Pregnancy - 4S
Congratulations on your pregnancy! This is an exciting time for you and your family. You might be feeling happy, excited, and even a little anxious about being pregnant, especially if this is your first pregnancy. Do not fear because we are all here to help you along this wonderful journey. Along this 9-month journey, we will be giving you tips and information on what to expect or know during your pregnancy.
Just like the preconception journey, we have a personalised plan for you that covers 4 important areas -
Symptoms (4S). You will be able to find information for each of the trimesters you will be going through.
More about anaemia in pregnancy.
More about Down Syndrome testing during pregnancy.
More about NIPT.
More about Pre-Eclampsia.
More about GDM.
Knowing the position of your baby and placenta is important because it will determine how you will most likely deliver your baby (i.e. normal vaginal delivery vs. caesarean section).
If your baby has not yet turned upside down (i.e. baby remains in breech position), your doctor may offer to manually turn your baby upside down within your womb, in order for you to deliver your baby normally through your vagina.
How much weight gain is considered healthy weight gain during your pregnancy? This
depends on your pre-pregnancy BMI level:
During the first trimester, it is common for mothers to lose weight due to poor appetite, nausea, and vomiting (as known as morning sickness). Once the morning sickness settles, you will start to gain weight.
To make sure that you don’t put on too much weight during your pregnancy, we will be tracking your weight during your pregnancy and provide you with reminders on healthy eating and active lifestyle. It is important to ensure that you have a good control over your weight as this can affect both you and your baby’s health. In mothers who put on too much weight, they are at risk of developing high blood pressure and gestational diabetes (see Second Trimester). Babies of these mothers also tend to grow larger than average, which may lead to a difficult delivery or the need to go through a caesarean section.
On the flip side, if you’re losing weight or gain too little weight throughout the pregnancy, it can increase your baby’s risk of being born too small, needing a longer hospital stay, or having low blood sugar level.
Micronutrients are vitamins and minerals that are important for you and your baby’s growth and development. There are a few key micronutrients that you should try to optimise from your diet:
a. Make sure that you are taking enough green leafy vegetables such as spinach as well as citrus fruits to ensure that you have enough folate in your diet. Folate (or folic acid) is important during the initial development of your baby’s nervous system, which usually happens during the first few weeks of his/her development.
a. Calcium helps to build, maintain and strengthen bones. If a pregnant mother does not have enough calcium within her, the developing baby may start to pull calcium from the mother’s bones. This can increase her risk of osteoporosis in her later life. Women should have at least 1000 mg of calcium intake each day. Have 2 glasses of low fat high calcium milk (~500 mg/250ml) to meet your daily calcium requirement. Vitamin D helps the body to better absorb the ingested calcium. Low sun exposure and sedentary lifestyle increase the risk of vitamin D deficiency.
a. DHA, one of the omega-3 fatty acids, is important for your baby’s brain and eye development during the pregnancy. It is mainly found in cold water deep-sea fish.
b. Owing to the mercury content concern, avoid shark, swordfish, king mackerel (known as “batang fish” locally) and tilefish (also called white snapper); and limit canned white tuna made from albacore tuna to one serving a week (1 serving = 1 palm size).
c. You can have 2 servings a week of salmon, sardines, herring, halibut or canned light tuna (e.g. skipjack, bigeye and yellowfin).
a. Pregnant women have increased needs for iron due to the increase in blood volume and additional needs of the unborn baby.
b. There are 2 forms of iron in foods — heme and non-heme. Heme iron is better absorbed by the body than non-heme iron. Sources of heme iron include red meat, chicken and fish. Sources of non-heme iron include grains, green leafy vegetables, legumes and nuts.
c. To boost iron absorption, consume vitamin C-rich foods (i.e. fresh fruits and vegetables) at the same meal or take it together with iron tablets. Avoid from taking meals/iron tablets with tea, coffee and milk which will reduce iron absorption.
d. Dark stools are normal when taking iron tablets.
Read about the Dos and Don’ts in pregnancy here.
Below is a list of information for more symptoms that you may experience during your pregnancy as well as some home-remedies that can be done. We have highlighted some of the dangerous (red-flag) symptoms that should prompt you to see your doctor immediately.
Also known as 'morning sickness', these symptoms can happen all day, and can occasionally be very severe. For most women who have morning sickness, the symptoms start when they're around 4 to 6 weeks pregnant and sometimes can last till as late as second trimester.
When to seek medical attention
If you have severe vomiting, cannot retain any food, and lose more than 10% of your pre-pregnancy weight, please see your doctor immediately. There are effective anti-vomiting medications that are safe for you and your baby, thus do seek medical help early if you are unwell.
You may notice a strange taste in your mouth, crave new foods, have a more sensitive sense of smell than usual, and no longer like some foods or drinks you used to enjoy.
It is normal to lose appetite during pregnancy. Studies have shown that 60% of pregnant women experience food aversions. Contributing factors include changing hormones and psyche during pregnancy. The loss of appetite may also be related to nausea and vomiting in pregnancy. This usually occurs in the first trimester of pregnancy, generally settling down later into the pregnancy.
When to seek medical attention
If you have severe nausea and vomiting and are unable to take in fluids or food at all, or if you feel symptoms of dizziness, weakness and increasing lethargy, please see your Doctor!
A common symptom is feeling tired or run down. Hormonal changes in your body at this time can make you feel tired, sick, emotional and upset.
Take frequent naps and rest when you can. Cut back on your work or daily activities, but engage in regular moderate activity, such as walking. Eat regular meals to keep energy levels even.
Exercise only when you feel well enough to do so. Remember to drink enough fluids and exercise in a cool environment.
You may have difficulty sleeping due to discomfort, sweating, leg cramps, the baby kicking, or the need to urinate.
Try to unwind before going to bed with a warm bath, relaxing music, stress-relieving exercises and comfortable clothing.
Your breasts may become fuller and feel tender, just as they might do before your period. They may also tingle. The veins may be more visible, and the nipples may darken and stand out.
Wear a supportive bra. They may be more comfortable than bras you currently wear.
If you notice a lump in your breast, you should consider seeing a Doctor for review.
Headaches are common symptoms due to increased blood circulation caused by hormonal changes.
Paracetamol is safe in pregnancy and may be used.
If your headache does not resolve with paracetamol, or if it is associated with fever, neck stiffness, visual changes, or high blood pressure, please visit your Doctor immediately.
You may experience dizziness in the first 20 weeks of pregnancy as your blood pressure falls initially. Thus, if you stand for a long time or get up quickly from sitting or lying down, you may feel giddy.
Seek medical attention if your symptoms are accompanied by shortness of breath or palpitations.
Contractions will occur starting in the second trimester (Braxton Hicks contractions), but regular painful contractions that increase in frequency and intensity are not normal, especially when you are preterm (< 37 weeks). This may be a sign of labour.
Take note of the duration and frequency of contractions.
Do see your Doctor if you have regular pain contractions that increase in frequency and intensity.
Bleeding is never normal in pregnancy. If it happens in the first trimester, it may be a sign of miscarriage. After the second trimester, it may be a sign of labour, or placenta abnormalities.
See a Doctor immediately if you have vaginal bleeding.
If you experience a gush of fluid, especially if it is persistent, you may likely have a broken waterbag or amniotic sac, also known as leaking liqour. If you are preterm (< 37 weeks), this is not normal and you need to see a Doctor immediately. If you are term (> 37 weeks), this may be a sign of labour.
Take note of the amount and frequency of leaking liquor.
See a Doctor immediately if you have leaking liquor.
You will start to experience your baby’s movements in the second trimester onwards. From the third trimester, you can start to count baby movements.
Generally, your baby should move every hour, or about 10 times a day.
If you do not feel your baby moving for a while, do lie on your side in a quiet room and pay attention to baby movements.
If you still do not feel any movements in the next 1 hour, do see a Doctor immediately.
Heartburn can feel like a burning feeling in your chest or throat. It is caused by the slowing down of your gastrointestinal tract and the relaxation of the muscles at the opening of the stomach, resulting in the reflux of the acidic gastric juices.
Constipation means having trouble with bowel movements. It is very common to become constipated while you are pregnant as food cannot move through your intestines as quickly as before. This is aggravated by your womb putting pressure on your bowels.
Haemorrhoids (piles) are swollen veins in the anus and/or rectum. They are more common in pregnancy, and you may experience pain or bleeding from the rectum. Good news is they tend to disappear after delivery.
Stool softeners such as lactulose are safe for use in pregnancy.p>
Do see your Doctor if you have persistent pain or bleeding from the rectum.
Loose or watery stools have the same causes in pregnancy as when you are not pregnant. It is most commonly caused by infection of the gut by germs, or irritation of the gut by spicy foods and medication. In most cases, diarrhoea will improve and go away within a few days.
See your doctor if you suspect that you are becoming lacking in fluid, if your symptoms do not settle after 3-4 days, or if you are passing blood.
As the baby grows and compresses your diaphragm, you have less room to breathe. As you progress further into your third trimester, you may occasionally feel breathless.
Try switching up positions, such as sitting upright or sleeping on propped up pillows or lying on your side to allow more space for your chest to expand while breathing. Breathing exercises with slow, relaxed and deep inhalation and exhalation can also sometimes help.
If you feel persistent breathlessness and other symptoms such as chest pain, palpitations, or dizziness, do see your Doctor immediately.
Pregnancy hot flushes result from changing hormone levels in pregnancy. They cause an increase in blood flow to your skin, making you feel flushed and warm. Your skin can look red and blotchy as well from the heat. Hot flushes are especially common at night, and are likely to peak at around 30 weeks.
Wear looser pieces of clothing, or keep your surroundings cool with a fan or aircon. You can also try taking a shower with lukewarm water, and keep hydrated with cooler drinks! Some studies have shown that yoga and working up a sweat can help to ease hot flushes. You may want to try that out!
Pregnancy hormones relax the connective tissue that holds your bones in place, especially in the pelvic area. These changes can be tough on your back, and often result in discomfort during the third trimester.
Do see your Doctor immediately if the pain is persistent despite paracetamol.
In pregnancy, there is additional mechanical stress on your joints due to weight from your growing baby and changes to your centre of gravity. This may cause pain in various joints.
Stay active, continue gentle stretching and strengthening. Paracetamol is safe in pregnancy and can give you some pain relief.
See your doctor if the pain is persistent despite paracetamol.
This is common as your body retains more fluids and your growing womb adds pressure to your legs — causing them to swell. It is worst at the end of the day especially in the third trimester.
Seek medical attention immediately if you have high blood pressure, painful swelling of one leg, or palpitations and breathlessness.
The cause of leg cramps is not known for certain. Some believe cramps are caused by a calcium deficiency, and that calcium tablets may help. Others believe the cramps are caused by decreased circulation of blood.
Itchy rash on the abdomen, hands and legs is quite common in pregnancy.
Use moisturising shower gels, and moisturisers after, to ensure that your skin remains hydrated and not dry.
Do see your Doctor immediately if you have itch without a rash, or a persistent rash despite the use of moisturizers.
As the enlarging uterus puts pressure on your bladder, you may need to urinate more frequently.
Try to reduce your fluid intake before going to bed. Also, avoid drinks with caffeine, which can increase the frequency of urination.
If you have pain during urination or have a fever, do see your Doctor.
The fluid your body retains in pregnancy places increased pressure on the nerve in the wrist. Common symptoms can include numbness, and pins and needles in the fingers.
The following measures may help:
Symptoms typically resolve after pregnancy.
1. Ministry of Health, Singapore (n.d.)
"MOH | COVID-19 Vaccination." Accessed July 20, 2021. https://www.moh.gov.sg/covid-19/vaccination. "MOH | COVID-19 Vaccination." Accessed July 20, 2021. https://www.moh.gov.sg/covid-19/vaccination.
2. Royal College of Obstetricians & Gynaecologists (June 2016)
Health Hub (n.d.) "Pregnancy Symptoms." Accessed July 20, 2021. https://www.healthhub.sg/live-healthy/986/pregnancy-symptoms.
3. Health Hub (2016) "5 Common Pregnancy Symptoms and How to Manage Them." Accessed July 20, 2021. https://www.healthhub.sg/live-healthy/1557/5-common-pregnancy-symptoms-and-how-to-manage-them.
4. Royal College of Obstetricians & Gynaecologists (October 2014).
"Pregnancy and Breast cancer." Accessed July 20, 2021. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-pregnancy-and-breast-cancer.pdf
5. Royal College of Obstetricians & Gynaecologists (8 August 2012). "Pre-Eclampsia." Accessed July 20, 2021. https://www.rcog.org.uk/en/patients/patient-leaflets/pre-eclampsia/.
6. Royal College of Obstetricians & Gynaecologists (21 September 2016). "Bleeding and/or Pain in Early Pregnancy." Accessed July 20, 2021. https://www.rcog.org.uk/en/patients/patient-leaflets/bleeding-and-pain-in-early-pregnancy/.
7. Royal College of Obstetricians & Gynaecologists (June 2019).
"When your waters break prematurely". Accessed July 20, 2021. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-when-your-waters-break-prematurely.pdf
8. Royal College of Obstetricians & Gynaecologists (February 2019).
"Your baby’s movements in pregnancy." Accessed July 20, 2021. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-your-babys-movements-in-pregnancy.pdf
9. Practitioners, The Royal Australian College of General (November 2014). "RACGP - Decreased Fetal Movements: A Practical Approach in a Primary Care Setting." Accessed July 20, 2021. https://www.racgp.org.au/afp/2014/november/decreased-fetal-movements-a-practical-approach-in-a-primary-care-setting/
10. Alonso-Coello P, Mills E, Heels-Ansdell D, López-Yarto M, Zhou Q, Johanson JF, et al. Fiber for the treatment of hemorrhoids complication: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101(1):181–8.
11. Health Hub (2016).
"Management of Common Pregnancy Symptoms." Accessed July 20, 2021. https://www.healthhub.sg/live-healthy/1709/management-of-common-pregnancy-symptoms
12. National Health Service (6 August 2019). "Gestational Diabetes." Accessed Aug 2, 2021. https://www.nhs.uk/conditions/gestational-diabetes/
13. Patient (1 Mar 2019). "Diarrhoea". Accessed Aug 2, 2021. https://patient.info/digestive-health/diarrhoea#nav-1
14. Health Hub (28 Jun 2021). "Can you have a healthy weight gain during pregnancy?" Accessed 2 Aug 2021. https://www.healthhub.sg/live-healthy/928/pregnancy-nutrition-during-pregnancy-eating-right-for-two
15. KK Women’s and Children’s Hospital (1 Jul 2021). "COVID-19 Vaccination for KKH Patients". Accessed 7 Aug 2021. https://www.kkh.com.sg/patient-care/Pages/COVID-19-Vaccination.aspx
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