Being pregnant for the first time can be a very exciting yet scary time in a woman’s life. There are many physical and emotional changes, which occur with pregnancy. Understanding these changes will help you and your partner prepare for the weeks and months to come and will help you differentiate what is normal and what should be a cause of concern which you should address with your physician. Table 1 lists some of the normal symptoms of pregnancy. Dr. Rodriguez is a board-certified perinatologist and co-director of maternal-fetal medicine at the Pomona Valley Hospital Medical Center in Pomona , Calif.

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Many of the changes that you will experience are triggered by hormones that nurture the baby and prepare your body for childbirth and nursing. Additionally, as your baby grows, the size of your uterus increases to about 1000 times its original size putting strain on the organs that surround the uterus, on your back muscles and causing a change in your posture.
 

Table1.            Symptoms of Pregnancy      NORMAL       ABNORMAL Breast tenderness Constipation Frequent urination Heartburn Hemorrhoids Mood swings Nausea Stuffy nose Bleeding Headache unrelieved by analgesic. Painful urination Stomach pains Swelling of one leg Visual problems  Weight loss

Your breasts may be one of the first indicators of your pregnancy. By 6 - 8 weeks your breasts will be noticeably larger they will continue to grow in size and weight throughout the first trimester. They are usually firm and tender and the nipples and areolas will darken. The small glands in the areola will become raised and bumpy. By 12 -14 weeks the breasts may begin producing colostrum, this fluid may leak from your breast by itself or if you massage your breasts.

Nausea and vomiting are also common findings during the first 3 months, but may occur throughout the pregnancy. Although it is referred to as morning sickness it can occur any time during the day particularly on an empty stomach. It is not unusual for a woman to loose some weight during the early part of the pregnancy but if this becomes excessive you should notify your physician. 

Heartburn , indigestion and constipation are also a common finding because changes in hormones slow the movement of food through the digestive tract. During the last part of pregnancy pressure on your rectum to your uterus often worsens the constipation. 

Hemorrhoids, swollen veins in the rectum, are also very common and can sometimes cause bleeding while having a bowel movement. If the bleeding is excessive notify your physician. Swollen veins (varicosities), also appear frequently in the legs but can also be found in the vulva and vagina. Varicosities can be uncomfortable but usually they are not a serious condition.
 

Table 2.       Safe Medications For Some Common                           Problems During Pregnancy Symptom  Medication Heartburn TUMs® Constipation Metamucil® , Citrucel®, Docusate (Colace®, Ducolax ®) Milk of magnesia. Hemorrhoids Tucks® Preparation H® Anusol®

Groin or lower abdominal pain is also a common finding as the round ligaments that support the uterus are stretched. 

There is also a need to urinate frequently caused by the pressure of the growing uterus on the bladder. As the pregnancy continues it may also be normal to leak some urine. If you have pain when you urinate or if you often feel you need to urinate right away you should consult your physician. 

The growing uterus can also put pressure on certain nerves causing numbness and tingling in the legs and toes and low back pain. This is usually not serious and will go away after the baby is born. 

A certain amount of water retention manifested as swelling in the ankles is very common particularly in the third trimester. If the swelling involves your hands and face this can be a manifestation of toxemia and you should notify your doctor. 

Leg cramps are also common in the third trimester particularly during sleep, these may be avoided by stretching your legs before going to bed. 

False labor or Braxton-Hicks contractions can start as early as the fifth month of your pregnancy. Maintaining good hydration and emptying your bladder frequently can minimize the symptoms. If contractions become regular and last for more than one hour you should contact your physician. 

Pregnancy is a time of not only physical changes but also emotional changes. Because of your increased hormone levels you may be irritable and have unpredicted mood swings. You may also feel anxious and depressed. Good nutrition with regular periods of rest and relaxation and setting special time aside for you and your partner will help your emotional as well as physical well being. 
 

PRENATAL (BEFORE BIRTH) CARE

Early prenatal care can help keep you and your baby healthy. Your first prenatal checkup will usually be after you have missed your second period (12 to 13 weeks' pregnant). 

Visits are scheduled as follows: