What to Expect in the First Trimester

You're pregnant! Now let the questions about everything begin. We pulled together a guide for the first trimester to satisfy the little voice inside your head (and hopefully put your mind at ease). Keep reading to learn about early pregnancy symptoms, prenatal tests, essential health considerations, and more.

First Trimester Symptoms

During the first trimester, you will no doubt experience a variety of symptoms that can range from subtle to obvious. And you may wonder if they are typical symptoms; for example, is that fatigue from work or could it be your baby bump? Here are some first-trimester symptoms to know about.

Food aversions (and cravings)

Being repelled by specific tastes and smells is expected in the first trimester. "Your digestion is slowing down, so some formerly appealing foods become intolerable," explains certified nurse-midwife Lisa Kane Low, Ph.D., R.N., a faculty member at the University of Michigan School of Medicine. Ignoring an aversion may only make you feel sicker, so don't feel you have to eat something just because you think it's good for you.

Cravings are the flip side of aversions: Although the cause is unknown, they may simply be your body's way of telling you to eat what you can stand. Unless they could be harmful, go ahead and indulge them.

Breast Changes

"Pregnant women always think of their bellies as the focal point," says Dr. Kane Low, "but usually the first physical symptom they notice is a too-tight bra." In fact, the symptoms of early pregnancy—such as acne, mood swings, cramps, and especially swollen, tender breasts—closely resemble PMS.

Fatigue

Extreme fatigue is very common in the first trimester of pregnancy. "Your metabolic rate—the amount of energy you burn just to exist—is way above normal then," explains Dr. Kane Low. The emotional ups and downs can also take their toll on you.

Fatigue should let up in your second trimester. But if it doesn't, you may be anemic—more than 50% of pregnant people are iron-deficient to some degree by week 28, according to Susan Watts, M.D., an obstetrician-gynecologist at Presbyterian Hospital of Dallas.

Weight Gain

While the average weight gain during the first trimester is about 5 pounds, some people actually lose weight because of morning sickness and food aversions. If it happens to you, don't panic: You'll soon see the numbers on the scale climb.

Just remember that pregnancy is not the time to go on a diet, but rather to eat as healthfully as you can (some people prefer eating six small meals throughout the day). "Anytime you deprive your body of the nutrients it needs, it has to rob them from someplace else," explains Dr. Kane Low. That means invading emergency stores of calcium or iron, for example.

Nausea

Increased sensitivity to low blood sugar and higher levels of the pregnancy hormones estrogen and Beta HCG can contribute to nausea. The following may help:

• Eat often. An empty stomach worsens nausea.
• Sniff lemons or snack on lemon-flavored foods.
• Drink at least eight glasses of water a day.
• Try sports beverages, such as Gatorade. They also supply glucose and essential minerals.
• Have a protein-rich bedtime snack. Protein keeps your stomach feeling full longer, making it easier to face the morning.
• Wear acupressure wristbands, such as Sea-Bands or the ReliefBand.
• Move. Exercise diverts blood from your stomach, alleviating nausea.
• Brush before eating. Toothbrushing stimulates the gag reflex.

First Trimester Tests and Appointments

You may be surprised to learn that being pregnant will mean lots of tests and appointments. Here are a few you can expect during the first trimester.

Pregnancy Tests

According to a report in the Journal of the American Medical Association, there's a 10% chance that you'll get a false negative reading if you take a pregnancy test on the first day you miss your period. That's because only 90% of pregnancies are detectable that early. If you mistakenly believe you are not pregnant, you might not avoid potentially harmful substances. In the interest of safety, assume (and act as if) you are pregnant and retest a week later.

OB-GYN Appointments

Call your doctor for an appointment as soon as you believe you are pregnant. Some will want to see you right away, but others will prefer waiting until you're eight weeks pregnant. Try to schedule prenatal visits so that your partner can come, too.

Ultrasound

Most obstetricians will perform an ultrasound at your first prenatal visit to confirm your pregnancy and date it. Later, you'll probably have a transabdominal ultrasound (like the ones you see on TV), but the early exam may be performed by inserting a plastic wand into your vagina. (Don't worry—it doesn't hurt.)

Due Date

Pregnancy is based on a 40-week (280-day) calendar. To calculate your estimated delivery date, add seven days to the first day of your last normal menstrual period, then add nine months. Your baby is considered full-term if they arrive anywhere from three weeks before to two weeks after this date (more than 90% of babies do). If your menstrual cycle regularly is 28 days long, you're more likely to give birth near your due date.

If your cycle is usually longer than 28 days, you're more likely to deliver later; and if it's shorter, earlier. But the most accurate way to date a pregnancy is via ultrasound measurement of the fetus's crown-to-rump length between eight and 12 weeks.

Chorionic Villus Sampling (CVS)

This diagnostic test for chromosomal disorders such as Down syndrome is usually performed between weeks 10 and 12. Chorionic villus sampling (CVS) can be done earlier than amniocentesis, but unlike amnio, it cannot detect neural-tube defects such as spina bifida.

In addition, says Donald R. Mattison, M.D., senior adviser to the directors of the National Institute of Child Health and Human Development and Center for Research for Mothers and Children, the miscarriage risk is slightly higher with CVS—around 1% vs. less than 1% for amnio.

First Trimester Health Concerns

X and Y Chromosomes

The sperm determines the baby's sex. Here's how it works: The egg and sperm each contribute one chromosome. The egg always carries an X; the sperm, either an X or a Y. If the fertilizing sperm contains an X chromosome, you will have a girl. If it contains a Y, you're having a boy.

Zygote

The fertilized egg, also known as a zygote, is the size of an apple seed when you can confirm that you're pregnant—about two weeks after conception. By week five, it's known as an embryo, and the placenta and umbilical cord are functioning. At eight or nine weeks, it's officially a fetus, and all its organs have been formed. By the end of the first trimester, it'll be almost 3 inches long, and the face will look recognizably human. No wonder you're tired!

Taking Vitamins

Even before you conceive, take a prenatal multivitamin with 400 micrograms of folic acid daily (take 600 micrograms when pregnant). "Folic acid goes a long way toward preventing serious neural-tube defects of the brain and spinal cord," explains Dr. Mattison. Spina bifida is perhaps the most well-known of these problems.

Avoid over-the-counter prenatal vitamins that contain herbals or "natural" products; they are not as strictly regulated. If the vitamins upset your stomach, iron is probably the culprit. Ask your doctor about taking folic acid alone until your morning sickness passes. In the meantime, eat lots of folate and iron-rich foods, such as beans, spinach, and raisins.

Genetic Counseling

If you're at risk of having a baby with an inherited disorder, genetic counseling can help you and your partner decide whether to undergo tests. These tests can determine if either of you is a carrier and see if your fetus is affected. Age and personal and family medical histories are just a few factors to consider when deciding on testing.

Infections

You may be surprised—and concerned—if your doctor prescribes antibiotics to treat a condition such as a simple gum or bladder infection. But infection anywhere in the body may lead to preterm labor. If your obstetrician prescribes antibiotics, it's likely because the benefits outweigh the risks. If another physician prescribes them, get your OB's approval before taking them.

Miscarriage

Fifteen to 20% of all pregnancies end in miscarriage, usually in the first trimester. Many blame themselves when it happens, but no evidence exists that emotional stress, physical activity, or sex causes it. Call your doctor immediately if you begin spotting, bleeding, or cramping.

If you miscarry and need help coping, ask your doctor to recommend a support group or find one online. Helpful books include Empty Cradle, Broken Heart: Surviving the Death of Your Baby by Deborah L. Davis, Ph.D. (Fulcrum, 1999); and Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth and Infant Loss by Ann Douglas and John R. Sussman, M.D. (Taylor, 2000).

First Trimester Life Changes

Exercise

There are many reasons to get (or stay) physical in the first trimester. "Exercise may help alleviate nausea," says Renee Jeffreys, an exercise physiologist and owner of Fitness for Women in Cincinnati. It also boosts energy, reduces stress, and helps you get in shape faster postpartum. (Anecdotal evidence also indicates that prenatal exercise makes for a shorter, easier labor.)

If you're feeling sick, at least walk, if only in 10-minute spurts. Whatever you do, monitor the intensity. Jeffreys suggests using the Borg Scale, which allows you to rate your exertion level from 1 to 10. Sitting would be a 1; an all-out sprint, a 10. If you worked out before becoming pregnant, stay between 3 and 5. If you're new to exercise, aim for 3.

Job Concerns

Before the first trimester is over, visit your company's human resources department to find out how much maternity leave you'll have and whether it will be paid, unpaid, or a combination of both. "You also need to think about your work environment, including chemical exposures, stress, and physical demands," says Dr. Kane Low. Try to avoid heavy lifting or standing for long stretches at a time.

Stress-related risks—such as demanding deadlines, long commutes, and grueling hours—are less tangible but shouldn't be ignored. Put your feet up on a footstool several times daily, ask for help, and delegate, if possible.

Kegels

Although leaking urine shouldn't be an issue this trimester, it's never too soon to start strengthening your pelvic floor muscles. Contract and relax them throughout the day, as though you're stopping and starting the urine flow (called a Kegel).

Labor Preparations

Pregnant people generally start taking childbirth preparation courses, such as Bradley or Lamaze classes, during the second trimester, but classes fill up quickly. Research the options in your area (your doctor or midwife and local hospitals probably have lists), and sign up early. While you're at it, look into breastfeeding and newborn care classes, hospital tours, and, if needed, big sibling classes.

Romance

While some people feel sexy when they're pregnant and enjoy not having to fuss with birth control, others don't want to do anything in bed but sleep. If you've lost your libido, don't fret; you'll probably find it in the second trimester, which many call the honeymoon period of pregnancy.

Baby Bump

You probably won't look pregnant until after your fourth month, when your uterus outgrows the pelvic cavity, but that doesn't mean you'll be able to wear your clothes comfortably until then. Increased estrogen levels promote fat storage in several places, including the waistline.

Telling People

Deciding when and with whom to share your news is a very personal decision, but there are a few things to consider. Keeping your pregnancy a secret will give you and your partner time to absorb the idea privately before others know. While some people wait until the risk of miscarriage drops markedly (at 14 weeks), others spill the beans right away because they'd tell their friends anyway if they miscarried. Telling co-workers is trickier.

You may find that your employer expects the news to be followed by the details of your maternity leave, but you may not have decided yet when to return to work—if ever.

Harmful Stuff to Avoid Your First Trimester

Avoid these things in the first trimester to increase the odds of a healthy pregnancy.

• Alcohol, cigarettes, illicit drugs
• Unheated deli meats, soft-cooked or raw eggs, raw or undercooked meats, raw sprouts
• Handling cat litter or gardening without gloves
• Herbal supplements and teas
• Hot tubs and saunas
• King mackerel, shark, swordfish, and tilefish; raw oysters, mussels, and other mollusks
• Oil-based paints, lead, mercury (found in some latex paints), chemical solvents, oven-cleaning products, and dry-cleaning chemicals
• Over-the-counter and prescription medicines not approved by your doctor
• Soft cheeses, such as brie and feta; unpasteurized milk and juice
• Unnecessary X-rays
• More than 200 mg of caffeine daily