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Most women expect pregnancy symptoms to include morning sickness and fatigue, especially during the first 12 weeks. But these are just a few of the changes that moms-to-be may develop. DISCOVER THE FACTS about eight pregnancy symptoms that women may be less likely to talk about. 1. Stomach troubles—Nausea during the first trimester often gives way to gas, constipation and heartburn as pregnancy progresses. Many women are embarrassed to talk about these symptoms, but they are normal. Nearly half of moms-to-be experience constipation, and most experience heartburn and gas. One of the main culprits for gastrointestinal distress is the hormone progesterone. Increased levels of this hormone during pregnancy help relax the intestinal muscles, slowing digestion. During pregnancy, it takes two to three times longer for foods to digest. As the baby grows, the uterus also puts added pressure on the stomach and gastrointestinal tract. older than 40, have a family history of varicose veins or have previously given birth. "Getting regular exercise and wearing compression stockings can help prevent varicose veins," says Thomas Paone, M.D., obstetrician/ gynecologist at New York Methodist Hospital. "After pregnancy, many women find that the swelling and other symptoms disappear." 4. Nasal congestion and nosebleeds— Some women feel like they have a perpetual cold during pregnancy or experience frequent nosebleeds. A likely culprit for both is the same increased blood flow that causes varicose veins. Nosebleeds are especially common in the winter, due to dry air. Running a hu m id i fier ca n help prevent nosebleeds and relieve stuffiness. Using a cotton swab like a Q-tip to place a small amount of petroleum jelly near the outside of each nostril may also help. 5. Bleeding gums—Pregnant women may notice blood on their toothbrush after brushing, which can be upsetting. Hormonal fluctuations contribute to swollen, red and tender gums—a condition often referred to as pregnancy gingivitis. "Gingivitis has been linked to preterm labor and delivery," says Jessica Goldman, certified nurse midwife at NYM. "While the exact mechanism is unknown, periodontal disease is linked to preterm rupture PREGNANCY SYMPTOMS THAT YOU MAY NOT KNOW ABOUT Eating six small meals a day—and limiting snacks before bedtime— can help prevent heartburn. To ease constipation, drink ten to 12 glasses of fluids every day and consume 25 to 30 grams of fiber daily. Gas is more challenging to prevent, but avoiding gas-producing foods like cabbage, broccoli and beans may help. 2. Skin changes (beyond stretch marks)—Some women notice dark patches on their face, breasts or inner thighs. Others may develop acne or a dark, straight line known as a linea nigra that begins at the naval and extends downward across the lower abdomen. It may be tempting to try bleaching creams or acne products to clear the skin, but these products may contain ingredients that are unsafe for the baby. Before using skin care products, women should talk with their doctors. Many of these skin changes begin to clear in the months following pregnancy. 3. Varicose veins—The amount of blood in a woman's body increases by 40 percent during pregnancy. A potential side effect of this is varicose veins—bulging veins that typically affect the lower extremities and pelvic region. Hemorrhoids—a type of varicose vein that develops in the anus—and spider veins on the legs are common examples of the varicose veins that may develop. Women are more likely to develop varicose veins if they are thrive WIN T ER 2 017/ / W W W.N Y M.O RG 10 W O M E N ' S H E A LT H 10