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Tuesday, 24 September 2019

Bizarre symptoms (Things We Don’t Know about Pregnancy Series #3)

For many women, pregnancy is a medley of bizarre and persistent symptoms – some well known, like morning sickness, and some… less so.

A missed period


Missing a period is a pregnancy symptom… but not every woman gets it! Some continue having “periods” for one, two, or more months. Whilst they are not truly menstruating, doctors can’t explain every bleed. Common explanations are implantation bleeding (when the embryo embeds into the uterus lining), subchorionic haematoma (where blood collects between the placenta and uterus lining), or miscarriage. Minor causes might be tears, inflammation, or infections. Around 1 in 5 women experience some kind of bleeding during pregnancy[1].

Pregnant woman via Pixabay.

Sleep


Pregnancy is associated with more and poorer sleep and some women – including me – have bizarre and vivid dreams.

One of my less gruesome “pregnancy dreams” involved gouging somebody’s eyes out. It was something I had to man up and do. I started with a spoon, but then one eyeball exploded, and ended up frenetically trying to scrape out all the debris splattered with gore.

Most studies conclude that concerns about labour or becoming a mother drive nightmares during pregnancy, based on the frequency that they themes arise. However, I feel it’s a stretch to say this explains the dreams I’ve been having – or, also commonly reported, vivid sex dreams!

Other scholars think rising progesterone may be responsible for sleepiness and dream intensity. Increased tiredness increases the volume of sleep and so the volume of dreams. Pregnancy discomfits also break up the rhythm sleep, meaning you wake more and recall more. We can’t ignore these physiological factors (hormones and discomfits), otherwise we’d expect to see the same kinds of and vividness of dreams in (involved) expectant fathers. Some expectant fathers do report increased dreaming and more vivid and anxious dreams, but not all or as much.

Although they’re not sure why, some researchers have linked poor sleep to longer and more difficult labour and delivery, with those sleeping less than 6 hours a night 4.5 times more likely to undergo Cesarean operation. Others found that shorter and easier deliveries were linked to labour nightmares, and hypothesised that this was because women were “practising” in their dreams!

Sleeping monkey by sparrow via Pexels.

Food cravings and aversions


Some pregnant women experience an increase in appetite, presumably because of the foetus’ nutrient demands, but a decrease in appetite is also common. I’ve experienced both. Charmingly, the decrease in appetite is frequently driven by nausea, or by feeling full – of baby, or gas. Most pregnant women will experience bloating at some point, which is caused by high progesterone levels.

Medical advice is to follow cravings, which may signal the need for certain nutrients. At the extreme end, some women suffer from pica, a craving for non-food things like dirt. Many crave ice cubes – which is directly linked to iron deficiency[2]; however, research has shown that pica sufferers with low iron do not necessarily crave iron rich foods – scientists can’t explain why.

I’m also sceptical. I’ve only had one strong aversion: for anything liquid! Not only was I off tea and coffee, I could barely stomach even ginger ale. As I forced myself to sip water, I felt unbelievably sick and dizzy. Surely, I thought, this makes no biological sense. At the same time, I was really keen on apples and salad – presumably because I needed their water. Looking it up, I found other women with the same problem were freezing their drinks to make ice lollies.

Anything associated with food during pregnancy is considered a craving or aversion. This includes a change in sense of smell. Women have reported being able to suddenly smell a non-burning candle across a room (and sometimes this is what signals they are pregnant!). Some think this develops to sharpen sensitivity to bitter flavours that might be poisons, but it doesn’t happen to all women, and isn’t selective towards bitter flavours. Scientists think it is also caused by rising hormone levels; this time, oestrogen. Or increased snot and mucus production, which can interfere with your senses. Mucus can even change the length or quality of vocal chords, and some pregnant women report their voice deepening!

Others experience a persistent metallic flavour in their mouth (dysgeusia). Dysgeusia can stick around, fade away, or come and go throughout pregnancy, including after birth: the reasons why are unknown. Dysgeusia might happen to push women towards avoiding risky foods – but the taste persists even with “safe” foods. Or it might serve to drive a woman to eat things with trace salt elements in them, like calcium, sodium and iron. Alternatively, it could just be a side effect, and serve no biological purpose.

Strawberry tart © TWDK.

Skin


As hormones change, skin can change during pregnancy. If you usually have bad skin, it may clear up, making you glow. If your skin is fine, you may come out in spots. And if, like me, you get hives whenever you ovulate, you may also get hives for nine long months. Hurrah.

Some women get PUPPP (pruritic urticarial papules and plaques of pregnancy) – a nasty, itchy rash that often starts on the stomach and spreads. The origin is unknown, but it mostly happens on first pregnancies (we don’t know why, but it rarely recurs) and when weight gain is rapid (scientists think rapid skin stretching might provoke an inflammatory reaction).

A pregnant woman’s skin is stretching and her blood laden with chemicals, making mild itching natural, but excessive itching, especially on the hands and feet, could be intrahepatic cholestasis, a serious liver condition that affects 1 in 140 pregnant women. It’s caused by the build-up of bile, which doctors think may be triggered by high levels of oestrogen. The condition often but not always runs in families and is more common in South Asians. As it carries an increased risk of prematurity or stillbirth, it is a serious complication.

Small lumps or bumps appearing or becoming more prominent on the nipples, however, are not a rash and indeed nothing to be worried about. These Montgomery tubercules lubricate the nipples and secrete chemicals that readily evaporate and stimulate the appetite of your baby – all in preparation for breastfeeding.

Linea nigra by Warinhari via Wikipedia Commons.

50% of pregnant women also develop dark skin patches... This includes the linea nigra, a line that sometimes appears on a pregnant stomach, especially for darker skinned women, and darkening and expanding areolas, or nipples[3]. Some women get dark patches on their face, called melasma or chloasma, and known as the “mask of pregnancy”. All of these are triggered by hormones overproducing melanin – and can occur in women on birth control. Sun exposure can exacerbate melasma, but it’s different to sun sensitivity, which some pregnant women also experience.

Pregnant women may also sweat more. This isn’t just the work of hauling round that extra weight: women are normally a couple of degrees cooler than men, but their body temperature is elevated when ovulating or pregnant (because of additional blood flow)! Sweating may be one possible explanation for an unexplained symptom I experienced for several weeks – sticky hands. Although my hands weren’t sticky, I kept thinking they were, especially after I touched food or water, driving me to excessive handwashing.

Hands and feet may also be affected by fluid retention and extra blood flow, causing them to expand. Foot swelling is exacerbated by carrying the extra baby weight, and a woman’s feet can change in shoe size, sometimes permanently. Doctors think permanent change happens when progesterone loosens the foot muscles, allowing the structure to reshape! Extra fluid may also affect gums, increase mouth sensitivity, and loosen teeth!

Children and animals


One particularly mysterious "symptom" is the reactions of children and animals. Some people swear their small children or animals “know” about a pregnancy before they do. Certainly, my cat has been extra friendly and attentive recently – as she was when I slipped a disc in my back. Scientists have shown that the reason breastfeeding infants can go off breastmilk when their mother becomes pregnant again is because the composition and so flavour changes[4] – but what about animals? Most likely, they are picking up something's "different" from your behaviour, rather than picking up on the pregnancy… which may mean that you know before you even know!

There are many unknowns when it comes to pregnancy, and over the next few months, I’ll be exploring more of them with you. Look out for my next blog post, which will be about the placenta.

To read our full article on the things we don't know about pregnancy, check out our site. This article will be updated as we add posts across the coming months.


References
why don't all references have links?
[1] Şükür, Yavuz Emre, et al. "The effects of subchorionic hematoma on pregnancy outcome in patients with threatened abortion." Journal of the Turkish German Gynecological Association 15.4 (2014): 239.
[2] Borgna-Pignatti, Caterina, and Sara Zanella. Pica as a manifestation of iron deficiency. Expert review of hematology 9.11 (2016): 1075-1080.
[3] Heffner, Linda (2010). The Reproductive System at a Glance. Wiley-Blackwell. p. 51. ISBN 978-1-4051-9452-5.
[4] Marquis, Grace S., et al. An overlap of breastfeeding during late pregnancy is associated with subsequent changes in colostrum composition and morbidity rates among Peruvian infants and their mothers. The Journal of nutrition 133.8 (2003): 2585-2591.

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