When I was pregnant with my daughter, I was so busy chasing my 2-year-old son I barely had time to breathe, never mind count fetal kicks. I was vaguely aware that her movements had slowed early in the ninth month, but when I went for my prenatal visit at 37 weeks, I didn't think to mention it.
I was leaving the examining room when my obstetrician asked matter-of-factly, "Is she moving okay?" I joked that my baby had run out of room to somersault, and he ordered a nonstress test, "just to be safe." (The test checks the baby's heart rate, which should go up with every movement.) The results were worrisome enough to warrant an ultrasound, which revealed that my amniotic fluid levels were low. Seven hours later, following an emergency induction, I gave birth to a healthy 5-pound, 10-ounce girl. I can't bear to think about what might have happened had my doctor failed to ask about my baby's movement.
While few expectant mothers will ignore such unambiguous trouble signs as vaginal bleeding and abdominal pain, even experienced moms may not notice or report other serious symptoms because they're accepted as normal. Fortunately, most of the unusual symptoms you may experience while pregnant are normal. But it's essential to tell your doctor about some, such as the following.
It's normal for babies to have quiet periods in utero, and a temporary dip in activity could just mean that your baby is sleeping or he's low on energy because you haven't eaten in a while. However, if you sense an overall slowdown in movement, call your doctor. A long lull could signal oligohydramnios, or low amniotic fluid, says Donna Dizon-Townson, MD, assistant professor of obstetrics and gynecology at the University of Utah in Salt Lake City.
If you're uncertain about how often your baby is moving, take time out to count fetal kicks. "Babies respond when their mom eats. So after breakfast or dinner, sit in a quiet room and just focus on how many times the baby is moving," advises Dr. Dizon-Townson. You should detect at least 10 movements in two hours. If you don't, call your healthcare provider.
Low amniotic fluid affects some 10 percent of pregnancies. Often, the mother is simply dehydrated, and drinking plenty of water will resolve the problem, says Dr. Dizon-Townson. Oligohydramnios may also be caused by a rupture in the amniotic sac, the placenta's failure to work properly, or rarely, a defect involving the baby's kidneys or bladder (amniotic fluid is actually baby's urine). In such cases, bed rest can minimize fluid loss and prolong your pregnancy.
However, if you're experiencing this problem after the 38th week of pregnancy or if your baby shows signs of distress (as mine did), your doctor may induce delivery to avoid the danger of the cord getting compressed, cutting off blood flow to the baby. Amniotic fluid serves as a cushion for the umbilical cord, preventing baby from crimping or crushing his own lifeline.
A Pain in the Leg
When Therese McFadden, of Lansdale, Pennsylvania, was six weeks pregnant with her third child, she tried to go running but was stopped in her tracks by a heavy, tight feeling in her left leg. "It felt like the hugest charley horse," she recalls. Her obstetrician advised her to go to the emergency room, where an ultrasound revealed a blood clot.
Pregnancy puts a woman at six times greater risk for blood clots in the deep veins of the legs, called deep vein thrombosis (DVT). Hormonal changes make your blood more likely to clot, says Dr. Dizon-Townson, while the pressure of the growing uterus on your veins can impede circulation, causing blood to pool in your legs and feet.
DVT might be difficult to distinguish from the ordinary leg cramps of pregnancy. But dependable red flags are that the symptoms occur in just one leg and the area is red, painfully swollen, and warm to the touch.
Unfortunately, DVT can also be silent. In such cases, the first "symptom" may be pulmonary embolism, when a piece of the clot breaks away and travels to the lung. If you experience shortness of breath, chest pain, or a rapid heart rate, call your doctor or 911. McFadden was promptly admitted to the hospital, where she received the blood-thinning drug heparin to dissolve her clot. She was sent home with Lovenox, a self-injectable form of heparin, to prevent additional clots.
Women who are older, overweight, or genetically predisposed to clotting are at higher risk for DVT, as are those put on bed rest. If you're ordered off your feet for another pregnancy complication, your doctor may recommend you take heparin or wear special compression stockings to promote circulation, says Dr. Dizon-Townson.
For women who are otherwise healthy, staying active and well-hydrated may help to prevent clots, she adds. It's also important to get on your feet in the hours and days after delivery, when DVT risk remains high.
Hormonal changes in pregnancy make women more susceptible to bacterial gingivitis -- swollen, red gums that may bleed when brushed -- caused by bacteria and plaque buildup in the mouth. But while bleeding gums are common in pregnancy, affecting up to 75 percent of moms-to-be, that doesn't mean they're normal, warns Marjorie Jeffcoat, DMD, dean of the school of dental medicine at the University of Pennsylvania.
If left unchecked, gingivitis can progress to periodontal (gum) disease, which can destroy the gum fibers and bone that hold your teeth in place. And the risks in pregnancy go beyond tooth loss: Pregnant women with periodontal disease are up to eight times more likely to deliver their babies prematurely, reports Dr. Jeffcoat. One possible explanation, she says, is that a gum infection causes a surge in a hormone that triggers labor.
To prevent these problems, keep up good brushing and flossing habits during pregnancy and visit the dentist for your regular dental cleaning and checkup. Even for women who develop gum disease, a basic cleaning in the second trimester can cut their risk for premature delivery in half, says Dr. Jeffcoat.
These women may also want to consider a nonsurgical dental procedure, called scaling and root planing. It involves cleaning plaque and tartar from beneath the gumline.
More than a third of pregnant women snore, even if they didn't before pregnancy. While snoring may seem like a minor annoyance, the noisy nighttime condition may raise your risk for complications, including slowed fetal growth. In a recent Swedish study, pregnant snorers were more than twice as likely as non-snorers to develop hypertension or preeclampsia, and their babies had lower birth weights and poorer Apgar scores.
Snorers may be prone to these complications because during sleep, their upper airways relax and partially close, preventing them from inhaling enough oxygen and exhaling enough carbon dioxide, says Natalie Edwards, PhD, a researcher in the department of medicine at the University of Sydney in Australia. The excess carbon dioxide in their system triggers blood vessels to constrict, raising blood pressure and reducing blood flow, including to the placenta.
Unfortunately, the hormonal changes, weight gain, and fluid retention (which can swell the upper airways) that come with pregnancy put moms-to-be at higher risk for both snoring and sleep apnea, a related and more serious condition in which a person momentarily stops breathing up to 800 times nightly.
Aside from a complaining spouse, the major clue that you snore or suffer from sleep apnea is daytime sleepiness, says Edwards. Both conditions can repeatedly stir you from deep sleep, leaving you exhausted. Of course this fatigue can be tough to distinguish from the usual fatigue of pregnancy, but if you nod off within minutes of lying down, regardless of the time of day, it could be a red flag.
A nondrug treatment for sleep apnea and snoring, called continuous positive airway pressure, can help to lower risks for snoring pregnant women with hypertension or preeclampsia, up to 90 percent of whom snore, says Edwards. During sleep, the snorer wears a nose mask attached to a machine, which blows a constant flow of filtered air through the nose and throat, keeping the upper airways from narrowing or collapsing, says Edwards.
Don't bother with over-the-counter nose strips such as Breathe Rite. They aren't effective for pregnancy-related snoring. The remedy only works when snoring is caused by a blocked nose, such as from nasal congestion, says Edwards.
Studies show depression during pregnancy is even more common than postpartum depression, affecting as many as 1 in 8 women. Yet it often goes unaddressed because women may miss or dismiss the warning signs, says Ruta Nonacs, MD, PhD, author of Baby Blues (Simon & Schuster, 2004).
"We hear a lot about mood swings during pregnancy, and so I think many pregnant women who are depressed discount it as a normal experience," says Dr. Nonacs. But while pregnancy may trigger some ups and downs, the lows of depression are chronic and pervasive, causing a woman to lose interest in or become unhappy with her work, relationships, and even her pregnancy. In severe cases, a depressed woman may become obsessed with thoughts of dying.
Treating depression in pregnancy is vital for the health of both mother and baby, says Dr. Nonacs. Depressed pregnant women are less likely to keep prenatal appointments, eat a healthy diet, and avoid alcohol and tobacco. Depression also causes a surge in stress hormones such as cortisol, further raising the risk for pregnancy complications. Studies have linked depression in pregnancy to preeclampsia and preterm labor. Moreover, 75 percent of these women go on to suffer postpartum depression.
The first-choice treatment for depression in pregnancy is psychotherapy, says Dr. Nonacs, but women should not rule out antidepressants. In studies, selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Zoloft have not been found to cause birth defects. And though some recent research suggests that newborns exposed to SSRIs in utero experience more tremors, spontaneous startles, and rapid eye movement (REM) sleep, such side effects, says Dr. Nonacs, typically resolve quickly and without medical treatment. More important, she adds, studies have found no long-term effects on the cognitive development of children exposed to antidepressants in the womb.
When Emily Fagiano, of Peterboro, New Hampshire, was eight months pregnant with her second son, she was diagnosed with hyperthyroidism, or an overactive thyroid. But it wasn't her obstetrician who detected the problem -- it was the endocrinologist she regularly sees for the type 1 diabetes she's had since childhood. "My obstetrician mistook my symptoms for the normal side effects of third-trimester pregnancy," says Fagiano, who remembers being chronically warm, unable to sleep, and often anxious or irritable.
Women who are predisposed to thyroid disorders are more likely to see them surface for the first time during pregnancy, says P. Reed Larsen, MD, division chief of endocrinology, diabetes, and hypertension at Brigham and Women's Hospital in Boston. But getting a diagnosis can be difficult, since many of the signs of overactive thyroid (chronic warmth, nervousness, heart palpitations, insomnia) or underactive thyroid (fatigue, weight gain, constipation, hair and skin changes) mirror common symptoms of pregnancy.
Yet it's vital that thyroid dysfunctions be managed in pregnancy. Untreated hyperthyroidism puts a mother at risk for cardiac irregularities and weight loss, and in severe cases, may cause fetal malnutrition or birth defects, says Dr. Larsen. Meanwhile, untreated hypothyroidism (underactive thyroid) raises the danger of miscarriage and may compromise baby's brain development. Fortunately, treatment during pregnancy virtually eliminates these risks.
Since pregnant women are not routinely screened for thyroid disorders, women with suspicious symptoms or risk factors -- particularly a personal or family history of thyroid or autoimmune diseases -- should request testing. (Fagiano has both autoimmune diabetes and a mother with hypothyroidism.) Women are treated easily with either a thyroid hormone replacement or antithyroid pill they need to take daily.
Screening for preeclampsia, or pregnancy-induced high blood pressure, is routine at prenatal visits, but every woman should know the warning signs of this serious pregnancy complication, says John T. Repke, MD, chair of obstetrics and gynecology at Penn State.
Preeclampsia, which usually develops after the 20th week of pregnancy, reduces blood flow to the baby and can cause health problems for Mom. Women at greatest risk are those with a family or personal history of preeclampsia, high blood pressure, or preexisting diabetes; or women who are obese or carrying more than one baby. Call your doctor immediately if you experience any of the following:
- Recurring or unremitting headaches
- Excessive swelling of feet, hands, or face
- Abdominal pain, particularly on the right side
- Rapid weight gain (i.e, 10 pounds in 4 days)
- Blurred vision; seeing light flashes or spots
- Flu-like achiness without the usual runny nose or sore throat
Marguerite Lamb is a mother of two in Glastonbury, Connecticut.
Originally published in American Baby magazine, December 2004.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.