.
o You may notice varicose veins on your legs that can be painful.
o You heart rate may increase.
o Your legs and back may begin to ache.
o A dark line (linea nigra) that runs from your belly button to the pubic bone may appear.
o You may experience pigment changes (chloasma) on your face and neck.
o You should be gaining weight.
o You may feel your baby move between 18 and 22 weeks.

The Third Trimester (Week 27-Week 40)

o You may have frequent urination from the baby pressing on your bladder.
o Your weight should continue to increase.
o You may have rib pain from the baby stretching out.
o You may experience hemorrhoids.
o Your belly button may protrude.
o Your saliva may begin to increase again.
o You may have shortness of breath from the baby pressing on your diaphragm.
o You may start to experience painless uterine contractions (Braxton Hicks).
o You may experience a watery discharge (colostrum) leaking from your breasts.
o You may start to notice stretch marks on your abdomen, breasts, and arms.
o You may experience backaches, along with continued leg aches.
o Swelling of your extremities may get worse this trimester.
o You may experience a heavy vaginal discharge.
o You may get itchy red bumps on your belly (PUPP rash).
o You may have alternating periods of fatigue and bursts of energy.

Morning Sickness

Nausea and vomiting in pregnancy, jointly known as “morning sickness,” affect approximately 80 percent of all pregnant women. Morning sickness usually begins around the sixth week of pregnancy. Although common in the morning, it can happen almost any time of the day. The majority of women will start feeling much better by the 12th week of pregnancy. Some women will continue to suffer for longer than 12 weeks, and some of these will feel its effects for the duration of their pregnancy.

About 1 percent of pregnant women will experience excessive nausea and vomiting (hyperemesis gravidarum). This condition can cause weight loss, dehydration, and electrolyte imbalance. It is usually treated with Reglan, Zofran, or Phenergan, all Class B medications that are safe if needed in pregnancy. In some cases, hyperemesis gravidarum is so severe that hospitalization is required. Intravenous fluids are usually administered to restore hydration, electrolytes, vitamins, and nutrients.

If the above medications are not working in pill form and you would prefer not to be admitted to the hospital, the use of Reglan and Zofran can be administered at home through a micro-infusion pump. Receiving these medications in this manner can be more effective in certain patients that do not get relief from using these drugs in pill form.

The exact cause of nausea and vomiting in pregnancy remains unknown. The most widely accepted reason is from the buildup of hCG (human chorionic gonadotropin) in your body. This is the hormone produced after the embryo implants, which will level off by the second trimester. Estrogen is another hormone that rises rapidly in pregnancy and could play a role. Some women may have an underlying gastric condition, such as gallstones or small bowel disease, that is exacerbated when pregnant.

Whatever the reason, morning sickness isn’t harmful to your pregnancy but can be quite an uncomfortable side effect of it.

Steps to try to make the experience more manageable:

  • Eat small, frequent meals during the day so that your stomach is never empty.
  • Avoid fatty foods, which are harder to digest.
  • Stay away from spicy, fried foods and acidic foods that can irritate your stomach.
  • Do not lie down right after a meal. Give yourself some time to digest.
  • Munch on crackers throughout the day.
  • Eat starchy foods, such as pasta, rice, or potatoes.
  • Take your prenatal vitamin with food.
  • Ginger-this remedy is thought to help settle your stomach and ease nausea.
  • Try acupuncture bands or the Relief Wrist Band.
  • Take 100 mg of vitamin B6 each day.
  • Be sure to rest or nap during the day.

You should always try non-medicinal remedies first. If nothing you have tried has worked, talk with your healthcare provider about over-the-counter remedies and medications that can be prescribed.

What Do Those hCG Levels Mean?

Human chorionic gonadotropin (hCG) is a hormone produced by the placenta at the moment implantation first takes place. When you buy a home pregnancy test, this is the hormone being measured in your urine. If there is any hCG hormone in your body, then you are very likely pregnant. The hCG is detectable even before you miss your period with the new, highly sensitive tests now available in drug stores. A home pregnancy test does not give you a level of hCG hormone, it will just indicate whether it’s present or not.

A doctor will not routinely measure your hCG levels unless some type of problem is encountered, such as early bleeding or cramping. However, if an early transvaginal ultrasound performed between five and eight weeks’ gestation cannot identify a viable fetus, you will be sent for quantitative hCG testing. This testing involves having your blood drawn three times over three days.

Detectable levels of hCG start at 5 mIU/ml during the first week of gestation. In a healthy pregnancy, blood levels of hCG will double every 36 hours. There is a great variation in hCG levels. The level itself doesn’t matter as much as the rate of change in the level. So if your doctor reports a low number after your first quantitative hCG, do not be discouraged. As long as the number doubles, this would indicate a viable pregnancy. Falling hCG levels always indicate a non-viable pregnancy.

About Dr. Charles Hux:
Dr. Charles Hux attended Case Western Reserve School of Medicine and completed his residency in obstetrics and gynecology and a fellowship in maternal-fetal medicine at Thomas Jefferson University. He received a master’s degree in genetics from Rutgers University. He maintains a private practice in Sea Girt, NJ and is primarily affiliated with Monmouth Medical Center in Long Branch, NJ. His articles have appeared in American Journal of Obstetrics/Gynecology, Prenatal Diagnosis, New England Journal of Medicine and Genetics. 

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