What to expect in pregnancy

What are the early signs of pregnancy?

The most common early sign of pregnancy is a missed period. This might be easier to detect if you use an app to track your menstrual cycle.

But your period might also be late, so you could wait a few days to see if it arrives. If it doesn't, you should do a pregnancy test to confirm whether or not you're pregnant.

Other early signs of pregnancy are similar to what you might experience before your period arrives, including:

• swollen or tender breasts
• tiredness or fatigue
• nausea

It's common to feel exhausted in the first 12 weeks of pregnancy. This is due to hormonal changes (like increased oestrogen and progesterone) in your body, so resting more often than usual is essential.

You might notice food cravings or aversions to some tastes and smells. This means that you might avoid foods you usually enjoy and vice versa. It’s important to remember that every pregnancy is different, and you might only experience a few of these symptoms if any at all. 

Ask your doctor or midwife if you’re worried about your symptoms. 

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How many trimesters are there in pregnancy?

Pregnancy happens in three stages called trimesters — first trimester, second trimester, and third trimester. 

A trimester lasts between 12 and 14 weeks, while a full-term pregnancy lasts around 40 weeks from the first day of your last period.

Which trimester is the most exhausting?

Many pregnant women find the first trimester the most exhausting. This can happen due to hormonal changes making you feel tired, nauseous, and emotional.

This can be challenging if you usually have lots of energy. So the best thing to do is get enough rest. It might help to set out some time in your day to sit down with your feet up. And accept help from your colleagues, friends, and family.

It's important to remember that every pregnancy is different. Ask your midwife for advice if you're concerned about your energy levels.

What’s morning sickness? 

Morning sickness is a common early sign of pregnancy. 

While it’s most common during the first three months, some women experience it throughout all three trimesters of pregnancy. And some women don’t experience morning sickness at all.

When does morning sickness start? 

Morning sickness most commonly starts around week 6 of pregnancy — two weeks after your missed period. 

But it can start earlier and might be one of the first things you notice. And despite being called morning sickness, it can happen at any time of the day. 

When does morning sickness end?

You might stop having morning sickness after the first trimester (12 to 14 weeks). But for some women, it can disappear and come back or happen throughout pregnancy. 

How to manage morning sickness

The good news is, morning sickness doesn't usually require any medical intervention, but there are things that you can do at home to help manage your symptoms. 

These include:

• getting plenty of rest 
• avoiding foods or smells that make you feel sick
• eating something plain (like dry toast) before you get out of bed
• eating small, regular meals — like bread, rice, crackers, and pasta
• eating cold food if the smell of hot meals makes you feel sick
• sipping plenty of water to prevent dehydration and vomiting 
• adding ginger to your diet — evidence suggests it may help reduce nausea and vomiting 

More severe forms of sickness in pregnancy sickness can affect your quality of life, leading to dehydration and weight loss. This may require medical intervention. 

Hyperemesis gavidarum is a severe form of pregnancy sickness where you’re constantly nauseous and sick throughout the day. This can often last for the whole of pregnancy and can lead to severe complications if not medically treated. 

Always speak to your midwife or doctor for advice if you’re worried about morning sickness. 

Pregnancy and your diet 

It’s essential to follow a balanced diet throughout pregnancy. This helps you to stay healthy and strong while giving your baby all the nutrients they need to grow and develop. 

A healthy diet during pregnancy also reduces the risk of health complications associated with giving birth. 

For example, the Mediterranean diet is linked to a lower risk of: 

• pre-term birth — giving birth before 37 weeks
• congenital disabilities — like a cleft lip and palate, clubfoot, hernias, heart defects, neural tube defects, and Down’s syndrome
• gestational diabetes — high blood sugar that develops during pregnancy and can lead to complications in labour

Pregnancy and weight gain 

It’s normal to gain weight during pregnancy due to your growing bump. 

The amount of weight you gain varies. But most women gain between 10kg and 12.5kg (22lb to 28lb) — this is considered a healthy amount throughout pregnancy. 

Most weight gain is due to your growing baby. And in the later stages of pregnancy, your body also stores fat ready to make breast milk. 

UK guidelines recommend consuming 200 additional calories a day only in the third trimester — unless your body mass index (BMI) was lower than 18.5kg/m2 before pregnancy.

What are the best foods to eat during pregnancy?

A varied diet is the best way to support your nutritional intake during pregnancy. 

You should also increase your protein intake by 6 grams a day — this equates to roughly 1 large egg. And you should aim to consume less sugar and saturated fats.

A healthy diet in pregnancy includes: 

• at least five portions of fruit and vegetables daily
• whole grain carbohydrates — like brown rice and pasta, bulgur, and quinoa 
• plant-based protein — like beans, lentils, legumes, pulses, nuts and seeds, eggs, dairy, lean meat, and fish
• healthy fats — like 1-2 portions of oily fish weekly (like salmon, mackerel, or sardines), avocados, nuts, seeds, and extra virgin olive oil

What vitamins and minerals are essential for pregnancy?

There are some essential nutrients in pregnancy which support the healthy development of your baby. 

These include: 

Omega-3 

Research shows that omega-3 (particularly in the form of DHA) is vital for your unborn baby's brain and eye development. It can also help prevent preterm birth and is essential for breastfeeding. 

You can get omega-3 by eating oily fish — like salmon, mackerel, or sardines. 

Depending on how much omega-3 you get from your diet, you might may need an extra 250mg of DHA daily. You can check your levels at home by doing an omega-3 and 6 blood test.

If you’re vegan or follow a plant-based diet, consider taking an omega-3 supplement. 

Speak to your doctor or midwife before starting this supplement. 

Iodine

Your body needs iodine to make thyroid hormones. These help regulate your metabolism and other essential body functions.

Iodine is also crucial for your baby’s bones and brain development. The amount you need increases from 150 mcg to 200 mcg daily in the UK when pregnant. But more recent studies have reported that excessive iodine intake can affect your thyroid health in pregnancy. So UK guidelines state it’s essential not to consume more than 200 mcg daily. Always speak to your doctor before increasing your iodine intake.

The best food sources of iodine are: 

• milk
• yoghurt
• cod
• haddock
• shellfish

Iodine is also found in plant foods — like cereals and grains. But the levels vary depending on the amount of iodine in the soil where the plants are grown. If you're vegan, consider taking an iodine supplement or eating foods fortified with iodine — like some types of plant-based drinks.

Iron

Iron makes red blood cells for both you and your baby, preventing anaemia. And because your blood volume increases during pregnancy, you need 27mg of iron daily. 

Iron-rich food sources include:

• red meat
• beans
• nuts
• dried fruit 
• fortified cereals and bread

Vitamin B9 (folate)

Folate is the naturally occurring form of vitamin B9. This nutrient ensures healthy placental and foetal tissue growth in pregnancy. 

Good food sources of folate include:

• leafy greens
• chickpeas
• wholegrains
• beans
• peanuts
• sunflower seeds

Folic acid is a synthetic form of vitamin B9. You can get this in the form of supplements. All pregnant women should take 400 mcg of folic acid daily.

Calcium

Calcium is an essential mineral for developing your baby’s bones. You need 1,200 mg of calcium daily when you’re pregnant.

Calcium-rich foods include: 

• milk, cheese, and yoghurt
• green leafy vegetables — like rocket, watercress, or curly kale
• tofu
• soya drinks with added calcium
• bread and any foods made with fortified flour
• sardines and pilchards

What foods should you avoid during pregnancy? 

There are some foods and drinks you need to be careful of and avoid during pregnancy to protect your unborn baby.

Food and drinks to avoid during pregnancy include:  

• raw shellfish and undercooked meats
• raw or undercooked eggs without the Lion Code
• soft-ripened cheese and unpasteurised dairy
• pâté and liver products
• shark, marlin, and swordfish
• supplements containing excess vitamin A and retinol
• all alcoholic beverages

Food and drinks to limit during pregnancy include:

• canned tuna — four medium cans a week
• oily fish — a maximum of 2 portions weekly
• caffeine — less than 200mg (one 12-ounce cup of coffee) a day
• herbal tea — no more than four cups daily

What supplements should you take when pregnant?

You should be able to get most nutrients from your diet during pregnancy. But there are certain supplements you should take. 

It's recommended that you take 400 micrograms of folic acid daily – from before you're pregnant until you're 12 weeks pregnant. This helps to reduce the risk of neural tube defects. A higher dose may be required in certain situations — your doctor can give you advice about this.

Additionally, all women should take 10mcg of vitamin D supplements daily during pregnancy.

If you follow a vegan or a vegetarian diet, prenatal supplements formulated can help bridge any nutritional gaps in your diet. But always check with your healthcare professional first before starting any new supplements.