The First Signs of Pregnancy

When women who are trying to get pregnant come in to see me, one question on their minds is often: how will I know when I’m pregnant? In this article, I talk about the most common early symptoms of pregnancy.

Often the first clue that a woman is pregnant is a missed or late period. And in modern America a common second sign is a positive home pregnancy test. Over-the-counter tests available at most pharmacies and many other stores can detect a pregnancy just about the time that a woman misses her period, about two weeks after conception. The urine tests measures low levels of a pregnancy specific hormone—beta human chorionic gonadotropin, often referred to as beta-hcg. If you follow the instructions and use a recently purchased kit, the at-home urine tests are pretty reliable. Many women wonder if a blood test given by their doctor is better in some way. The big difference is that a blood test can detect a pregnancy a few days earlier. But at that point, before the period is even missed, many women aren’t even suspicious that they are pregnant. So blood testing for pregnancy isn’t routinely needed.

But not all women have regular cycles and some that do may not be focusing on the dates of their periods closely enough to know that they are pregnant. Other early signs of a pregnancy are breast swelling and tenderness, fatigue and changes in your skin. I had one patient who knew she was pregnant every time her face “broke out.” To be sure, even women who are not pregnant often have these symptoms. But noticing them may prompt you to think about your period or go buy a kit for pregnancy testing.

And then there is the dreaded morning sickness. This only rarely occurs before week 6 of pregnancy (4 weeks after conception…remember pregnancy weeks count two when you weren’t even pregnant by measuring from the last menses) and sometimes may start as late as the end of the first trimester (13 weeks). Some lucky individuals never have any morning sickness, but 50%-75% of women note some nausea, food aversions, or sensitivities to tastes and smells. Calling it morning sickness is misleading—symptoms can occur at any hour, and too many patients have told me that the name really should be “all day sickness.”

In some women, morning sickness can be severe, with nausea that results in vomiting, the inability to keep anything down, and eventual weight loss and worry. Years ago, it was incorrectly thought that morning sickness was a psychological condition—a mother’s emotional rejection of her pregnancy. We now recognize that theory for what it was—nonsense. But even though morning sickness doesn’t have psychological origins, it will sure play with your patience and emotions.

            What to do, if you are affected by morning sickness?  Here are some tips that may help:

°         Get extra rest

°         Keep your stomach from becoming completely empty by eating frequent smaller meals

°         Eat dry crackers when you get up in the morning

°         Avoid fried, spicy, and acidic foods

°         Be attentive to smells, noises, and other things that trigger your nausea, and avoid them.

°         Take extra vitamin B6 (25-50 mg two or three times a day either alone or as part of a B-complex vitamin).

             But mostly, it’s time that makes things better: morning sickness usually disappears by the end of the first trimester. Although many women worry about the effect of nausea on their pregnancy, such fears are largely unnecessary. Even if your nausea is so severe that you lose weight during early pregnancy, your baby is well protected in your uterus. If, however, you can keep nothing down and start to feel dizzy or lightheaded, or notice that your urine has decreased in volume and turned very dark, you should call your obstetrical care provider (or primary care doctor). He or she may want to see you and may recommend intravenous fluid or medicines to help control the nausea.

Some women worry when they don't feel any changes during early pregnancy. They become concerned that because they don't feel nauseated, something must be wrong. If you feel well, be glad: All these symptoms correlate very poorly with the pregnancy's health and outcome. Not feeling sick or tired or swollen is not an indication of a problem.

In as many as 25% of pregnancies, women experience bleeding or spotting in early pregnancy. Although the cause of the bleeding is often unclear, it may occur because of loosening of the placental attachment to the uterine wall. Bleeding does not necessarily mean a problem—many such pregnancies proceed without further problems.

Bleeding may, however, be an indication of a condition that requires medical attention. Bleeding can be an early sign of miscarriage or, rarely, a pregnancy developing in the fallopian tube. The latter condition, although unusual, can cause serious complications. You should call your obstetrical care provider if you experience bleeding or spotting after conception. This is particularly important if you experience cramps or other abdominal pains in addition to bleeding or spotting, if the bleeding is heavy enough to soak a maxi pad, or if you have had a tubal pregnancy in the past. Your obstetrical care provider may wish to see you, to be sure that there is nothing serious to worry about. If you haven’t identified someone who will care for your pregnancy yet, call your primary care provider or seek help through a walk in clinic or (last resort) emergency room.

Do you have any questions about early signs of pregnancy? If so, post them here.

Jeffrey Ecker, M.D., is an attending perinatologist (high-risk obstetrician) at Massachusetts General Hospital. He is also an Associate Professor at Harvard Medical School.

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