Signs and symptoms of pregnancy

Last updated June 16, 2024

Signs and symptoms of pregnancy are common, benign conditions that result from the changes to the body that occur during pregnancy. Signs and symptoms of pregnancy typically change as pregnancy progresses, although several symptoms may be present throughout. Depending on severity, common symptoms in pregnancy can develop into complications. Pregnancy symptoms may be categorized based on trimester as well as region of the body affected.

Early pregnancy

Many of the early signs of pregnancy will be similar to symptoms that come right before a period, and it can be hard to tell the difference.^[1]^[2]

Implantation bleeding

Implantation bleeding is light vaginal bleeding in the first 10–14 days of pregnancy caused by the normal implantation of the embryo in the uterine lining. Implantation bleeding may be confused with a regular period.^[3]^[4] Heavy vaginal bleeding in the first trimester or bleeding associated with pain, may be a sign of a complication, such as a miscarriage or an ectopic pregnancy, that would need to be assessed by a healthcare provider.^[5]

Breast tenderness

Hormonal changes in early pregnancy can cause breast swelling and tenderness. Breast tenderness typically improves as the body adjusts to the pregnancy.^[4]

Fatigue

Fatigue in the first trimester is common due to changes in hormones.^[6]^[7]

Increased Vaginal Discharge

An increase in vaginal discharge is common during pregnancy due to hormonal changes. The discharge, known as leukorrhea, is usually thin and milky white. However, if the discharge changes color or consistency significantly, it is essential to consult a healthcare provider.^[8]

Nausea and vomiting (morning sickness)

Nausea and vomiting, known as morning sickness, occurs in 80% of pregnant women.^[9] Although described as "morning sickness," pregnant women can experience this nausea any time of day or night. The exact cause of morning sickness remains unknown. Nausea and vomiting in pregnancy is typically mild and self-limited, resolving on its own by the 14th week of pregnancy. Other causes should also be ruled out when considering treatment. Initial treatment is typically conservative, and may include changes to diet and emotional support. For women that do not improve with initial treatment, medications, such as pyridoxine and doxylamine, may also be used.^[9] A rare form of severe nausea and vomiting known as hyperemesis gravidarum can occur in 1% of pregnant women and can affect fetal and maternal health.^[10]

Mid and later pregnancy

Musculoskeletal pain and discomfort

Low back pain and pelvic girdle pain – Pregnancy-related low back pain (PLBP) and pregnancy-related pelvic girdle pain (PGP) are common conditions occurring in an estimated 45% of pregnant women and 25% of postpartum women.^[11] Most of the literature does not distinguish between PLBP and PGP as since their precise definitions often overlap, however it is possible to differentiate them through history taking, clinical examination, provocative test maneuvers, and imaging.^[12] Pregnancy-related low back pain and pelvic girdle pain can occur together or separately. The pain is often dull, intermittent, worse in the evening, and usually occurs within 30 minutes of activities like walking, standing, or sitting.^[12] Both PLBP and PGP can negatively impact quality of life for those affected, and the severity of discomfort typically increases with advancing pregnancy.^[13] During pregnancy, the enlarged abdomen and gravid uterus place additional strain on lumbar muscles and shift the pregnant woman's center of gravity. These postural compensations culminate in an increased load on both lumbar spinal musculature and the sacroiliac ligaments, manifesting as low back pain and/or pelvic girdle pain.^[12] Hormonal changes throughout pregnancy also cause an increase in joint laxity further contributing to the development of PLBP and PGP. Predictors for the development of low-back and pelvic pain during pregnancy include strenuous work, prior lumbo-pelvic pain, and a history of pregnancy-related PGP and LBP. Additional risk factors are advanced maternal age, increased parity, and higher body mass index, and previous pelvic trauma. There is moderate-quality of evidence that interventions such as physical therapy management, osteomanipulative therapy, acupuncture or craniosacral therapy reduce low back pain during pregnancy.^[13] Maternity support belts have not been shown to reduce low back pain in pregnancy.^[14] Land or water based exercise may both prevent and treat lower back and pelvic pain, yet current research in this area is of low quality.^[15]
Carpal tunnel syndrome – Carpal tunnel syndrome can occur in up to 70% of pregnant women and typically has a benign course.^[16]^[17] It manifests as pain, numbness, and tingling in the thumb, index finger, middle finger and the thumb side of the ring finger.^[18] The symptoms of carpal tunnel syndrome during pregnancy are usually mild and do not require treatment. However, if necessary, wrist splinting at night is the initial treatment that is recommended.^[17]
Leg cramps – Leg cramps (involuntary spasms of the calf muscles) can affect between 30% and 50% of pregnant women and most commonly occur in the last three months of pregnancy.^[19] Leg cramps typically last only for a few seconds, however they can be extremely painful and last for minutes.^[20] There is not clear evidence whether oral electrolyte and vitamin treatments (such as magnesium, calcium, vitamin B or vitamin C) are effective in treating leg cramps during pregnancy.^[21]
Round Ligament pain – Round ligament pain commonly occurs in the second trimester and manifests as a sudden, sharp pain in the groin area or lower abdomen, on one or both sides. Typically the pain only lasts for a few seconds. During pregnancy, the growing uterus can put stress on the round ligament of the uterus, causing it to stretch and lead to pain. Paracetamol (acetaminophen) is the recommended pain reliever for pregnant women with round ligament pain.

Fluid imbalance and kidney function

Dehydration – Caused by expanded intravascular space and increased third spacing of fluids. Complications include uterine contractions, which may occur because dehydration causes body release of ADH, which is similar to oxytocin in structure. Oxytocin itself can cause uterine contractions and thus ADH can cross-react with oxytocin receptors and cause contractions.
Swelling/Edema – Swelling occurs when excess fluid accumulates in regions of the body, resulting in abnormal enlargement or "puffiness." This commonly occurs in the upper and lower extremities. Compression of the inferior vena cava (IVC)^[22] and pelvic veins by the uterus leads to increased hydrostatic pressure in the vasculature of the lower extremities. This increase in pressure shunts fluid from within the vasculature to the extracellular space. Treatment includes raising legs above the heart, advising patient to sleep on her side to prevent the uterus from compressing the inferior vena cava, reflexology, water emersion^[23] & compression stockings.
Increased urinary frequency – Caused by increased intravascular volume, elevated GFR (glomerular filtration rate), and compression of the bladder by the expanding uterus. It may appear rather suddenly by head engagement of the fetus into cephalic presentation. Doctors advise pregnant women to continue fluid intake despite this. Urinalysis and culture are ordered to rule out infection, which can also cause increased urinary frequency but typically is accompanied by dysuria (pain when urinating).^[24]

Gastrointestinal (GI)

Heartburn – Heartburn (Regurgitation) is a burning pain in the chest, behind the breastbone that occurs when stomach acid travel up the esophagus and causes irritation. This sometimes happens in pregnancy due to relaxation of the lower esophageal sphincter (LES), which normally keeps acidic stomach contents in the stomach. Additionally, heartburn is worsened when the growing fetus increases intra-abdominal pressure, thereby compressing the stomach and pushing stomach contents through the relaxed lower esophageal sphincter (LES). The acidic contents of the stomach irritate the lining of the esophagus, resulting in a burning sensation in the mid chest. Regurgitation and heartburn in pregnancy can be at least alleviated by eating multiple small meals a day, avoiding eating within three hours of going to bed, and sitting up straight when eating.^[25]^[26] If diet and lifestyle changes are not enough, antacids and alginates may be required to control indigestion, particularly if the symptoms are mild.^[26] Surgical repair may also be indicated.^[27] If these, in turn, are not enough, proton pump inhibitors may be used.^[26] If more severe, it may be diagnosed as gastroesophageal reflux disease (GERD).
Constipation – Constipation occurs in 11–38% of pregnant women.^[28] Constipation during pregnancy is thought to be due to decreased smooth muscle motility in the bowel caused by normal increases in progesterone.^[29] Treatment for constipation includes dietary modifications, including increased fiber and fluid intake, stool softeners, and laxatives.^[28]
Hemorrhoids – Hemorrhoids are enlarged veins near or inside the rectum. Hemorrhoids are common in pregnancy as a result of constipation and increased intra-abdominal pressure. Hemorrhoids can cause bleeding, pain, and itching.^[30] Treatment is symptomatic, including improving underlying constipation. Symptoms may resolve spontaneously after pregnancy, although hemorrhoids may remain in the days after childbirth.^[31]

Skin and vasculature changes

Diastasis recti – During pregnancy, the growth of the fetus exerts pressure on the abdominal muscles. On occasion, women experience a separation of their rectus abdominis. The rectus abdominis is divided centrally (mid-line) by the fibrous linea alba.^[32] In pregnancies that experience rapid fetus growth or in women with weak abdominal muscles, this pressure can cause the rectus abdominis muscle to separate along the linea alba, creating a split between the left and right sides of the rectus abdominis.^[33] Diastasis recti is common, and occurs more frequently as pregnancy progresses, up to and including labor.^[34] Elevated BMI, multiparity (twins, triplets, etc.), and diabetes have been identified as risk factors.^[35] Many cases of diastasis recti correct themselves after birth. In cases that persist, exercise may help, but sometimes surgery is needed to improve symptoms and prevent chronic problems.^[36]^[37]
Varicose veins -Dilation of veins in legs caused by relaxation of smooth muscle and increased intravascular pressure due to fluid volume increase.^[38] Treatment involves elevation of the legs and pressure stockings to relieve swelling along with warm sitz baths to decrease pain.^[39] There is a small amount of evidence that rutosides (a herbal remedy) may relieve symptoms of varicose veins in late pregnancy but it is not yet known if rutosides are safe to take in pregnancy.^[23] Risk factors include obesity, lengthy standing or sitting, constrictive clothing and constipation and bearing down with bowel movements.
Striae gravidarum (stretch marks) – pregnancy-related stretch marks occur in 50% to 90% of women,^[40] and are caused both by the skin stretching and by the effects of hormonal changes on fibers in the skin.^[41] They are more common in younger women, women of color, women having larger babies and women who are overweight or obese, and they sometimes run in families.^[41] Stretch marks generally begin as red or purple stripes (striae rubra), fading to pale or flesh-color (striae alba) after pregnancy that will generally be permanent.^[40]^[41]^[42] They appear most commonly on the abdomen, breasts, buttocks, thighs, and arms, and may cause itching and discomfort.^[40]^[41] Although several kinds of multi-component creams are marketed and used, along with vitamin E cream, cocoa butter, almond oil and olive oil, none have been shown to prevent or reduce stretch marks in pregnancy.^[40]^[41] The safety for use in pregnancy of one herbal ingredient used in some products, Centella asiatica, has been questioned.^[41] Some treatments used to reduce scarring, such as topical tretinoin lasers,^[42] are sometimes used on stretch marks, but evidence on them is limited.^[41] Topical tretinoin has been shown to cause malformations in animals, without adequate human studies on safety in human pregnancies.^[43]
Generalized itching – It is a quite common complaint in pregnancy to have generalized itching which is not due to any systemic disease or any skin lesion.^[44] The itching is very frustrating and it may disturb sleep which leads to exhaustion and impaired quality of life. There is no clear satisfying treatment for this symptom. More research is needed to define a possible, effective, and safe management.^[44]

Related Research Articles

Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. The pain may be described as sharp, dull, or crampy. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. Severe bleeding may result in a fast heart rate, fainting, or shock. With very rare exceptions, the fetus is unable to survive.

<span class="mw-page-title-main">Constipation</span> Bowel dysfunction

Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement. Complications from constipation may include hemorrhoids, anal fissure or fecal impaction. The normal frequency of bowel movements in adults is between three per day and three per week. Babies often have three to four bowel movements per day while young children typically have two to three per day.

Heartburn, also known as pyrosis, cardialgia or acid indigestion, is a burning sensation in the central chest or upper central abdomen. Heartburn is usually due to regurgitation of gastric acid into the esophagus. It is the major symptom of gastroesophageal reflux disease (GERD).

Dysmenorrhea, also known as period pain, painful periods or menstrual cramps, is pain during menstruation. Its usual onset occurs around the time that menstruation begins. Symptoms typically last less than three days. The pain is usually in the pelvis or lower abdomen. Other symptoms may include back pain, diarrhea or nausea.

A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on whether the prolapsed section is visible externally, and whether the full or only partial thickness of the rectal wall is involved.

The rectus abdominis muscle, also known as the "abdominal muscle" or simply the "abs", is a pair of segmented skeletal muscle on the ventral aspect of a person's abdomen. The paired muscle is separated at the midline by a band of dense connective tissue called the linea alba, and the connective tissue defining each lateral margin of the rectus abdominus is the linea semilunaris. The muscle extends from the pubic symphysis, pubic crest and pubic tubercle inferiorly, to the xiphoid process and costal cartilages of the 5th–7th ribs superiorly.

Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure. Complications for the mother can include disseminated intravascular coagulopathy and kidney failure. Complications for the baby can include fetal distress, low birthweight, preterm delivery, and stillbirth.

<span class="mw-page-title-main">Vaginal bleeding</span> Medical condition

Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductive system, such as abnormal uterine bleeding.

Complications of pregnancy are health problems that are related to, or arise during pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality.

Symphysis pubis dysfunction (SPD), commonly known as pubic symphysis dysfunction or lightning crotch, is a condition that causes excessive movement of the pubic symphysis, either anterior or lateral, as well as associated pain, possibly because of a misalignment of the pelvis. Most commonly associated with pregnancy and childbirth, it is diagnosed in approximately 1 in 300 pregnancies, although some estimates of incidence are as high as 1 in 50.

Pubic symphysis diastasis is the separation of normally joined pubic bones, as in the dislocation of the bones, without a fracture that measures radiologically more than 10 mm. Separation of the symphysis pubis is a rare pathology associated with childbirth and has an incidence of 1 in 300 to 1 in 30,000 births. It is usually noticed after delivery but can be observed up to six months postpartum. Risk factors associated with this injury include cephalopelvic disproportion, rapid second stage of labor, epidural anesthesia, severe abduction of the thighs during delivery, or previous trauma to the pelvis. Common signs and symptoms include symphyseal pain aggravated by weight-bearing and walking, a waddling gait, pubic tenderness, and a palpable interpubic gap. Treatment for pubic symphysis diastasis is largely conservative, with treatment modalities including pelvic bracing, bed rest, analgesia, physical therapy, and in some severe cases, surgery.

Diastasis recti, or rectus abdominis diastasis, is defined as a gap of about 2.7 cm or greater between the two sides of the rectus abdominis muscle. The distance between the right and left rectus abdominis muscles is created by the stretching of the linea alba, a connective collagen sheath created by the aponeurosis insertions of the transverse abdominis, internal oblique, and external oblique. This condition has no associated morbidity or mortality. Physical therapy is often required to repair this separation and surgery is an option for more severe cases. Standard exercise rarely results in complete healing of the separated muscles.

Pelvic girdle pain can be described as a pregnancy discomfort for some women and a severe disability for others. PGP can cause pain, instability and limitation of mobility and functioning in any of the three pelvic joints. PGP has a long history of recognition, mentioned by Hippocrates and later described in medical literature by Snelling.

The affection appears to consist of relaxation of the pelvic articulations, becoming apparent suddenly after parturition or gradually during pregnancy and permitting a degree of mobility of the pelvic bones which effectively hinders locomotion and gives rise to the most peculiar and alarming sensations.

Ovarian diseases refer to diseases or disorders of the ovary.

A heterotopic pregnancy is a complication of pregnancy in which both extrauterine (ectopic) pregnancy and intrauterine pregnancy occur simultaneously. It may also be referred to as a combined ectopic pregnancy, multiple‑sited pregnancy, or coincident pregnancy.

A postpartum disorder or puerperal disorder is a disease or condition which presents primarily during the days and weeks after childbirth called the postpartum period. The postpartum period can be divided into three distinct stages: the initial or acute phase, 6–12 hours after childbirth; subacute postpartum period, which lasts two to six weeks, and the delayed postpartum period, which can last up to six months. In the subacute postpartum period, 87% to 94% of women report at least one health problem. Long term health problems are reported by 31% of women.

Round ligament pain (RLP) is pain associated with the round ligament of the uterus, usually during pregnancy. RLP is one of the most common discomforts of pregnancy and usually starts at the second trimester of gestation and continues until delivery. It usually resolves completely after delivery although cases of postpartum RLP have been reported. RLP also occurs in nonpregnant women.

<span class="mw-page-title-main">Uterine incarceration</span> Medical condition

Uterine incarceration is an obstetrical complication whereby a growing retroverted uterus becomes wedged into the pelvis after the first trimester of pregnancy.

Early pregnancy bleeding refers to vaginal bleeding before 14 weeks of gestational age. If the bleeding is significant, hemorrhagic shock may occur. Concern for shock is increased in those who have loss of consciousness, chest pain, shortness of breath, or shoulder pain.

Sleep problems in women can manifest at various stages of their life cycle. Both subjective and objective data indicate that women are at an increased risk of experiencing different types of sleeping problems during different life stages. Factors such as hormonal changes, aging, psycho-social aspects, physical and psychological conditions, and the presence of sleeping disorders can disrupt women's sleep. Research supports the presence of disturbed sleep during the menstrual cycle, pregnancy, postpartum period, and menopausal transition. The relationship between sleep and women's psychological well-being suggests that the underlying causes of sleep disturbances are often multi-factorial throughout a woman's lifespan.

References

↑ "Symptoms of pregnancy: What happens first". Mayo Clinic. Retrieved 30 June 2022.
↑ "The 14 Earliest Pregnancy Symptoms to Look Out For". What to Expect. Retrieved 25 June 2023.
↑ "Is implantation bleeding normal in early pregnancy?". Mayo Clinic. Retrieved 24 October 2020.
1 2 "Symptoms of pregnancy: What happens first". Mayo Clinic. Retrieved 13 September 2021.
↑ "Bleeding During Pregnancy". www.acog.org. Retrieved 30 June 2022.
↑ "1st trimester pregnancy: What to expect". Mayo Clinic. Retrieved 13 September 2021.
↑ Poole, C. J. (September 1986). "Fatigue during the first trimester of pregnancy". Journal of Obstetric, Gynecologic & Neonatal Nursing. 15 (5): 375–379. doi:10.1111/j.1552-6909.1986.tb01409.x. ISSN 0884-2175. PMID 3639925.
↑ Masuk, Mahmud (23 November 2023). "Symptoms of Pregnancy | Signs of Pregnancy". Take Your Life Words. Retrieved 13 January 2024.
1 2 Quinla, Jeffrey D.; Hill, D. Ashley (1 July 2003). "Nausea and vomiting of pregnancy". American Family Physician. 68 (1): 121–128. ISSN 0002-838X. PMID 12887118.
↑ Herrell, Howard Ernest (15 June 2014). "Nausea and vomiting of pregnancy". American Family Physician. 89 (12): 965–970. ISSN 1532-0650. PMID 25162163.
↑ Vermani, Era; Mittal, Rajnish; Weeks, Andrew (2010). "Pelvic Girdle Pain and Low Back Pain in Pregnancy: A Review". Pain Practice. 10 (1): 60–71. doi:10.1111/j.1533-2500.2009.00327.x. ISSN 1533-2500. PMID 19863747. S2CID 1847620.
1 2 3 Casagrande, Danielle; Gugala, Zbigniew; Clark, Shannon M.; Lindsey, Ronald W. (September 2015). "Low Back Pain and Pelvic Girdle Pain in Pregnancy". JAAOS – Journal of the American Academy of Orthopaedic Surgeons. 23 (9): 539–549. doi: 10.5435/JAAOS-D-14-00248 . ISSN 1067-151X. PMID 26271756. S2CID 20678117.
1 2 Liddle, Sarah D; Pennick, Victoria (30 September 2015). "Interventions for preventing and treating low-back and pelvic pain during pregnancy". The Cochrane Database of Systematic Reviews. 2015 (9): CD001139. doi:10.1002/14651858.CD001139.pub4. ISSN 1469-493X. PMC 7053516 . PMID 26422811.
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↑ Liddle, SD; Pennick, V (30 September 2015). "Interventions for preventing and treating low-back and pelvic pain during pregnancy". The Cochrane Database of Systematic Reviews. 2015 (9): CD001139. doi:10.1002/14651858.CD001139.pub4. PMC 7053516 . PMID 26422811.
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1 2 Mondelli, M.; Rossi, S.; Monti, E.; Aprile, I.; Caliandro, P.; Pazzaglia, C.; Romano, C.; Padua, L. (September 2007). "Long term follow-up of carpal tunnel syndrome during pregnancy: a cohort study and review of the literature". Electromyography and Clinical Neurophysiology. 47 (6): 259–271. ISSN 0301-150X. PMID 17918501.
↑ Burton, Claire; Chesterton, Linda S; Davenport, Graham (26 April 2014). "Diagnosing and managing carpal tunnel syndrome in primary care". British Journal of General Practice. 64 (622): 262–263. doi:10.3399/bjgp14x679903. ISSN 0960-1643. PMC 4001168 . PMID 24771836.
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1 2 3 Treatments for indigestion and heartburn in pregnancy from National Health Service in the United Kingdom. Page last reviewed: 19/11/2012
↑ Olsson, Anders; Kiwanuka, Olivia; Wilhelmsson, Sofia; Sandblom, Gabriel; Stackelberg, Otto (6 September 2021). "Surgical repair of diastasis recti abdominis provides long-term improvement of abdominal core function and quality of life: a 3-year follow-up". BJS Open. 5 (5). doi:10.1093/bjsopen/zrab085. ISSN 2474-9842. PMC 8438255 . PMID 34518875.
1 2 Vazquez, Juan C (20 February 2008). "Constipation, haemorrhoids, and heartburn in pregnancy". BMJ Clinical Evidence. 2008. ISSN 1752-8526. PMC 2907947 . PMID 19450328.
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↑ Staroselsky, Arthur; Nava-Ocampo, Alejandro A.; Vohra, Sabina; Koren, Gideon (February 2008). "Hemorrhoids in pregnancy". Canadian Family Physician. 54 (2): 189–190. ISSN 0008-350X. PMC 2278306 . PMID 18272631.
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↑ Saladin, Kenneth S. (2012). Anatomy & Physiology: the Unity of Form and Function (6th ed.). New York NY: McGraw-Hill.
↑ "Separated Muscles". Pregnancy Info: Birth, Baby, and Maternity Advice. 2011.
↑ Rohmann, Riana (11 August 2011). "Exercises To Correct Abdominal Separation After Pregnancy". livestrong.com.
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↑ Pictures from: Mayo Clinic and GymCompany
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1 2 3 4 Brennan, M; Young, G; Devane, D (14 November 2012). "Topical preparations for preventing stretch marks in pregnancy". The Cochrane Database of Systematic Reviews. 2012 (11): CD000066. doi:10.1002/14651858.CD000066.pub2. PMC 10001689 . PMID 23152199.
1 2 3 4 5 6 7 Tunzi, M; Gray, GR (15 January 2007). "Common skin conditions during pregnancy". American Family Physician. 75 (2): 211–18. PMID 17263216.
1 2 Alexiades-Armenakas, MR; Bernstein, LJ; Friedman, PM; Geronemus, RG (August 2004). "The safety and efficacy of the 308-nm excimer laser for pigment correction of hypopigmented scars and striae alba". Archives of Dermatology. 140 (8): 955–60. doi:10.1001/archderm.140.8.955. PMID 15313811.
↑ "Renova (tretinoin) cream". DailyMed. FDA and National Library of Medicine.
1 2 Rungsiprakarn, P; Laopaiboon, M; Sangkomkamhang, US; Lumbiganon, P (19 February 2016). "Pharmacological interventions for generalised itching (not caused by systemic disease or skin lesions) in pregnancy". The Cochrane Database of Systematic Reviews. 2016 (2): CD011351. doi:10.1002/14651858.CD011351.pub2. PMC 8665832 . PMID 26891962.

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[1] "Symptoms of pregnancy: What happens first". Mayo Clinic. Retrieved 30 June 2022.

[2] "The 14 Earliest Pregnancy Symptoms to Look Out For". What to Expect. Retrieved 25 June 2023.

[3] "Is implantation bleeding normal in early pregnancy?". Mayo Clinic. Retrieved 24 October 2020.

[mayoclinic.org-4] 1 2 "Symptoms of pregnancy: What happens first". Mayo Clinic. Retrieved 13 September 2021.

[5] "Bleeding During Pregnancy". www.acog.org. Retrieved 30 June 2022.

[6] "1st trimester pregnancy: What to expect". Mayo Clinic. Retrieved 13 September 2021.

[7] Poole, C. J. (September 1986). "Fatigue during the first trimester of pregnancy". Journal of Obstetric, Gynecologic & Neonatal Nursing. 15 (5): 375–379. doi:10.1111/j.1552-6909.1986.tb01409.x. ISSN 0884-2175. PMID 3639925.

[8] Masuk, Mahmud (23 November 2023). "Symptoms of Pregnancy | Signs of Pregnancy". Take Your Life Words. Retrieved 13 January 2024.

[Quinla_121–128-9] 1 2 Quinla, Jeffrey D.; Hill, D. Ashley (1 July 2003). "Nausea and vomiting of pregnancy". American Family Physician. 68 (1): 121–128. ISSN 0002-838X. PMID 12887118.

[10] Herrell, Howard Ernest (15 June 2014). "Nausea and vomiting of pregnancy". American Family Physician. 89 (12): 965–970. ISSN 1532-0650. PMID 25162163.

[11] Vermani, Era; Mittal, Rajnish; Weeks, Andrew (2010). "Pelvic Girdle Pain and Low Back Pain in Pregnancy: A Review". Pain Practice. 10 (1): 60–71. doi:10.1111/j.1533-2500.2009.00327.x. ISSN 1533-2500. PMID 19863747. S2CID 1847620.

[:0-12] 1 2 3 Casagrande, Danielle; Gugala, Zbigniew; Clark, Shannon M.; Lindsey, Ronald W. (September 2015). "Low Back Pain and Pelvic Girdle Pain in Pregnancy". JAAOS – Journal of the American Academy of Orthopaedic Surgeons. 23 (9): 539–549. doi: 10.5435/JAAOS-D-14-00248 . ISSN 1067-151X. PMID 26271756. S2CID 20678117.

[:1-13] 1 2 Liddle, Sarah D; Pennick, Victoria (30 September 2015). "Interventions for preventing and treating low-back and pelvic pain during pregnancy". The Cochrane Database of Systematic Reviews. 2015 (9): CD001139. doi:10.1002/14651858.CD001139.pub4. ISSN 1469-493X. PMC 7053516 . PMID 26422811.

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