Pregnancy Symptoms
What's normal, what's not, and what actually helps - A complete symptom guide across all three trimesters, with Singapore-specific advice. See also: first trimester, second trimester, and third trimester guides for week-by-week details.
Symptoms by Trimester - At a Glance
Intensity across all three trimesters. Colours indicate typical severity: light = mild / occasional, dark = common / significant.
| Symptom | W4 | W6 | W8 | W10 | W12 | W14 | W16 | W18 | W20 | W24 | W28 | W32 | W36 | W40 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Morning nausea / vomiting | ||||||||||||||
| Fatigue / exhaustion | ||||||||||||||
| Breast tenderness | ||||||||||||||
| Frequent urination | ||||||||||||||
| Food aversions / cravings | ||||||||||||||
| Heartburn / acid reflux | ||||||||||||||
| Back pain | ||||||||||||||
| Swelling (oedema) | ||||||||||||||
| Braxton Hicks contractions | ||||||||||||||
| Shortness of breath | ||||||||||||||
| Pelvic pain / PGP | ||||||||||||||
| Constipation | ||||||||||||||
| Leg cramps | ||||||||||||||
| Insomnia / poor sleep |
Morning Sickness - In Depth
What actually helps (evidence-based):
Ginger
Fresh ginger tea, ginger biscuits, ginger capsules (250mg 4x/day). Anti-emetic properties are well-studied.
Vitamin B6 (pyridoxine)
10–25mg up to 3 times per day. Often combined with doxylamine (Diclegis/Bonjesta). Available on prescription.
Small, frequent meals
Empty stomach worsens nausea. Eat every 2–3 hours. Keep plain crackers by the bed for before rising.
Acupressure (P6 point)
Sea-Bands on the wrist. Pericardium 6 point. Effect size is modest but many women report benefit.
Avoid triggers
Strong smells, fatty foods, spicy food, lying flat after eating. Highly individual - Find your triggers.
Cold foods
Cold foods produce fewer odours than hot food. Smoothies, cold fruit, refrigerated crackers often tolerated better.
Antiemetics (prescription)
Metoclopramide, ondansetron, promethazine - For severe cases. All used in pregnancy and considered relatively safe when benefits outweigh risks.
Hyperemesis Gravidarum (HG) - Know the Difference
Morning Sickness
- •Nausea with or without vomiting
- •Can keep some food/fluids down
- •Difficult but manageable
- •Resolves by Week 14–16
- •No significant weight loss
Hyperemesis Gravidarum
- •Persistent vomiting (3+ times/day)
- •Cannot keep anything down
- •Dehydration, dark urine or no urination
- •Weight loss >5% of body weight
- •Fainting, extreme weakness
HG requires hospital treatment - IV fluids, anti-emetics, vitamin supplementation. Do not wait it out. Go to KKH A&E or your nearest hospital if you cannot keep water down for more than 24 hours.
Pain in Pregnancy - What's Normal vs What Needs Review
If you're in the third trimester, our contraction timer can help you tell the difference between Braxton Hicks and true labour contractions.
Round ligament pain
Usually normalSharp, stabbing pain in lower abdomen or groin, usually brief (seconds). Caused by stretching of the ligaments supporting the uterus. Common in T2.
Seek review if: Persistent pain, or accompanied by fever, bleeding, or urinary symptoms
What helps: Move slowly. Support belt. Rest.
Back pain
Usually normalLower back ache, usually dull. Due to posture shift, weight gain, and relaxin hormone loosening ligaments. Common throughout T2 and T3.
Seek review if: Severe pain with fever or urinary symptoms (possible pyelonephritis - Kidney infection in pregnancy is serious)
What helps: Physiotherapy. Prenatal yoga. Sleep with pillow between knees. Avoid prolonged standing.
Pelvic girdle pain / SPD
Usually normalPain in the pubic bone, groin, and inner thighs. May click. Worse on stairs, standing on one leg, rolling in bed. Caused by relaxin and symphysis pubis dysfunction.
Seek review if: Severe instability, inability to walk
What helps: Pelvic support belt. Physiotherapy. Keep knees together when getting in/out of car. Rest.
Braxton Hicks
Usually normalTightening or hardening of the uterus. Irregular, painless or mildly uncomfortable. Increases toward term.
Seek review if: Regular, painful contractions before 37 weeks (preterm labour), or any contractions with bleeding or leaking fluid
What helps: Drink water. Change position. Walk. If contractions become regular → call hospital.
Abdominal / rib pain
Usually normalUpper abdominal or rib pain in T3 is common - Baby's feet or uterine pressure. Also normal to feel baby's kicks under ribs.
Seek review if: Severe upper right abdominal pain or pain under the ribs - Can indicate HELLP syndrome (serious) especially with headache and visual changes
What helps: Position change. Gentle stretching. Report persistent severe pain immediately.
Headaches
Usually normalCommon in T1 due to hormonal changes and increased blood volume. Dehydration and blood pressure changes also contribute.
Seek review if: Severe, sudden headache (especially after Week 20) - Possible pre-eclampsia. Headache with visual disturbances, swelling, or right-sided rib pain → immediate review
What helps: Paracetamol (safe in pregnancy at standard dose). Hydration. Rest. Avoid ibuprofen and aspirin (unless prescribed by doctor).
Vaginal Discharge in Pregnancy
| Appearance | What It Likely Is | Action |
|---|---|---|
| Clear or milky white, mild odour | Leucorrhoea - Normal increased discharge due to hormones and cervical changes. Common throughout pregnancy. | Normal. Use panty liners for comfort. No treatment needed. |
| Pink or light brown spotting, small amount | Implantation bleeding (early pregnancy) or post-coital spotting - Cervix is more vascular in pregnancy. | Normal if very light and brief. Any bright red blood or ongoing spotting → contact your doctor. |
| Bright red bleeding, any amount after Week 6 | Possible miscarriage, placenta praevia, or placental abruption depending on trimester. | Seek medical review immediately. Do not wait. |
| Thick white, cottage cheese texture, itch | Thrush (candidiasis) - Very common in pregnancy due to hormonal changes. | See your doctor. Clotrimazole pessaries are safe in pregnancy. Oral fluconazole is avoided in T1. |
| Grey or yellow, fishy odour | Bacterial vaginosis - Common in pregnancy. Associated with preterm birth if untreated. | See your doctor. Metronidazole is used after T1 if necessary. |
| Watery, clear, difficult to control | Possible amniotic fluid leak (PPROM). Especially if sudden gush or ongoing slow leak. | Go to hospital immediately. This is an emergency if before 37 weeks. |
| Pink mucous plug | Cervical mucous plug releasing - Often a pre-labour sign after 37 weeks. | Expected at end of T3. Labour may start hours to days later. Call hospital if before 37 weeks. |
Skin and Hair Changes
Linea nigra
Dark vertical line from navel to pubic bone. Pigmentation due to oestrogen stimulating melanocytes.
No treatment needed - It fades within months of delivery.
Resolves: Yes, fades postpartum
Melasma (chloasma)
Brown patches on face, especially upper lip, cheeks, and forehead. 'The mask of pregnancy'. Made worse by sun exposure.
SPF 50 sunscreen daily. Wide-brimmed hat outdoors. Singapore's UV index is extreme - Sun protection is important.
Resolves: Largely fades within 3–6 months postpartum
Stretch marks
Pink, red, or purple streaks on belly, breasts, hips, and thighs as skin stretches. Appear from T2 onwards.
Moisturising reduces discomfort but evidence that it prevents stretch marks is weak. Genetics determines susceptibility.
Resolves: Turn silver-white and fade, rarely disappear completely
Pruritic urticarial papules (PUPPP)
Itchy rash in stretch marks on the abdomen. Usually in T3 with first pregnancies or multiple pregnancies.
Oatmeal baths, antihistamines (discuss with doctor), topical steroids if severe. Resolves after delivery.
Resolves: Resolves after delivery
Acne
Increased androgens in T1 may cause breakouts. For others, skin clears completely.
Gentle cleansers. Avoid retinoids and tetracyclines. Azelaic acid and topical erythromycin are safe alternatives.
Resolves: Usually resolves postpartum
Hair thickening
Oestrogen extends the hair growth phase - Less shedding means thicker hair. A commonly reported 'pregnancy glow' component.
Enjoy it - It's temporary. Postpartum hair shedding (telogen effluvium) begins around 3–6 months after delivery.
Resolves: Hair shedding begins 3–6 months postpartum
Spider veins / varicose veins
Increased blood volume and progesterone relaxing vein walls. Common on legs and vulva in T3.
Compression socks. Elevate legs. Avoid prolonged standing. Exercise. Varicose veins usually improve after delivery.
Resolves: Often improve postpartum
Palmar erythema (red palms)
Redness of the palms due to increased oestrogen and blood flow. Usually in T2 onwards.
Normal and harmless. No treatment required.
Resolves: Resolves postpartum
Mental Health Symptoms in Pregnancy
Prenatal anxiety and depression are more common than postnatal - Affecting ~15% of pregnant women. They are underreported because many women believe they "should" feel happy. Mental health symptoms during pregnancy are real, valid, and treatable. Our postpartum mental health guide covers what to watch for after birth too.
Prenatal anxiety
Signs: Excessive worry that is difficult to control, physical symptoms (racing heart, difficulty breathing), difficulty concentrating, sleep disruption disproportionate to physical discomfort, intrusive thoughts about harm coming to baby.
What to do: Speak to your GP or OB. Cognitive behavioural therapy (CBT) is effective. Mindfulness-based approaches have good evidence. Medication options are available when benefits outweigh risks - Do not stop any current psychiatric medication without medical advice.
Prenatal depression
Signs: Persistent low mood for more than 2 weeks, loss of interest in activities, hopelessness about the pregnancy or future, inability to function at work or home, thoughts of self-harm or that baby would be better off without you.
What to do: This is a medical condition. Tell your doctor, not just your partner. KKH perinatal psychiatry service, NUH, polyclinic referral for counselling. Crisis line: Samaritans of Singapore 1800 221 4444 (24hr).
Tokophobia (fear of childbirth)
Signs: Severe fear of labour and delivery - May be primary (never given birth) or secondary (following a difficult previous birth). Can lead to significant avoidance of antenatal care.
What to do: Tell your OB or midwife. Specialised psychological support is available. Elective caesarean may be considered for severe secondary tokophobia. This is not weakness.
Mental health support in Singapore
KKH Perinatal Psychiatry
6225 5554 - Ask for referral
IMH Mental Health Helpline
6389 2222 (24hr)
Samaritans of Singapore
1800 221 4444 (24hr, free)
SAMH Helpline
1800 283 7019
Mindline.sg
mindline.sg (digital mental health tools)
PSI (Perinatal Society SG)
psing.org - Professional referral directory
Warning Signs - Go to Hospital Now
- •Sudden severe headache that does not respond to paracetamol
- •Visual disturbances - Flashing lights, blurring, tunnel vision
- •Severe swelling of face, hands, or legs appearing suddenly
- •Upper right abdominal pain or pain under the ribs
- •Nausea and vomiting in T2/T3 after it had resolved
A&E or delivery suite immediately. Call 995 if unable to travel.
- •Regular contractions before 37 weeks - 4 or more in an hour
- •Persistent lower back pain (different from usual backache)
- •Pressure in the pelvis or feeling that baby is 'pushing down'
- •Change in vaginal discharge - Watery, bloody, or mucousy
Call your hospital immediately. Do not wait.
- •Sudden severe abdominal pain - Constant (not coming-and-going)
- •Vaginal bleeding (but abruption can occur without external bleeding)
- •Uterus feels hard and tender
- •Decrease in foetal movement
Emergency - Call 995 or go to A&E immediately.
- •Baby noticeably quieter than usual (after 28 weeks)
- •No movement felt in 2–4 hours when baby is usually active
- •Trusting your instinct that something is different
Call your hospital or delivery suite same day. Do not wait overnight.
- •Unable to keep any fluids down for more than 24 hours
- •Vomiting more than 3–4 times per day
- •Dark urine, dizziness on standing, fainting
- •Weight loss, extreme weakness
Go to A&E or call KKH (6225 5554). IV fluids and anti-emetics needed.
Continue Your Pregnancy Journey: