Early Pregnancy Symptoms and Management
Common Symptoms of Early Pregnancy
Nausea and vomiting are the most prevalent early pregnancy symptoms, affecting 30-90% of pregnant women, typically beginning at 4-6 weeks gestation, peaking at 8-12 weeks, and subsiding by week 20. 1
Timing and Onset
- Half of women begin experiencing symptoms by day 36 after their last menstrual period, with 89% experiencing symptoms by the end of the eighth week 2
- Symptoms do not begin until after key stages of embryogenesis are complete 2
- Even biochemically detected pregnancy losses before 6 weeks may produce symptoms, though substantially reduced 2
Most Common Symptoms by Trimester
First Trimester (Weeks 1-12):
- Nausea and vomiting (87.8% of women) 3
- Fatigue (77.9%) 3
- Breast pain and tenderness (76.2%) 3
- Urinary frequency 4
Second and Third Trimesters:
- Polyuria (79.9-88.4%) 3
- Fatigue (75.6-88.4%) 3
- Heartburn (71.3-81.8%) 3
- Pelvic pressure 4
- Insomnia 4
- Lower backache 4
Full Spectrum of Symptoms
- Pregnant women experience an average of 24.2 symptoms during pregnancy, double the 11.2 symptoms experienced by healthy non-pregnant controls 4
- Symptoms involve most body systems and are more numerous than mentioned in current obstetric texts 4
- The third trimester is associated with the greatest number of symptoms, with marked decline after delivery 4
Management of Nausea and Vomiting
Assessment and Severity Grading
Use the Motherisk Pregnancy-Unique Quantification of Emesis (PUQE) Score to assess severity: 1
- Score ≤6: Mild
- Score 7-12: Moderate
- Score ≥13: Severe
Stepwise Treatment Approach
Early treatment of nausea and vomiting may reduce progression to hyperemesis gravidarum. 1
Step 1: Lifestyle and Dietary Modifications
- Dietary changes should be the first-line approach for mild cases 1, 5
- These modifications may resolve mild cases without medication 5
Step 2: First-Line Pharmacotherapy
- Vitamin B6 and doxylamine combination is the initial pharmacologic treatment 1
- This combination is safe and effective for symptom control 1
Step 3: Moderate to Severe Cases
- Ondansetron 1
- Metoclopramide 1
- Promethazine 1
- Intravenous glucocorticoids may be required in severe cases 1
- Hydration and adequate nutrition are essential components 1
Critical Management Principles
Treatment should begin early to prevent progression: 5
- Once nausea and vomiting progresses, it becomes more difficult to control 5
- Early intervention may prevent hospitalization 5
- Women's perception of symptom severity is critical in determining treatment approach 5
Address medication safety concerns: 5
- Many women avoid seeking treatment due to concerns about medication safety 5
- Safe and effective treatments are available 5
- The condition should not be minimized or undertreated 5
Management of Heartburn
Heartburn is common in the latter part of pregnancy and resolves after delivery. 1
Pathophysiology
- Increased progesterone levels cause relaxation of the lower esophageal sphincter 1
- This facilitates gastroesophageal reflux 1
Treatment Approach
- Standard diet and lifestyle measures 1
- Pharmacologic treatment as needed (specific agents not detailed in guidelines but should follow standard GERD protocols safe in pregnancy)
Common Management Pitfalls
Majority of women do not take action to alleviate symptoms: 3
- Women either do nothing or take incorrect/empirical actions 3
- Major source of knowledge is based on previous experience and advice from close relatives rather than medical guidance 3
- Women with higher education levels are more likely to take scientifically proven actions 3
Healthcare providers should: 3
- Actively question pregnant women about symptoms and management strategies
- Identify inappropriate practices
- Provide education on appropriate evidence-based practices
- Not minimize symptoms as "just morning sickness" 5
When to Escalate Care
Refer for evaluation if: 6