From the Guidelines
The earliest symptoms of pregnancy typically begin around 4-6 weeks, with nausea and vomiting being the most common, peaking at 8-12 weeks, and subsiding by week 20, as reported in a 2024 study published in Gastroenterology 1. These symptoms can include heartburn, nausea, and vomiting, which affect 30%–90% of pregnant women. The severity of these symptoms can be quantified using the Motherisk Pregnancy Unique Quantification of Emesis score, as shown in Table 1 of the study 1. Some key points to consider:
- Nausea and vomiting of pregnancy (NVP) is commonly associated with elevated levels of human chorionic gonadotropin and estrogen, and changes in GI motility 1.
- Progesterone can have an inhibitory effect on GI and small bowel motility, leading to delayed gastric emptying 1.
- Diet and lifestyle modification are the initial steps in managing these symptoms, including reducing spicy, fatty, acidic, and fried foods, and eating small, frequent, and bland meals 1.
- If symptoms are persistent or severe, therapeutic options include ginger and vitamin B6, as well as H1-receptor antagonists like doxylamine, which is US Food and Drug Administration–approved and recommended by the American College of Obstetricians and Gynecologists (ACOG) 1.
From the Research
Earliest Symptoms of Pregnancy
The earliest symptoms of pregnancy can vary from woman to woman, but some common symptoms include:
- Nausea and vomiting 2, 3, 4, 5, 6
- Fatigue 2, 3, 5
- Breast pain or tenderness 3
- Vaginal bleeding or spotting 4, 6
- Lower abdominal cramping 4
- Polyuria (frequent urination) 3
- Heartburn 3
Onset of Symptoms
According to a study published in the Journal of Clinical Epidemiology, nearly 90% of women with successful pregnancies experience symptoms within 8 weeks of their last menstrual period (LMP) 2. Another study found that the top three most reported complaints during the first trimester were nausea-vomiting, fatigue, and breast pain-tenderness 3.
Relationship Between Symptoms and Pregnancy Loss
Research suggests that certain symptoms, such as vaginal bleeding and lower abdominal cramping, may be associated with an increased risk of pregnancy loss 4, 6. On the other hand, nausea and vomiting may be associated with a decreased risk of pregnancy loss 4, 6. A study published in the American Journal of Obstetrics and Gynecology found that women who experienced bleeding without nausea between 6 and 8 weeks' gestation had an increased risk of clinical pregnancy loss 6.
Management of Symptoms
Pregnant women often use non-pharmacological methods to manage their symptoms, such as avoiding certain foods or activities 3. However, it is essential for women to consult their healthcare providers for proper guidance on managing their symptoms and ensuring a healthy pregnancy. Midwives and nurses can play a crucial role in educating women on appropriate practices to alleviate their physical symptoms 3.